IHME (US) Model Projects NY Peak on April 9, 2020
NY Governor Cuomo Projects NY Peak at end of April
“U.S. Was Slow to Respond to Coronavirus Outbreak Because China Withheld a Significant Amount of Data.”
— Dr. Birx
“The Chinese numbers seem to be a little bit on the light side, and I’m being nice when I say that relative to what we witnessed and what was reported.”
— President Trump
“This is battlefield medicine and the use of real time frontline assessment.”
— Dr. Vladimir Zelenko, who has been prescribing hydroxychloroquine and azithromycin as treatment for COVID-19
- Recent Developments and Headlines
- Numbers and Trends
- Projections and Our (Possible) Future
- Flattening the Curve
- Potential New Treatments
- New Scientific Findings
- Stories From the Frontline
- Practical Tips
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Note: As there is a lot of inaccurate information circulating, we only include information that we can confirm from a credible source or that is based on data that we can verify. To the extent that we derive information from an online source, we provide a link to the source, which typically provides more detail that is included in our update. If you have any questions about any information included in an update, or if you have a different view, please let us know and we will supplement or correct as needed.
A. Recent Developments and Headlines
Note: All changes noted in this Update are since the 4/01 Update
Sources: New York Times Coronavirus Updates, New York Post Coronavirus Updates, Zero Hedge Coronavirus Updates, Drudge, Breitbart, Wall Street Journal, Coronavirus White House Task Force Briefing, NY Governor Daily Briefing, and Worldometers
- The coronavirus is affecting 203 countries and territories (+0)
- Worldwide Active Cases = 695,708 Cases (+55,646) (+8.7%)
- US Active Cases = 201,354 (+24,069) (+13.6%)
- US New Cases = 29,752 (+5,386 > yesterday) (+22.2%)
- NY Active Cases = 75,540 (+5,465) (+7.8%)
- NY New Cases = 7,918 (-440 < yesterday) (-5.6%)
- US deaths = 5,112 (+1,056), NY deaths = 2,219 (+505)
- UN says outbreak “most challenging crisis we have faced since WWII”
- U.S. Intel Confirms China Hid Severity of Coronavirus Outbreak
- Russia sends planeload of medical products to US
- Coronavirus is now the third leading cause of death in the US
- FDA reports shortages of malaria drugs touted by Trump
- Fla. Governor orders residents to stay home except for essential activities
- Entire State of Pa. Placed Under Stay-at-Home Order; Wolf Calls It “Most Prudent Option”
- NY Governor Cuomo closes all NYC playgrounds to stop coronavirus spread
- Trump sending troops to Mexico border amid coronavirus threat
- US Coast Guard: Cruise ships must stay at sea with sick onboard
- China reinstates travel bans as virus bounces back
- China Puts County in Henan Province On Lockdown After New Corona Cluster Emerges
- Study concludes pandemic could have been avoided if China had acted 3 weeks earlier
- China acknowledges underreporting coronavirus cases in official count
- China to start reporting asymptomatic cases
- Italy health official says nation hit ‘plateau’ 3 weeks after lockdown
- Coronavirus cases in Mexico pass 1,000, health emergency declared
- Germany has extended its national social distancing ‘guidelines’
- Hong Kong closes bars, karaoke lounges, beauty salons and other public areas as new cases jump
- Japan closes borders to travelers from 73 countries, including UK and US
- Saudi hints that annual Hajj pilgrimage will be banned this year
- Philippines’ Duterte Tells Police of Quarantine Violators: ‘Shoot Them Dead’
- Bolsonaro, isolated and defiant, dismisses the coronavirus threat to Brazil
- Belarus president believes vodka and saunas will cure coronavirus
- Ecuador: Families Keep Remains for Days as Coronavirus Victims Pile Up
- Thai government puts thousands at risk with botched hand-out program
- India reports new batch of cases
- Indian migrants walk hundreds of miles to go home
- Historic Peruvian bull ring converted to virus homeless shelter
- Africans rush for chloroquine as virus tsunami looms
- “Sailors don’t need to die”: Captain of nuclear carrier (USS Roosevelt) with over 100 COVID-19 cases pleads for help
- 1,000 sailors removed from USS Roosevelt
- US Navy to try building tent-city hospital for coronavirus-stricken sailors
- European experts ready smartphone technology to help halt coronavirus spread
- CDC continues “review” of facemask recommendation
- California county health officials urge widespread use of masks in public
- Hawaii Lt. Governor: Everyone Should Wear A Mask When Leaving Home
- Asia may have been right about facemasks and the rest of the world is coming around
- NYC health department urges medical workers to reuse and ration masks
- Carnival says it still has 6,000 passengers on ships, some will not disembark until late April
- NYPD considering ‘DOA Teams’ to collect bodies of coronavirus victims
- UK pubs hatch plan to become grocers
- Cape Cod Residents Petition To Close Bridges During Coronavirus Pandemic
- NYC veterinarians forced to choose people over pets in war against coronavirus
- NYC map shows total cases testing positive for coronavirus by ZIP code
- Coronavirus lingers in air after patients leave room, study finds
- China ‘finds new coronavirus strain that lasts for 49 days’ in infected patient
- Reopened Wuhan retailers greeted by light shopper turnout
- Doctor dies of coronavirus after leaving retirement to fight the pandemic
- Hospitals in England order doctors to shave beards amid coronavirus crisis
- US hospitals tell staff to keep quiet about coronavirus working conditions
- Facing shortages, Michigan asks feds for hydroxychloroquine
- Italian nurse strangles doctor girlfriend, claims she gave him coronavirus
- Reports: King of Thailand Self-Isolating in Germany with 20 Female Servants
- Wimbledon Canceled for 1st Time Since WWII Because of Virus
- Home from spring break, dozens of college students test positive for the virus
- The World Is Running Out Of Condoms As Factories Face COVID-19 Lockdown
- Don’t Nag Your Husband During Lockdown, Malaysia’s Government Advises Women
B. Numbers and Trends
[Note: All numbers in this update are worldwide unless otherwise indicated. The numbers in this update only include cases that have been (i) confirmed through testing, and (ii) reported. The actual number of cases may be materially higher than confirmed cases, which means that the number of actual deaths from COVID-19 and recoveries may both be materially higher than reported. As testing in US ramps up, confirmed cases may rise rapidly as actual but unidentified cases are confirmed.]
