Video Playlist: Understanding COVID-19, coronavirus and SARS-CoV-2

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This playlist contains video-updates relating to the novel coronavirus SARS-CoV-2 and the disease it causes COVID-19. They also added other epidemiology videos for you that they think will help you make sense of what you read about COVID-19 in the literature or media. We have only given information below about the UPDATE videos, but all videos are included in this playlist. The speaker is Franz Wiesbauer, MD MPH, Internist and founder at Medmastery.

We have added a bit more information for some of the videos in this playlist below. Visit YouTube for all the information on all the videos in this playlist.

COVID-19 Update 1: How to tell if a pandemic is likely to occur or not–R0 and the serial interval.

In this video, you’ll learn how the reproductive ratio (R0) and the serial interval influence the spread of an infectious agent. We’ll compare the R0 and serial intervals of SARS-CoV-2 to that of other comparable diseases in order to get a feeling for the likelihood of COVID-19 becoming a pandemic.

COVID-19 Update 2: How to stop an epidemic – Herd immunity

In this video, you will learn about the basic principle used in combating epidemics called herd immunity. Having susceptible individuals protected as a result of a significant proportion of the population (or the herd) being immune, allows for infectious disease to become stable within the community. Through examples, including SARS-CoV-2, let’s explore what proportion of a population needs to be immunized in order to reach herd immunity (in order for R naught to become equal to or lower than one).

Links for References:
The latest on the coronavirus
Marc Lipsitch on Twitter
Coronavirus disease (COVID-19) Pandemic

Herd Immunity

COVID-19 Update 3: Symptoms of COVID-19

In this video, you will learn about the symptoms associated with COVID-19. They are quite a bit different from a regular cold. The disease seems to start with a fever, followed by a dry cough. Around 80% of confirmed cases are mild and can stay home whereas 20% are more severe and need inpatient care. We also discuss a paper published in the respected journal The Lancet that describes the clinical course of 99 cases hospitalized for SARS-CoV-2 associated pneumonia.

List of References:
Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study
The latest on the coronavirus
Coronavirus disease (COVID-19) Pandemic

COVID-19 Update 4: Clinical characteristics of COVID-19

In this video, you will learn about the clinical characteristics including the severity of the COVID-19 disease, the mortality or case fatality rate, age distribution and risk factors for mortality. The information discussed comes from an article published by the Journal of the American Medical Association about the characteristics of and important lessons from the COVID-19 outbreak in China. A summary and report of 72,314 cases (as of February 11, 2020) from the Chinese Center for Disease Control and Prevention. The statistics were collected from examining four groups of patients -confirmed cases, suspected cases, clinically diagnosed cases, and the group of asymptomatic cases. Within this group, 62% were confirmed, 22% were suspected, 15% were clinically diagnosed and 1% were asymptomatic.

List of References:
Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China

COVID-19 Update 5: Estimating case fatality rates for COVID-19

In this video, you will learn about COVID-19 case fatality rates and how to estimate and calculate them. We review and utilize the data from the Johns Hopkins coronavirus map, as of March 3rd, 2020. There we have the total number of confirmed cases, total deaths and total cases recovered. So what’s that time delay in COVID-19? Many want to know what’s the delay between when a patient is reported as a case until eventual death? We look at the natural progression of the disease – the time of infection, the time of symptom onset, the time when that case is reported, and the time of death. The incubation period of COVID-19 has been estimated to be around 5.2 days on average.This study found a mean duration of 7.1 days for symptom onset to reporting.The time from disease onset to eventual death is 22.3 days. We have constructed a fictitious epidemic to further demonstrate the needed data and calculations.

List of References:
Johns Hopkins Dashboard Maps Global Coronavirus Cases

COVID-19 Update 6: Seasonality: will COVID-19 go away in the summer?

In this video, you will learn about the expected seasonality of the coronavirus by examining the behavior of influenza, and reviewing multiple published resources as references. Influenza is clearly seasonal, that’s a fact. The incidence is higher in winter – December through April for the northern hemisphere, June through September in the southern hemisphere, and in the tropics, the incidence appears to be greatest during the rainy season. Some resources say the common cold coronaviruses are also seasonal with little transmission in the summer, so SARS-CoV2 will also behave like that.The problem with this statement is that they forget the fact that new viruses (we’ve never been exposed to) behave very differently from existing viruses where there is pre-existing immunity. We review the three main reasons or factors for the seasonality of influenza – the environment, human behavior and the depletion of susceptible hosts to draw the conclusion it’s likely that we’re going to see further spread of SARS-CoV-2 in the summer.

