Coronavirus Update 4-3

Today’s Features

• Recent Developments and Headlines
• Numbers and Trends
• Projections and Our (Possible) Future – IMHE model update
• Potential New Treatments
• New Scientific Findings
• Stories From the Frontline – Global survey of doctors

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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 4/02 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 204 countries and territories (+1)
• Worldwide Cases exceed 1,000,000
• Worldwide Active Cases = 751,828 (+56,120) (+8%)
• US Active Cases = 228,875 (+27,521) (+13.7%) 
• NY Active Cases = 83,081 (+7,541) (+10%)
• US deaths = 6,095 (+983), NY deaths = 2,538 (+319)
• Half the world on lockdown, AFP reports
• Pence says US facing similar trajectory to Italy
• Dr. Fauci: all states should have stay-at-home orders
• Dr. Birx: Because of China, ‘We Didn’t Know How Contagious’ Coronavirus Is
• President Trump Issues Order Compelling Companies To Supply Ventilator-Makers “To Save American Lives” 
• Trump Invokes the Defense Production Act to require 3M to provide medical masks to US hospitals
• US Cities increasingly cracking down on people defying stay-at-home orders
• The CDC is expected to advise all Americans to wear cloth masks in public
• Dr. Birx: Civilians Wearing Masks May Get ‘False Sense of Security’
• Tennessee Governor Requires All Citizens To Remain at Home
• New York could deplete its ventilator stockpile in 6 days.
• NJ Gov. Murphy suggests social distancing at home
• NJ Gov. Orders State Police To Commandeer Needed Medical Supplies
• U.S. Army rolls into Seattle with field hospital built for combat
• 1.3 million Americans tested; 238,000 New Yorkers tested
• Putin extends Russian shutdown
• Infection in New Delhi slum sparks fears of mass breakout
• Italy cases, deaths continue to level off
• Indonesian President Rejects Lockdown as Jakarta Governor Claims Hundreds Dead
• Residents: ‘Nobody in Wuhan Believes the Official Numbers’ of Coronavirus Deaths
• China is undercounting its coronavirus toll, the C.I.A. has found.
• China: Some ‘Cleared’ Coronavirus Patients Test Positive Three Times
• China Claims 98% of Large Industrial Businesses Are Back at Work
• China Forcing Uyghur Health Workers into Coronavirus Treatment Centers
• Deaths spike in Ecuador, and officials fear a dramatic undercount of virus cases
• North Korea Insists: ‘Not One Single Person’ Has Chinese Coronavirus
• India: Mob of 100 Throws Stones at Doctors Treating Coronavirus
• Temporary Morgue the Size of Two Football Pitches Being Built in London
• Over 10,000 French Police Officers Quarantined over Coronavirus Infection Fears
• Sicilian Mayor Says Obey Lockdown or You Will Be Guilty of ‘Mass Murder’
• Israel Ranked As Safest Country To Be In During Pandemic
• S. Korea says over 27,000 self-quarantined
• Report: Global Backlash Forces Chinese City to Ban the Eating of Cats and Dogs
• L.A. Mayor Eric Garcetti Urges Residents to Report Stay-at-Home Violators: ‘Snitches Get Rewards’
• Los Angeles Mayor Eric Garcetti Advises Residents to Wear Masks in Public
• Texas Border City Orders Masks Worn in Public or $1000 Fine
• Report: Elon Musk Delivered CPAP Machines After Promising Ventilators
• Houston Police Chief: Burglaries Up 20 Percent After Coronavirus Stay-Home Orders
• It Was a Lot Worse Than I Imagined’: Berlin Mayor Who Intentionally Caught Coronavirus
• First Coronavirus Cases Among L.A. Homeless 
• London’s Francis Crick institute develops rapid test
• Wuhan Residents Line Up for Hours to Buy Graves for Loved Ones
• 104-year-old World War II Veteran Beats Coronavirus
• Amazon Bans Sale Of N95 And Surgical Masks To General Public
• Robert Kraft Ferries Nearly 2 Million N95 Masks Back To US On Patriots’ Private Jet
• Man Hides Coronavirus Symptoms to See Wife in Maternity Ward
• Coronavirus ‘may cause brain damage’ as dangerous swelling found in ‘confused’ patients  
• Florida Governor designates attending religious services as an essential activity
• Texas Governor Abbott: Church an ‘Essential Service,’ Practice Social Distancing
• Residents in Texas city can face $1,000 fine for not wearing ‘some form of covering over their nose and mouth’ 
• Nursing home infections, deaths surge amid lockdown measures
• Planned Parenthood Seeks Donations of Protective Medical Equipment for Abortions During Pandemic
• Navy relieves captain who raised alarm about coronavirus outbreak on aircraft carrier
• Europe braces for domestic abuse ‘perfect storm’ amid coronavirus lockdown
• From voice messages to videos, India’s slavery survivor networks reach out to  members to spread coronavirus awareness
• U.S. eases ban on gay blood donors amid coronavirus
• Residents snitch on businesses, neighbors amid shutdowns
• Amid coronavirus scare, Americans flock to remote land, survival retreats
• Britain, struggling to test health care workers, vows to scale up efforts
• Under-fire UK government pledges 100,000 tests a day
• Milan shuts crematorium to deal with body backlog
• Cruise ship with coronavirus patients docks in Florida
• France is converting part of a food market into a morgue
• Cellphone data shows where social distancing measures worked, and what happened without them
• American Airlines Gives Up on Most Overseas Flying This Summer
• To enforce new rules, British police use drones, shaming and a ban on Easter egg sales
• Nurse battling coronavirus: ‘Worse than a gunshot’
• Poll:  Dr. Fauci has 70% approval rating
• UN climate summit canceled