1. Confirmed Total Cases and New Cases
- Worldwide: 937,008 Total Cases (+8.7%)
- New Cases = 76,044 (+1,688 > yesterday) (+2.2%)
- Europe: 484,648 Total Cases (+9.2%)
- New Cases = 35,414 (+633) (+1.8%)
- United States: 215,344 Total Cases (+15.8%)
- New Cases = 29,752 (+5,386 > yesterday) (+22.2%)
- US States:
- 28 States > 1,000 cases (+3)
- 17 States > 2,500 cases (+3): NY, NJ, CA, MI, MA, FL, WA, IL, LA, PA, TX, GA, CO, CT, TN, IN & OH
- Top 5 States: (i) NY: 83,901 (+7,918); (ii) New Jersey: 22,255 (+3,559); (iii) California: 9,936 (+1,348); (iv) Michigan: 9,334 (+1,719), and (v) Florida: 7,773 (+1,032)
- For more information on US States, see https://ncov2019.live/data
- New York State:
- NY Total Cases = 83,901 (+15%)
- NY New Cases = 7,918 (-440 < yesterday) (-5.6%)
- New York City:
- NYC Total Cases = 47,439 (+10%)
- NYC New Cases = 4,300 (-2,618 < yesterday) (-37.8%)
2. Confirmed Active Cases
- Worldwide: 695,078 Active Cases Worldwide (+8.6%)
- New Active Cases = 55,016 (-2,144 < yesterday) (-3.7%)
- Top 5 Countries: (i) 201,354 (+24,069); (ii) Italy: 80,572 (+2,937); (iii) Spain: 72,084 (+3,584); (iv) Germany: 58,350 (+3,417), & (v) France: 42,022 (+2,861)
- US Active Cases = 201,354 (+24,069) (+13.6%)
- US New Active Cases = 24,069 (+2,373 > yesterday) (+9.9%)
- New York State Active Cases = 75,540 (+7.8%)
- NY State New Active Cases = +5,465
3. Series or Critical Cases
- Worldwide serious or critical cases = 35,772 (+2,680)
- US series or critical cases = 5,005 in US (+429)
- US serious or critical cases = 2.5% of Active Cases in US (-0.1%), compared with worldwide percentage of 5%
[Note: Serious and critical cases give insight into the need for ICU beds and ventilators]
- Worldwide deaths = 47,264 (+4,900) (+11.6%)
- Top 5 Countries: (i) Italy: 13,155 (+727); (ii) Spain: 9,387 (+923); (iii) US: 5,112 (+1,056); (iv) France: 4,032 (+509); & (v) China: 3,312 (+0)
- Worldwide Cosed Case Fatality Rate = 20% (+1%) [Note: Fatality Rate for Closed Cases is significantly higher than estimated range of public health officials (1% to 3.4%) because public officials are estimating the number of actual cases that have recovered but not been reported]
- US deaths = 5,112 (+1,056)
- NY deaths = 2,219 (+505)
- NYC deaths = 1,374 (+460)
C. Projections and Our (Possible) Future
1. IHME (Murray) Model
- The IHME Projection Model is a model being relied on the White House Coronavirus Task Force to set policy, plan and execute the response of the federal government to the coronavirus outbreak, and provide recommendations and guidance to States, local governments and US citizens. The assumptions underlying the model and the projections are updated daily in response to changes during the prior 24 hours. The projections include both projections for the US and each State. The projections include projections of the number of (i) hospital beds, ICU beds and ventilators that will be required by each State, and the number of deaths. See the IMHE data here
Key Findings of Updated IHME Model:
- Updated projections as of 4/1/20 show that nationwide, COVID-19 deaths will peak on April 16, when we predict 2,607 deaths (range of 1,294 to 4,140) in a single day. This projection is higher than our estimates released on March 31, which projected peak US COVID-19 deaths at 2,214 (range of 1,106 to 3,321) on April 15.
- April 16 also is now estimated as the peak hospital use date in the US. At this peak date, the US is projected to need 260,342 total hospital beds (38,849 for ICU) and 31,082 ventilators to support COVD-19 patients. This could equate to a projected shortage of 84,671 total hospital beds and 18,905 ICU beds given current COVID-19 trajectories.
- A total of 93,765 US COVID-19 deaths (range of 41,399 to 177,381) are currently predicted through the epidemic’s first wave. These COVID-19 death predictions are higher than what was released on March 31, a difference of 11,624 deaths (though their estimated ranges overlapped). These estimates assume the strong continuation of statewide social distancing measures in places where they are already enacted, and future adoption within the next seven days in states without them. If such policies are relaxed or not implemented, the US could experience a higher COVID-19 death toll and hospital burden than what our models currently predict.