List of References:
Trump says coronavirus will ‘miraculously’ be gone by April ‘once the weather warms up’
Global Influenza Seasonality: Reconciling Patterns across Temperate and Tropical Regions
Roles of Humidity and Temperature in Shaping Influenza Seasonality
Absolute Humidity and the Seasonal Onset of Influenza in the Continental United States
The role of absolute humidity on transmission rates of the COVID-19 outbreak
The US 2009 A(H1N1) influenza epidemic: quantifying the impact of school openings on the reproductive number.
Shortcomings of Vitamin D-Based Model Simulations of Seasonal Influenza

COVID-19 Update 7: This is probably the most important picture of the whole coronavirus epidemic

People are saying that the coronavirus is “as dangerous as a normal flu”. But this is not true. We are dealing with a virus that is much more contagious and also much more dangerous. In this video we draw comparisons of how fast the flu viruses of the past spread, compared to COVID-19. You will also learn to calculate the doubling interval using Austrian data. We also review how the healthcare system in Austria will handle the critical cases and how long before overwhelm. The examples in the video are for Austria, but the same principle applies to all countries.

List of References:
Estimates of the reproduction number for seasonal, pandemic, and zoonotic influenza: a systematic review of the literature
Number of hospital beds in Austria from 1985 to 2018
Compensation for intensive care services in Austria
COVID-19 Update 8: Zinc and chloroquine for the treatment of COVID-19?

COVID-19 Update 8: Zinc and chloroquine for the treatment of COVID-19?

We have been asked again and again – “What else can I do, apart from social distancing, hand hygiene, and so on, to protect myself from COVID-19?” There are additional actions that can be taken. In this video we examine some details about the virus in Korea and how they are handling things differently. We take a look at the biology of the virus. We examine what happens when our cells are infected with SARS-CoV-2. And finally, we review a study that suggests the possible use of zinc and chloroquine in the fight against SARS-CoV-2.

List of References:
Physicians work out treatment guidelines for coronavirus
Expert Consensus on Chloroquine Phosphate for the Treatment of Novel Coronavirus Pneumonia
Zn2+ Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture
Chloroquine Is a Zinc Ionophore

COVID-19 Update 9: Hydroxychloroquine and azithromycin for the treatment of COVID-19–Review of study by Didier Raoult

Let’s be clear. We hope that hydroxychloroquine will be successful in future clinical trials. We just want to point out that based on this one trial, hype is not warranted. Beware what you hear! President Trump recently Tweeted out a message saying Hydroxychloroquine and Azithromycin taken together, have a real chance to be one of the biggest game changers in the history of medicine. He is referring to a study by Prof. Didier Raoult and coworkers from Marseille France. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. In this video we review the major problems of this study – groups not being comparable, incomplete testing in the control group, patient dropouts, which might have significantly changed their conclusions, inconsistent reporting of data, and a potentially dangerous combination of drugs

List of References:
Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial
Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an openlabel non-randomized clinical trial
Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an openlabel non-randomized clinical trial
Clinical presentation and virological assessment of hospitalized cases of coronavirus disease 2019 in a travel-associated transmission cluster

Update COVID 10: Is COVID-19 an airborne disease? Will we all need to wear face-masks against SARS-CoV-2?

There seems to be a lot of confusion in the droplet versus aerosol discussion and how these relate to the spread of COVID-19. Is it airborne and inhaled or droplet based via fomites and hands? The uncomfortable truth is that we have evidence for both modes. In this video we first define what a droplet and an aerosol is based on their behaviour in the environment. We then examine both through the findings from two published studies. We will also discuss how long viral particles survive and stay viable and able to infect after they fall on a surface or get suspended in the air. For COVID-19, we agree that the various transmission routes may predominate in different settings. The airborne route is relevant for hospitals and hospital staff as well as crowded and badly ventilated public spaces. Everyone else is more likely to get the virus through touching surfaces, bad hand hygiene and then touching their face.

List of References:
Aerodynamic Characteristics and RNA Concentration of SARS-CoV-2 Aerosol in Wuhan Hospitals during COVID-19 Outbreak
Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient
Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1
Recognition of aerosol transmission of infectious agents: a commentary

COVID-19 Update 11: How exactly the coronavirus becomes airborne

Different diseases have different modes of transmission. And at the same time, one disease can have multiple modes of transmission. Influenza that’s transmitted by aerosols is generally thought to be associated with a more severe illness than influenza that’s transmitted via contact or fomites. In this video we continue on from update #10 and examine in greater detail the impact of particle size, the concentration of viral RNA in coarse and fine aerosols, and how they differ in the transmission of COVID-19. Surprisingly, larger particles (from a cough or sneeze) contain less virus than small particles, and are less likely to penetrate into lungs. Individuals who are sick produce fine, virus laden particles during speaking and breathing that have a high viral load and can travel far down into the lungs of a susceptible individual.

