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