- Our model’s increase in nationwide deaths since the March 31 release is primarily driven by increasing death tolls in states that previously had very few COVID-19 deaths. States with more COVID-19 deaths, such as New York and Washington, show far less fluctuation across daily updates. If the number of cumulative COVID-19 deaths rise by state, we expect increasing accuracy for predictions across states.
Peak Projections for US and States:
Key NY Projections:
- 8 days until peak use of hospital beds, ICU beds and ventilators on April 9, 2020
- 75,224 hospital beds needed, 13,010 beds available, resulting in a shortfall of 62,214 hospital beds
- 11,621 ICU beds needed, 718 beds available, resulting in a shortfall of 10,903 ICU beds
- 9,297 ventilators needed
[Note: NY Governor has said that NY is looking at 5 models in making their projections. Based on those models, Governor Cuomo is projecting that NY will peak in late April.]
Source: IMHE website here
2. ‘Immunity passports’ could speed up return to work after Covid-19
- Immunity passports” for key workers could be a way of getting people who have had coronavirus back into the workforce more quickly, scientists and politicians in the UK have suggested.
- Researchers in Germany are currently preparing a mass study into how many people are already immune to the Covid-19 virus, allowing authorities to eventually issue passes to exclude workers from restrictive measures currently in place.
- The study, which is yet to finalize funding, would involve testing the blood of more than 100,000 volunteers for coronavirus antibodies from mid-April. The test would then be repeated at regular intervals on an accumulatively larger sample of the population, to track the pandemic’s progress.
- It would make it easier to decide when and where schools in the country could reopen, and which people are safe to go back to work.
- “Those who are immune could be issued with a kind of vaccination pass that would for example allow them to exempted from restrictions on their activity,” said Gerard Krause, head of epidemiology at the Helmholtz Centre for Infection Research in Braunschweig.
- He said the worst case scenario – based on what is known about immunity to coronaviruses that cause common colds – is that former patients would have only partial resistance for about three months.
- “It could be that this coronavirus causes a pretty robust immune response, which is durable and protective for much longer, maybe a year or even five years, but we don’t know because it’s a new virus,” he said.
- Immunity passports are a “reasonable provisional measure”, Openshaw said, but he stressed that people granted the passports would have to be kept under close observation to ensure they were not becoming reinfected.
- “In subsequent monitoring, it would be really important to determine whether those who do return to normal circulation are in fact protected,” he said.
D. Flattening the Infection Curve
1. The Math of Social Distancing
- As we wait for scientists and healthcare professionals to develop a vaccine for COVID-19, there is another, more readily available tool at our disposal.
- Social distancing, defined as measures taken to reduce physical contact, is the first line of defense for containing an infectious disease like COVID-19. That’s because these infections spread when people cough, sneeze, or touch surfaces on which the virus resides.
- To help us grasp the impact these measures can actually have, today’s infographic illustrates how a reduction in social exposure can contain the spread of infection.
- The calculations used to create today’s infographic come from Signer Laboratory, a stem cell research lab located in the Moores Cancer Center at the University of California San Diego.
- Using a summation formula makes it possible to estimate the number of new infections over a 30 day period, across three scenarios.
|Scenario||5 Day Period||30 Day Period|
|No Social Distancing Practiced||1 person infects 2.5 others||406 people infected as a result|
|50% reduction in social exposure||1 person infects 1.25 others||15 peopled infected as a result|
|75% reduction in social exposure||1 person infects 0.625 others||2.5 people infected as a result|
- To arrive at the figures reported above, the researchers made a number of key assumptions.
- First, they estimated the basic reproduction number (R0) of COVID-19 to be 2.5, a figure supported by recent research. This means that, on average, an infected individual will spread the disease to 2.5 other people.
- Next, they assumed that an infected individual will unknowingly spread COVID-19 over the median five day incubation period. After this period, the individual will begin to develop symptoms, immediately self quarantine, and no longer pose a threat.
- Finally, they assumed a direct linear correlation between social interactions and R0. This means that when an infected person reduces their physical contact with others by 50%, they also spread the disease by an amount 50% less.
- While the figures above are the results of mathematical estimations, researchers have actually studied social distancing from a variety of angles.
- One study used simulations to determine the magnitude and timing of social distancing measures required to prevent a pandemic.
- Results showed that when no action was taken, 65% of the population contracted the disease. However, if sufficient social distancing measures were implemented instead, the attack rates were:
- 45% (distancing begins after a 4 week delay)
- 21% (distancing begins after a 3 week delay)
- 7% (distancing begins after a 2 week delay)
- What’s clear is that social distancing was significantly more effective when implemented with minimal delay—the final illness attack rate rose quickest beyond the third week. With the global number of COVID-19 cases still rising, many governments have issued quarantine orders and travel bans.
- The math supports these decisions—reducing our physical contact with others, even when we aren’t experiencing any symptoms, is crucial. Studies like the one summarized above also prove that taking action sooner, rather than later, can go a long way in reducing the spread of infection.
- The key takeaway from all of this? Social distancing is a powerful disease control tool, but only if we all participate.
E. Potential New Treatments and Testing
1. Scientist from Netflix ‘Pandemic’ series says he may have found potential cure for coronavirus
- Dr. Jacob Glanville, a San Francisco-based doctor who was featured on Netflix’s series “Pandemic” says his team may have found antibodies which could treat COVID-19.
- “We are happy to announce we have completed the engineering and we have some very potent antibodies that can be effective against the virus,” said Dr. Glanville on Monday.