List of References:
Infectious virus in exhaled breath of symptomatic seasonal influenza cases from a college community
Qualitative Real-Time Schlieren and Shadowgraph Imaging of Human Exhaled Airflows: An Aid to Aerosol Infection Control

COVID-19 Update 12: Attack rates of COVID-19 depend on face-to-face time spent with infected persons

This paper submitted to the Lancet describes the transmission patterns seen in the so-called Munich cohort. It’s interesting for several reasons: individuals who interacted for less than 15 minutes were not infected by confirmed COVID-19 cases, even back-to-back encounters in a canteen were able to cause disease transmission, attack rates in families can be as high as 70-80%.

List of References:
Outbreak of COVID-19 in Germany Resulting from a Single Travel-Associated Primary Case

COVID-19 Update 13: Randomized Controlled Trial of Hydroxychloroquine in Patients with COVID-19

Finally, we have a randomized clinical trial assessing the efficacy of hydroxychloroquine for the treatment of mild cases of COVID-19. The trial was performed in Remnin Hospital in Wuhan and seems to have adhered to good scientific research principles. Also, their chosen outcomes (recovery times and CT findings) are much more relevant as compared to PCR of nasopharyngeal swabs. This is great news. We are looking forward to hearing about the results of the recently launched WHO mega-trial, which also assesses chloroquine (among other drugs).

List of References:
Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial

COVID-19 Update 14: Are children contributing to the spread of COVID-19?

There’s a lot of discussion if kids contribute to the transmission and spread of COVID-19. This paper took an interesting and “quick and dirty” approach to gauge how much kids contribute to the epidemic.

List of References:
Hundreds of severe pediatric COVID-19 infections in Wuhan prior to the lockdown
Population Pyramids of the World from 1950 to 2100

COVID-19 Update 15: Can we disinfect and reuse N95 masks?

Personal protective equipment (including masks) are vital for protecting health care workers from infection with COVID-19. In this video we briefly review the two mask types used in clinical settings — the surgical mask and the N95 mask. We take a deeper look at the more effective N95 mask and the contract transmission risk associated with reuse. We also examine extra precautions set out by the CDC to reduce the risk of contact transmission. We review and discuss several articles on decontamination methods and preventing compromisation of the proper fit of the mask.

List of References:

List of References Continued:
Decontamination and Reuse of N95 Respirators with Hydrogen Peroxide Vapor to Address Worldwide Personal Protective Equipment Shortages During the SARS-CoV-2 (COVID-19) Pandemic
Addressing COVID-19 Face Mask Shortages [v1.3]

COVID-19 Update 16: Effectiveness of surgical masks for prevention

In this video, we further touch on the distinction between droplets and aerosols. The WHO and others claim that COVID-19 is primarily spread by the inhalation of aerosols and near range droplets. There are others who disagree with this statement, and so there is confusion on if masks are helpful or not. To support this claim, we review a study in which viral load in the air was measured in various public locations. Finally, we take a look at a recent trial demonstrating that simple surgical masks worn by individuals with upper respiratory tract infections could significantly reduce viral concentration in the exhaled air.

List of References:

List of References Continued:
Respiratory virus shedding in exhaled breath and efficacy of face masks
Aerodynamic Characteristics and RNA Concentration of SARS-CoV-2 Aerosol in Wuhan Hospitals during COVID-19 Outbreak
Influenza Virus Aerosols in Human Exhaled Breath: Particle Size, Culturability, and Effect of Surgical Masks
Infectious virus in exhaled breath of symptomatic seasonal influenza cases from a college community
Qualitative Real-Time Schlieren and Shadowgraph Imaging of Human Exhaled Airflows: An Aid to Aerosol Infection Control

COVID-19 Update 17: How an app can get us out of lockdown

There are two sets of tools available to fight an epidemic — containment tools and mitigation tools. In this video we explain the use of the tools in the successful fight of an epidemic, using SARS and Ebola as examples. Containment tools are used at the start of an outbreak to track the dissemination of a disease by identifying infected cases and their contacts, and to subsequently isolate or quarantine them. When containment no longer works, mitigation is put into place. Mitigation is much more disruptive for society and the economy than containment.

