Transcript of Caring for Patients with the New Coronavirus

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70 views 26 Feb 2020

00:00:11

Hello, my name is Nikah Alexander, I am a communications person here at the World Health Organization today, we're going to talk about clinical management for people who are sick with the new Corona virus. But the novel coronavirus I won't be doing most of the speaking will be my colleague, Dr. Janet D.S.. Janet, John, introduce yourself. Hello, everyone. My name is Janet. Yes, I'm the team lead for clinical management at the WTO emergency program.

00:00:39

And so clinical management means how you care for a patient who is sick, right? It's the treatment. So this could be a very specific kind of conversation we're having today for health care workers. But we want this to be interesting, both for health care workers and for the general public. So hopefully you will it will be interesting of interest to anybody who wants to learn more about this disease, but it really is more about that specific topic of how patients are cared for.

00:01:08

So this is a new disease. I want to timestamp this a little bit. We're recording this on the 1st of February. At the moment, there are 12000 cases of the disease in China, 12000 cases in China and one hundred and thirty cases in 23 other countries. So it really is centered in China at the moment. But people are working together to learn more. So how do you learn more about disease, which at this point is 1 month old?

00:01:32

We've only known about it for one month.

00:01:34

Well, that's a it's a challenging situation. But with the WTO, we have established a global clinical network. So we are in touch with at least twice a week, but more so by e-mail on a large teleconference calls with clinicians that are actually caring for the patients, clinicians, you know, from China, for Mohan from Shanghai, as well as clinicians from France and the US and the other countries that have been caring for patients. And it's an opportunity for everyone to share how what it's like to care for those patients, what they're doing, what they're presenting with, what their symptoms are, what their complications are.

00:02:10

And so what do we know? What have you learned so far? So it seems that that large that is that the disease is a leads to a mild illness. So most patients have mildly ill, which means they have maybe a fever, cough, sore throat, muscle aches. But there is a percentage that does get severely ill. We think it's about 20 percent, but we will see those patients go on to develop severe pneumonia. They can also develop dehydration, respiratory failure, which means that they would need a breathing machine to help them continue breathing.

00:02:47

And there have been deaths. About at the moment, what we understand from Chinese authorities is about 2 percent of the people for which they have information. 2 percent of the patients in China have died. Is that about right? Yes. OK. So that again, timestamp for this time. This is one month after we've known about the disease and information may change and evolve as time goes on.

00:03:10

Exactly. I mean, I think for those patients that remain in hospital, so we have to see what their outcomes will be after being in the hospital.

00:03:19

So that you just summarized what we do know. So most for most people, it's a mild disease. About 20 percent severe and two percent have died. What do you not know? What are the questions you're trying to get answers on?

00:03:33

Well, we we also have us have an idea that those that are have died with disease tend to be of older age and have chronic other medical conditions such as diabetes. But we would like to have a better understanding of that. So that's what we need to know. So truly, what are the risk factors for severe disease? What are the risk factors for for death? We also need to know what is what treatments would work? What antiviral treatments would work for this novel coronavirus at the moment.

00:04:05

There is no specific treatment. There's not an existing medication that you can pull off the shelves and say this works for people who are sick with and with the new coronavirus.

00:04:15

So with this new coronavirus, we have no known effective antiviral therapies. There are some that are have potential we think may work, but we have no known effective antiviral therapies. So what do you do?

00:04:28

What are these? These doctors that you're speaking with in China and elsewhere, how are they treating these patients?

00:04:33

So because the patients that are mild at large that they have, you know, self-limiting disease, which means they get better with some time. So they get treated, you know, with symptomatic treatments such as paracetamol for fevers or for those that get sick in hospital, then they require supportive care treatment. So this may be on the hospital ward or in the intensive care ward. That would mean if you have pneumonia and you need oxygen therapy, you get oxygen therapy.

00:05:00

If you need I.V. fluid therapy, you get intravenous fluid therapy if you are suspected to have an infection, a co-infection. So in addition to the novel coronavirus, a bacterial infection, which can happen, then we give you antibiotics. And if you develop respiratory failure, you go on mechanical ventilation.