- Glanville told Radio New Zealand that his team used a series of five antibodies that were able to neutralize SARS in 2002, and adapted them to attack COVID-19.
- “The new virus is a cousin of the old SARS. So what we’ve done is we’ve created hundreds of millions of versions of those antibodies, we’ve mutated them a bit, and in that pool of mutated versions, we found versions that cross them over,” Glanville said Monday. “So now we know they bind on the same spot as the new virus, Covid-19.
- Glanville said his team is in communication with the U.S. government about conducting a study about the drugs usefulness.
- “Part of the reason we think we’re moving pretty fast is that instead of starting from scratch discovering an antibody, we went to these existing antibodies that were already extremely well characterized against SARS. And we’ve adapted them. So we’re piggybacking on two years of research,” Glanville said.
- Although Glanville says that although his “short-term” vaccine takes effect quickly, the disadvantage is that antibodies only give protection for eight to 10 weeks, unlike a true vaccine.
- The next phase in the process will be to send the antibodies to the military for confirmation testing, and Charles River Laboratories for safety testing. He says his team has partnered with 2 companies to scale up production of the drug once it is approved, and would begin human trials at the end of summer.
- If the drug is safe, Glanville said it could begin to be released in September.
2. British American Tobacco working on coronavirus vaccine using tobacco leaves
- BAT said a division of BAT’s Reynolds American Inc could churn out between 1 million and 3 million doses of the vaccine using proteins extracted from tobacco leaves by that time.
- The vaccine, which is undergoing pre-clinical testing, uses a cloned part of the virus’s genetic sequence to make antigens — substances that spark an immune response in the body — that is inserted into tobacco plants for reproduction.
- Once harvested, the antigens are extracted, purified and then inserted into the body to fight the virus.
- BAT said it was working with the FDA and with British health authorities on launching clinical studies as soon as possible.
F. New Scientific Findings and Other Advancements
1. Worldwide genetics race to uncover who is most susceptible to coronavirus
- Researchers across the world are working to uncover whether DNA variations among humans affect how susceptible individuals are to the novel coronavirus. Drawing on studies that found an association between more severe Covid-19 cases and individuals with lower lymphocyte – or white blood cell – counts, the two said that lymphocyte count “may play a role in susceptibility to viral infection and disease progression”.
- Scientists are pooling genetic data from Covid-19 patients to determine whether differences in genetic coding affect how severely a patient suffers.
- Their study also found “significant and consistent risk reduction” for the coronavirus from people with type O blood, lending support to an earlier study by Chinese researchers that found patients with type A blood had higher rate of infection and tended to have more severe Covid-19 symptoms, while those with type O blood had a lower risk of serious infection.
2. Coronavirus can cause heart injury even for those without underlying issues
- Coronavirus can cause heart damage — even in patients without any underlying cardiac issues, according to a troubling new study.
- The research, published last Friday in the journal JAMA Cardiology, found that 19.7% of a group of 416 infected patients hospitalized in Wuhan, China, suffered damage to their hearts.
- “We know that the cardiac injury risk is there, no matter if you had prior heart disease or not,” lead author Dr. Mohammad Madjid, an assistant professor of cardiology at McGovern Medical School at UTHealth, told Healthline.
- The study also determined that the death rate was much higher for patients who experienced heart issues. Of the cases with cardiac problems, 51% died compared to 4.5% of those without, researchers said.
3. Rare coronavirus patient’s mild symptoms but long illness may point to ‘chronic’ mutation: researchers
- Chinese researchers have raised the possibility that a new subtype pathogen of Covid-19 that has low toxicity but with prolonged ability to infect others might have occurred after observing a rare case in which the disease appeared to be “chronic”, pointing to the possibility of a mutation.
- The researchers warn there may be more “chronic infected patients” who carry the infection into their surroundings and trigger an outbreak.
- A middle-aged man whose symptoms were not severe appears to have formed a “dynamic balance” with the coronavirus after an extremely prolonged illness lasting 49 days, Chinese military researchers reported in a preprint article on Medrxiv.org last week.
- The patient had been observed to have both a high Covid-19 viral load and, at the same time, his immune cell indicators had remained stable.
- “The virus and the host may even form a symbiotic relationship,” said the researchers from the Army Medical University in Chongqing, No 967 Hospital of PLA, Dalian, and General Hospital of the PLA Central Theatre Command in Wuhan.
- As the signs showed that his body could not eliminate the coronavirus with regular therapy and that he might still have been infectious, the patient was treated with a plasma transfusion from recovered Covid-19 patients.
- It was, to date, the longest known duration of “viral shedding” for a patient who survived Covid-19. Previous clinical observation showed the median time of surviving patients turning negative was 20 days, with the longest case at 37 days. Usually, the longer the duration is, the more severe the case.
- This patient, however, had intermittent low fever and did not have a cough, chill, shortness of breath or other typical Covid-19 symptoms. CAT imaging of the patient showed infection lesions on bilateral lungs, which disappeared a few days after he was admitted to hospital, and his body temperature also returned to normal, the researchers found.
- The patient’s nucleic acid test for Covid-19 remained positive with a consistently high viral load similar to those of severe or critical cases, which suggested a prolonged infective ability.
- Researchers believe such information may indicate a new mild subtype of the virus, which has lower toxicity and weaker transmissibility but is more difficult to eliminate.
- They warned that there might be more such “chronically infected patients”, who were more likely to be neglected but could go on to spread the infection in their surroundings and cause a new outbreak.