List of References:
Infectious disease experts provide evidence for a coronavirus mobile app for instant contact tracing

COVID-19 Update 18: When are patients really infectious?

Individuals are infectious with COVID-19 when they’re shedding the virus, which means that the virus replicates in the cells of their upper or lower respiratory tract. In this video, we will examine published articles discussing viral shedding, the incubation period (mean incubation period was 5.2 days) and the serial interval, by examining the results of 77 COVID-19 transmission pairs. The study found that infectiousness starts 2.3 days before symptom onset. That patients are most infectious 0.7 days before symptom onset.They also found that 44% of infectiousness or infections occurred in the pre-symptomatic phase making it difficult to track.

List of References:
Temporal dynamics in viral shedding and transmissibility of COVID-19
Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia

COVID-19 Update 19: ACE inhibitors and COVID-19

Hypertension is one of the most frequent coexisting chronic conditions among patients with COVID-19. Some experts have suggested that antihypertensive medications, such as ACE inhibitors increase a person’s risk of severe outcomes to SARS-CoV-2 infection. More and more data are now accumulating that they are perfectly safe and should not be stopped. In this update, we’ll look at several published articles that demonstrate that ACE inhibitors and ARBs were not associated with worse outcomes or increased mortality.

List of References:
Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19
Association of Renin-Angiotensin System Inhibitors With Severity or Risk of Death in Patients With Hypertension Hospitalized for Coronavirus Disease 2019 (COVID-19) Infection in Wuhan, China
Association of Inpatient Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Mortality Among Patients With Hypertension Hospitalized With COVID-19.
HFSA/ACC/AHA Statement Addresses Concerns Re: Using RAAS Antagonists in COVID-19

COVID-19 Update 20: Pregnancy and COVID-19

Information on COVID-19 and pregnancy is frequently updating. current information confirms that pregnant women can get Covid-19, however, despite the physiologic changes in pregnancy, the majority of them are more likely to be asymptomatic or have mild illness and fully recover. In this video we review recent resources and recommendations on handling pregnancy during COVID-19. These include changes in prenatal appointment structure, shortened hospital stays post-labor, COVID-19’s effect on laboratory values, and differentiating symptoms of COVID-19 from typical postpartum causes.

List of References:
COVID-19 FAQs for Obstetrician-Gynecologists, Obstetrics
Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study
AAEM Position Statement on Protections for Emergency Medicine Physicians during COVID-19
‘People Are Dying’: 72 Hours Inside a N.Y.C. Hospital Battling Coronavirus

COVID-19 Update 21: Why superspreaders are so important for the spread of SARS-CoV-2

In this video, we discuss what is a superspreader event (SSE) and why superspreader events are so important for the spread of SARS-CoV-2. Superspreading has also been called “dispersion”. Several respected groups of researchers from Israel, the UK, and Hong Kong, have shown that only 10 to 20% of COVID-19 patients are responsible for 80% of secondary infections. So if we can prevent these superspreader events, we could prevent a second wave of infections. We also discuss cluster sites and their commonalities — the three Cs and superemitters and their impact on the spread.

List of References:
Clustering and superspreading potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in Hong Kong
Estimating the overdispersion in COVID-19 transmission using outbreak sizes outside China
Probability of a large 2019-nCoV outbreak following introduction of cases
COVID-19 Inmate Testing
Long term care data dashboard
What settings have been linked to SARS-CoV-2 transmission clusters?
COVID-19 settings of transmission – database
Indoor transmission of SARS-CoV-2
Closed environments facilitate secondary transmission of coronavirus disease 2019 (COVID-19)
Aerosol emission and superemission during human speech increase with voice loudness
Stochasticity and heterogeneity in the transmission dynamics of SARS-CoV-2

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Please note: Medmastery’s videos, medical lectures, medical illustrations, and medical animations are for medical education and exam preparation purposes, and not intended to replace recommendations by your doctor or health care provider.

About Franz Wiesbauer MD MPH

Franz Wiesbauer is an internist with a specialization in cardiology. He trained at the Medical University of Vienna and the Johns Hopkins University in Baltimore, where he was a Fulbright student.

Dr. Wiesbauer is an associate professor for internal medicine at the Medical University of Vienna. His primary research focus is on lipids, cardiovascular epidemiology and echocardiography.

He is the founder of the elearning platform where he and his colleagues are teaching the most important clinical skills to doctors, students and other healthcare providers.

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