00:05:19

So I just want to be really clear on this antibiotic side, because this is a virus, you can't treat viruses with antibiotics. But as you said, if the person has this virus and a bacteria, you give them the antibiotics to treat the act. Exactly. OK.

00:05:35

What are we doing then to find a specific treatment?

00:05:39

So W.H.O. is working nonstop with global experts. We have the R&D blueprint, which is accelerating research during outbreaks and they have assembled multiples, also meetings, teleconference meetings with global experts on research. And there are two main outputs that will come out of that. One is the prioritization of potential therapeutics. So based on the evidence, what therapeutics that are out there are in pipeline in development, should we use in a clinical trial? Yeah. Focus on like used to treat patients.

00:06:14

And the second aspect is a development of a master clinical trial protocol, which is the best way to test new therapeutics for efficacy and safety. So for a general public, I just want to simplify the language a little bit there. You said W.H.O. has an R&D blueprint. It's like a group that works on research and development. If that sounds right, and then what is the clinical trial in this context? I think before I came to the h-o, I thought a clinical trial was about chemicals and, you know, pipettes and whatnot.

00:06:45

But it's actually establishing a way of some buit patients treated with this. Some patients treat with that and then comparing their outcomes. Or how does a clinical trial work in a school?

00:06:55

I think what you've described this is this is true. So what we are doing with the global experts is developing a master protocol, which has clear protocol on how you use these new therapeutics because they need to be tested. Patients will get randomized into one treatment group or another treatment group depending on what the final protocol determines. And. That's about how it works. And consent is always a question people wonder about as well. If someone's in a trial, do they have their do they give their agreement to be part of that?

00:07:31

But these trials are always reviewed for ethics and there's a consent.

00:07:36

Oh, yeah. So any any clinical trial has informed consent involved in ethics approval at the country level. So we're in the early phases. So I just you know, we're developing the master trial protocol with global experts.

00:07:49

OK. That's the stage right now. We're going to wrap up soon. But what would be your advice, Dr. Diaz, for health care workers who are watching and who are interested and want to know what to do if there is a patient or they think somebody might be a patient with this disease in their health care setting.

00:08:06

So I think to start off with, it's important to get familiarized with the W.H.O. Web site. It has a lot of useful technical guidance documents to inform about the disease and how to treat the disease and how to prevent the spread of disease. For those of you that are actually health care workers or for your patients, I think the most important thing is to recognize a potential person that may have novel coronavirus. We have the case definitions on the Web site, so you can read those and you post those in the clinic.

00:08:39

And then, you know, if you suspect someone may have the virus, then quick action is to isolate and prevent further spread of the virus. And we have guidelines on that. And then if someone is very sick with the virus, with the severe complications, then initiate supportive care treatments like I described below before.

00:09:00

So this is for health care workers. We're not saying members of the public should be identifying people who are sick. And I say this is really for health workers. I think for members of the public, you know, if you develop a fever, cough or shortness of breath and you must seek medical care and advise if you have traveled to the effect to the affected areas. Yes. Thank you.

00:09:21

So that's at the moment, as we said, the 1st of February when we're recording this with the knowledge we have now. The outbreak is mostly in China. The vast majority of cases are in China. The cases in other countries have a travel history or linked to China. Again, mostly. And as Dr. D.I. Said, the focus is really on people in China to listen to what the national health authorities are saying. And when you should go to a health care center versus staying at home, because some times the disease is mild.

00:09:52

And then for people elsewhere in the world. Fever, cough and difficulty breathing, you should seek medical advice on what you should do next. That's a good summary. Yes. And you mentioned that more information can be found. That's at W.H.O., that I.A. were improving the Web site, adding more information as we go along. But there is information for if you're traveling. Protective advice for yourself. And there's a lot of guidelines for ministries of health and health workers and so on.

00:10:18

So thank you so much for watching today. And thank you for being with us. One thing actually, one more I should add is that this is a more of a general kind of discussion we had, but we're also developing debate shows, developing courses and has more detailed information really for health care workers that is more specific and really meant for you and to help you in your work. Thank you very much. And check back often for more information.

00:10:43

By. Thanks again. Thank you.