4. Infected but Feeling Fine: The Unwitting Coronavirus Spreaders
- As many as 25 percent of people infected with the new coronavirus may not show symptoms, the director of the CDC warns — a startlingly high number that complicates efforts to predict the pandemic’s course and strategies to mitigate its spread.
- In particular, the high level of symptom-free cases is leading the CDC to consider broadening its guidelines on who should wear masks.
- This helps explain how rapidly this virus continues to spread across the country.
- The agency has repeatedly said that ordinary citizens do not need to wear masks unless they are feeling sick. But with the new data on people who may be infected without ever feeling sick, or who are transmitting the virus for a couple of days before feeling ill, Mr. Redfield said that such guidance was “being critically re-reviewed.”
- Researchers do not know precisely how many people are infected without feeling ill, or if some of them are simply presymptomatic. But since the new coronavirus surfaced in December, they have spotted unsettling anecdotes of apparently healthy people who were unwitting spreaders.
- For example, as many as 18 percent of people infected with the virus on the Diamond Princess cruise ship never developed symptoms, according to one analysis. A team in Hong Kong suggests that from 20 to 40 percent of transmissions in China occurred before symptoms appeared.
- The high level of covert spread may help explain why the novel coronavirus set off a pandemic in a way that the SARS and MERS viruses did not.
- The new virus spreads about as easily as flu, “and when’s the last time anyone thought anything about stopping influenza transmission, short of the vaccine?” said Dr. Michael T. Osterholm, an infectious disease expert at the University of Minnesota.
G. Stories from the Frontline
1. Helmet ventilators by Texas mom-and-pop business widely ordered for coronavirus
- A spacesuit-like helmet ventilation device manufactured by a Texas mom-and-pop business is in high demand as doctors across the world request it to treat COVID-19 patients.
- Sea-Long Medical Systems Inc. in the small town of Waxahachie, run by Chris Austin, previously fielded a few dozen orders a week for the device, originally designed to supply oxygen to patients being treated in hyperbaric chambers.
- Now, Austin says “‘overwhelmed’ doesn’t scratch the surface” as thousands of orders pour in each day, from top hospitals in the US and even as far as the United Arab Emirates.
- “We really look at where is the need,” Austin told the network. “We know New York has a stronger need. We know Boston. We know Chicago. … But we also know that we have to get what we can to Italy.”
- The devices, which only cost $162 apiece, could help free up ventilators, — which cost five figures — for the most critically ill COVID-19 patients.
- The helmets were originally designed to run through ventilators, but with the help of Dr. Bhakti Patel, a pulmonologist at the University of Chicago and her mentor, Dr. John Kress, the company has modified them to be hooked up to a hospital’s regular oxygen supply.
- The team also added a viral filter to avoid exposing others to COVID-19.
- “I would love for there to be a silver bullet for this pandemic,” Patel told NBC. “My best hope is that the way it changes the game is that maybe it shaves off the number of patients who need a ventilator — even if it’s 1 out of 3 or 1 out of 5.”
- This week, the helmet has already been used on an 81-year-old man with COVID-19 at the University of Chicago Medical Center, producing “encouraging results.”
- Doctors in Italy also found that it helped some coronavirus patients.
- Back in 2016, Patel tested the Sea-Long helmet against an oxygen mask for a group of 83 intensive care patients suffering from acute respiratory distress.
- The results clearly swung in the helmet’s favor — with patients who used them requiring ventilation 18.2 percent of the time, compared to 61.5 percent who wore the masks. Helmet-using patients also had a better 90-day survival rate, according to the study, published in the Journal of the American Medical Association.
- In the US, Massachusetts General Hospital and the Hospital of the University of Pennsylvania have ordered the helmets, NBC reported. The company — which has seen droves of volunteers offering to help — has also received orders from Canada, Mexico and across Europe, Austin said.
- Amid the surging demand, the cost of the device will not rise, he added.
- “This probably sounds sappy,” he said. “But we think of what if that was our son or daughter or grandfather sitting there in that bed gasping for air and we have to explain to him: ‘I’m sorry. We don’t have anything for you.’ “
2. While NY Labs are processing tests in 24-48 hours, a backlog builds in California and possibly other States, which calls reported number of cases into question
- On the surface, the American COVID-19 testing regime has finally hit its stride. Over the past five days, the states have reported a daily average of 104,000 people tested, according to data assembled by the COVID Tracking Project, a volunteer collaboration incubated at The Atlantic. Today, the U.S. reported that 1 million people have been tested for the coronavirus—a milestone that the White House once promised it would hit the first week of March.
- But things are not going as smoothly as the top-line numbers might suggest. Our reporting has unearthed a coronavirus-testing crisis. Its main cause is the private companies that now dominate the country’s testing capacity. Testing backlogs have ballooned, slowing efficient patient care and delivering a heavily lagged view of the outbreak to decision makers.
- Though the problem is national in scope, California is its known epicenter. Over the past week, the most populous state in the union—where the country’s first case of community transmission was identified, in late February—has managed to complete an average of only 2,136 tests each day, far fewer than other similarly populous states, according to our tracking data. Yet California also reports that more than 57,400 people have pending test results. Tens of thousands of Californians have been swabbed for the virus, but their samples have not yet been examined in a lab.
- In the meantime, California has completed fewer tests per capita than the country’s next five-largest states—and fewer tests per capita than any of the 34 states that regularly report their full testing data. New York has tested 13 times more people, on a per capita basis.
- The over-reporting error, the lackluster testing rate, and that persistently huge number of pending tests suggest something is rotten in the Golden State’s testing regime. Even more troubling, they raise the possibility that all across the country, huge numbers of results are stuck in purgatory.
- Within the clinical-testing world, it is an open secret that Quest Diagnostics — one of the industry’s two big players, along with Labcorp—has struggled to scale up its operations in California. And yet, Quest has continued to accept specimens from across the country, leading to a huge backlog of tests at the company’s facility in San Juan Capistrano.
- Quest has overpromised to prestigious institutions and medical centers around the country, and people are used to relying on Quest for quick and cheap results, but those time and time again have proven not to have the best quality. And in this situation, it has been disastrous to patient care.” (Greene is also an associate professor at the UW School of Medicine.)
- “Lab turnaround time is critical,” says Geoff Baird, the acting laboratory-medicine chair at the University of Washington. “More than a day is a tragedy. Three to five is okay for outpatients if they can sit at home, but it doesn’t address the problem in a hospital.”
- One physician at a community hospital in California, who requested anonymity to protect her job, echoed the sentiment that waiting on negative results hurts her ability to provide care. “Time to negative result for a mildly ill patient is maybe the most worrisome thing right now,” she told us, because it is creating “the bottleneck which will result in denial of care to patients we can save.”
- By contrast, when the Utah-based nonprofit ARUP Laboratories realized that it could not fulfill any more COVID-19 tests, it refused to take more specimens. In mid-March, the University of Washington hit a similar wall, and stopped taking specimens for a time. The Mayo Clinic laboratory in Minnesota, which often tests samples from across the country, has slowly opened up its capacity to avoid running a backlog.
- The public-private partnership can work. In New York, the company BioReference Laboratories made the decision to bring up all available COVID-19 test assays, regardless of manufacturer, in the last week of February. “It was pretty clear at that time that the chance of this breaking open was pretty much certain,” Jon Cohen, the executive chairman of BioReference, told us. “It was just a matter of when and how big it was gonna be.” The company brought online five different platforms for testing, including Roche’s.
- As BioReference scaled up, New York Governor Andrew Cuomo brokered a deal for it to provide testing capacity to the state. “To his credit, [he] actually reached out,” Cohen said. (The two men had a preexisting relationship.) Working with Northwell Health, the largest New York health-care provider, BioReference committed much of its processing capacity to the state. “The result of that is that we ended up being the lab that is doing all the drive-throughs of all of New York State,” Cohen said, “including New Rochelle,” the site of one of the most intense early outbreaks. He said his company’s turnaround times are 24 to 48 hours for outpatient testing and “within 24 hours” for hospitals.
- Through BioReference and other commercial companies, as well as its own laboratories, New York now has almost 20 percent of all the completed tests in the United States. As a consequence, the number of confirmed cases has skyrocketed, but at least New York knows the severity of its outbreak.
- If New York is on one end of the spectrum, California is on the other. What’s unclear is how common California’s and Quest’s situations are. No other state reports that it has such a huge backlog of tests stuck in private laboratories, but California’s reporting idiosyncrasy likely reflects reality better than other states’ reporting. For example, Illinois Governor J. B. Pritzker tweeted yesterday that private-lab results in his state are taking “4-7 days and sometimes even up to 10 days.”
3. D.I.Y. Coronavirus Solutions Are Gaining Steam
- Essential medical supplies, from exam gloves to ventilators, are in short supply. In response, the world’s open-source enthusiasts have banded together to dig up and catalog blueprints of critical do-it-yourself gear and tools that can save lives.
- While government officials scramble to find a solution, do-it-yourself makers are pressing ahead in what some corners of the internet are calling a medical hackathon.
- When Mr. Cavalcanti started the group, he told his fellow moderators that it needed to “grow faster than the virus.”
H. Updates and Different Views
1. Malaria Drug (Hydroxychloroquine) Helps Virus Patients Improve
- The malaria drug hydroxychloroquine helped to speed the recovery of a small number of patients who were mildly ill from the coronavirus, doctors in China reported this week.
- Cough, fever and pneumonia went away faster, and the disease seemed less likely to turn severe in people who received hydroxychloroquine than in a comparison group not given the drug. The authors of the report said that the medication was promising, but that more research was needed to clarify how it might work in treating coronavirus disease and to determine the best way to use it.
- “It’s going to send a ripple of excitement out through the treating community,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University.
- The study was small and limited to patients who were mildly or moderately ill, not severe cases. Like many reports about the coronavirus, it was posted at medRxiv, an online server for medical articles, before undergoing peer review by other researchers.
- But the findings strongly support earlier studies suggesting a role for the drug, Dr. Schaffner said.
- “I think it will reinforce the inclination of many people across the country who are not in a position to enter their patients into clinical trials but have already begun using hydroxychloroquine,” he said.
- Previous reports from China and France that the drug seemed to help patients, along with enthusiastic comments from President Trump, have created a buzz around hydroxychloroquine and the closely related chloroquine, which are decades-old drugs used to treat malaria and autoimmune diseases like lupus and rheumatoid arthritis.
- With no proven treatment for the coronavirus, many hospitals have simply been giving hydroxychloroquine to patients, reasoning that it might help and probably will not hurt, because it is relatively safe.
- The earlier reports from France and China drew criticism because they did not include control groups to compare treated versus untreated patients. Researchers called the reports anecdotal, and said the lack of controls made it impossible to determine whether the drugs worked.
- Among health officials who declined to endorse the drugs, and who called for clinical trials, were some members of the president’s coronavirus task force — including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Dr. Stephen Hahn, commissioner of the Food and Drug Administration.
- The new study, of 62 patients with an average age of about 45, did have a control group. It was conducted at the Renmin Hospital of Wuhan University, in Wuhan, China. The patients were carefully chosen to exclude people with medical problems that could be made worse by hydroxychloroquine, like abnormal heart rhythms, certain eye diseases, and liver or kidney problems.
- Half the subjects — the controls — received just the usual care given to coronavirus patients, and half had usual care plus hydroxychloroquine. The usual care included oxygen, antiviral drugs, antibiotics and other treatments.
- Their disease was considered mild, even though all had pneumonia that showed up on CT scans. After giving informed consent, they were assigned at random to either the hydroxychloroquine or the control group. They were treated for five days, and their fevers and coughing were monitored. They also had chest CT scans the day before the study treatment began, and the day after it ended.
- Coughing and fever eased a day or so earlier in the patients who received hydroxychloroquine, and pneumonia improved in 25 of 31, as opposed to 17 of 31 in the controls.
- The illness turned severe in four patients — all in the control group.
- Two patients had minor side effects from hydroxychloroquine: One had a rash and another had a headache.
- Dr. Schaffner cautioned that the results applied only to patients with relatively mild illness, like the ones in the study, and could not be generalized to advanced cases.
- “If you want to treat people who are already seriously ill, we don’t know how well this will work,” he said.
- If the drug is helping, it is not clear how. There are two possible ways. In laboratory studies, it can stop the virus from invading cells. But hydroxychloroquine can also dial back an overactive immune system, which is why it can treat autoimmune diseases. And a powerful immune reaction to the coronavirus is suspected of playing a role in some of the severest cases of the disease.
- “We don’t know which of the pharmacologic aspects of hydroxychloroquine are most active, the antiviral part, or the immunomodulatory part,” Dr. Schaffner said. “We don’t know, but it does reinforce the notion, as the authors say briefly, it reinforces the thinking about the nature of many of these pneumonias we are seeing, which seem to have an immune basis, as opposed to being secondary bacterial pneumonia, which we see so often in influenza.”
[Note: This article takes on some significance because it was published by the NY Times, which has been a strong critic of President Trump for promoting unproven and potentially dangerous drugs. See, Opinion | No, These Medicines Cannot Cure Coronavirus.]
I. Practical Tips and Useful Information
1. Should I Make My Own Mask?
- To mask or not to mask?
- For the past few months, public health officials have advised that healthy people should not wear masks as a way to protect themselves from coronavirus. But as we learn more about the virus, more experts are challenging the official guidance and saying that there is probably some benefit to covering our faces in public.
- But for now, commercially made masks are virtually impossible to find. Many people have hoarded masks in recent months, and everyone agrees that any available supply of medical masks should be reserved for hospitals and emergency workers. That means if you want a mask, you probably have to make it yourself.
[Note: For a tutorial on how to make your own fabric face mask from common household materials, see: How to Make a Face Mask With Fabric].
- “Cover your face with cloth — however you want to do that,” said Shan Soe-Lin, a lecturer at the Yale Jackson Institute for Global Affairs who was a co-author of a widely shared article about the need to cover your face. “Cover your face pretty thoroughly from your mouth to your nose to prevent large aerosol droplets coming out or going in.”
- Last week, the German Medical Association suggested citizens find or make a simple fabric mask when out in public and leave medical-grade masks for front-line workers. In Austria, grocery store shoppers are now required to wear masks. In New York, Governor Andrew M. Cuomo has advised anyone over 70 to wear a mask.
- The highest quality, most expensive medical masks — called N95 respirator masks — should be reserved for hospital workers and emergency responders who are regularly exposed to high viral loads from infected patients, both from frequent contact as well as medical procedures that can spew tiny viral particles into air. The rest of us don’t need that level of protection.
- If you’re staying home and nobody in your family is infected, you don’t need a mask most of the time. But more experts now say that wearing a nonmedical or homemade mask to go the grocery store or pharmacy may be a good idea. Studies of mask use to prevent the spread of respiratory illnesses, including SARS, another form of coronavirus, show a simple mask can lower risk of infection. The effect is greatest when masks are used along with hand hygiene and social distancing.
- “I think the vast amount of data would suggest that the coronavirus is an airborne infection carried by respiratory droplets, and it also can be passed on by direct contact,” said Dr. Siddhartha Mukherjee, assistant professor of medicine at Columbia University, who recently wrote an article about how the coronavirus behaves inside patients. “The mask works two ways — not only to protect you from me, but me from you.”
- While we don’t have a lot of research on the effectiveness of homemade masks in preventing the spread of infection, scientists who study airborne diseases can offer some guidance. A mask sewn from a pattern or an improvised face covering made with a T-shirt probably offer some protection. The thicker the fabric, the better: think heavy cotton T-shirt or a thick, felt-like fabric, said Linsey Marr, a Virginia Tech scientist and an expert in the transmission of viruses in the air. While some people have suggested using a bandanna, the fabric is typically so thin and flimsy that it would likely offer little protection. Double or triple the bandanna fabric if that’s all you have.
- “I’ve been saying some protection is better than none,” said Dr. Marr, who noted that local health departments have been asking aerosol scientists for guidance on potential mask materials to deal with supply shortages. She said her team will have results soon with more specific recommendations for materials to use in masks.
- Dr. Marr emphasized that most people do not need the high level of protection offered by a medical mask. “The potential for exposure is so much lower in a grocery store compared to working in a hospital close to patients,” she said.
- Dr. Soe-Lin said she believes an added benefit of a mask is that it serves as a constant reminder against touching your face, a major way that the virus is spread. But no face covering, whether it’s homemade or a medical mask, makes you invincible. Pulling a mask on and off or fidgeting with it will lessen its effectiveness. And in theory, fiddling with your mask could contaminate it. Always remove a mask by the ear loops or the tie — never the part that covers your face. Dr. Soe-Lin said she has used cloth masks for three weeks and washes and dries them regularly. Someone with only one mask can hand wash at night and let it air dry. If a mask gets wet or damp while you are wearing it, it’s less effective, she said.
- “I don’t think there is any evidence that this is going to make things worse, but there is evidence that it provides some additional good,” said Robert Hecht, professor at the Yale School of Public Health, who was the co-author of the face mask article with Dr. Soe-Lin. “Under this emergency situation we’re in, it seems, in our view, hard to argue against covering your face. We have large numbers of infections occurring which don’t need to happen if people were to use the masks.”
- Dr. Mukherjee said he is hopeful that large companies and the government will produce and distribute inexpensive masks for essential workers like grocery clerks and delivery drivers, as well as the general public. Questions about durability, reuse and sanitizing masks, as well as the best fabric to use in a homemade mask, still need to be answered.
- If you decide to start wearing a mask, you should know that it takes some getting used to. A mask can be hot and uncomfortable and fog your glasses if you wear them. But pulling it up and down defeats the purpose of wearing it.
- “I still believe that masks are primarily for health care workers and for those who are sick to help prevent spreading droplets to others,” said Dr. Adit Ginde, a professor of emergency medicine at the University of Colorado School of Medicine. “However, I do believe that for limited circumstances when individuals must be in close quarters with others, a correctly positioned mask or other face cover for a short duration could be helpful.”
Source: Should I Make My Own Mask?
1. It’s Only A Matter Of Time Until COVID-19 Lockdowns Lead To Civil Unrest And Violent Crime
- The United States of America is basically closed for business, leaving citizens jobless, broke, and without options. We’re facing restrictions on movement the likes of which our nation has never seen. The stores that are open have never fully restocked after the “panic buying” of previous weeks, leading to shelves barren of things like meat, flour, toilet paper, and rice.
- It’s only a matter of time before these issues combine to become the flashpoint that could lead to an explosion of civil unrest and violent crime.
Reasons for Concern:
The financial situation
- Unemployment skyrocketed, with 3.3 million claims last week, and the Fed estimates that number to climb to a whopping 47 million due to the virus. Many of these jobs may not come back after the Covid-19 virus has run its course through the nation – businesses small and large are going to be defaulting on their April rent payments, and many simply won’t be able to catch up later.
The supply situation
- A lot of people are blaming “hoarders” and preppers for the shortages seen in stores. Of course, it’s nonsense to blame preppers because we’ve been buying our things over a course of years. And honestly, if it was only “panic buyers” causing problems, wouldn’t the stores be replenished by now? After all, people have hardly been able to shop for two weeks in many states due to social distancing measures.
- In reality, there are major issues with the supply chain, a problem many folks aren’t seeing because they’re not at the store. Distribution systems are breaking down.
Restrictions on movement
- The third worrisome factor is extreme restrictions on movement. Never in my lifetime have I witnessed such a thing in the United States as we’re seeing now.
- Texas and Florida have checkpoints where they’re testing travelers for health problems, escorting them to quarantine, or turning them away. Rhode Island police went so far as to go door-to-door with the National Guard, searching for “New Yorkers” who had fled the virus in their home state.
- Most states have closed non-essential businesses and schools for the foreseeable future. Local authorities are beginning to crack down on groups of people and innocent Americans risk being questioned when they leave their homes to walk the dog or go to the store. Last week, thousands of Americans considered essential workers were given “travel papers” to show the authorities if they’re stopped when they are going to work. Travel papers. In the United States of America.
- If you can’t satisfy the requirements laid out by your state or local government, you could face fines and even misdemeanor charges for breaking stay-at-home orders.
Can’t count on 911
- Add to all of the above, police officers are getting sick. Hundreds of NYPD and Detroit police officers have tested positive for Covid-19.
- Some places, like Cincinnati, are limiting in-person police responses to crimes “to reduce unnecessary contact between officers and the public to reduce the spread of COVID-19.”
- How long before officers just stop coming in to work and instead, stay home to take care of their families? And, can you blame them if they do?
Other countries are seeing civil unrest
- The Covid-19 lockdowns are resulting in violence in other countries.
- Italy has begun to see chaos. People are running out of food, money, and patience.
- It isn’t just an Italian problem. As soon as restrictions were partially lifted in China, citizens began to riot, beating police with their own shields and overturning police cars.
This could be the perfect storm
- It’s only a matter of time before the factors above combine to create the “perfect” conditions for widespread civil unrest and crime. When Cat Ellis wrote her book about surviving this pandemic, there’s a reason she included detailed information about securing your property and preparing for potential assaults on your home or retreat. You’ve got your supplies. Now you need to focus on defensive planning.
- And if you think that is far-fetched, then why are retailers across the country boarding up their windows?
[Note: While it’s hard to believe that this types of situations could happen in America, its worth considering how much has happened in the last 30 days that we never thought could happen (if we ever thought about it at all). Although I have never been a prepper or doomsday type of person, and still am not, these types of situations don’t seem so outlandish anymore. For that reason, it seems prudent to at least consider how we would deal with these types of situations if they occur, which still seems unlikely (but not as unlikely as a month or so ago).]For full article, see: It’s Only A Matter Of Time Until COVID-19 Lockdowns Lead To Civil Unrest And Violent Crime