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.]

Source:  Worldometers

1. Confirmed Total Cases and New Cases

• Worldwide: 1,019,571 Total Cases (+8.8%)
  • New Cases = 82,563 (+6,519) (+8.6%)
• Europe: 521,479 Total Cases (+7.6%)
  • New Cases = 36,831 (+1,417) (+4%)
• United States: 245,373 Total Cases  (+13.9%)
  • US New Cases = 30,029 (+277) (+1%)
• US States:
  • 28 States > 1,000 cases (+0)
  • 17 States > 2,500 cases (+0): NY, NJ, CA, MI, MA, FL, WA, IL, LA, PA, TX, GA, CO, CT, TN, IN & OH 
  • Top 5 States: (i) NY: 93,053 (+9,152); (ii) New Jersey: 25,590 (+3,335); (iii) California: 11,207 (+1,271); (iv) Michigan: 10,791 (+1,457), and (v) Louisiana: 9,150 (new)
• For more information on US States, see https://ncov2019.live/data
• New York State:
  • NY Total Cases = 93,053 (+11%)
  • NY New Cases = 9,152 (+1,234) (+15.6%)
• New York City: 
  • Total Cases = 51,809 47,439 (+9.2%)
  • NYC New Cases = 4,370 4,300 (+70) (1.6%%)

2. Confirmed Active Cases

• Worldwide: 751,828 695,078 Active Cases Worldwide (+8.1%)
  • New Active Cases = 56,750 (+1,734) (+3.2%)
  • Top 5 Countries: (i) 228,875 (+27,521); (ii) Italy: 83,049 (+2,477); (iii) Spain: 74,974 (+2,890); (iv) Germany: 61,267 (+2,917), & (v) France: 41,290 (-732)
• US Active Cases = 228,875 (+27,521) (+13.7%) 
• NY Active Cases = 83,081 (+7,541) (+10%)

3. Series or Critical Cases

• Worldwide serious or critical cases = 37,688 (+1,966)
• US series or critical cases = 5,421 in US (+416)
• US serious or critical cases = 2.4% 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]

4. Deaths

• Worldwide deaths = 53,325 (+6,061) (+12.8%)
  • Top 5 Countries: (i) Italy: 13,915 (+760); (ii) Spain: 10,348 (+961); (iii) US: 6,095 (+983); (iv) France: 5,387 (+1,355); & (v) China: 3,322 (+10) 
  • Deaths per 1M population: (i) Italy: 230; (ii) Spain: 221; (iii) US: 18; (iv) France: 83; & (v) China: 2
  • Worldwide Cosed Case Fatality Rate = 20% (+0%) [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 = 6,095 (+983)
• NY deaths = 2,538 (+319)
• NYC deaths = 1,562 (+188)

C. Projections and Our (Possible) Future

1. IHME (Murray) Model

Background

• The IHME Projection Model is a model that includes projections of (i) the resources (e.g., the number of hospital beds, ICU beds and ventilators) that will be required by each State, (ii) the date on which the maximum number of resources will be required by each State (the “peak day”), and (iii) the number of deaths for each State.  The IMHE Model began making projections on March 26, and the assumptions underlying the model and the projections are updated daily in response to changes that have occurred during the prior 24 hours.   
• The White House Coronavirus Task Force has referenced the model in its daily briefings and appears to be using the model to develop plans and guidance in response to the epidemic.  The Gates Foundation is funding the development of the IHME Model. The IHME Mode can be found at http://www.healthdata.org/covid/updates.

Key Findings of Updated IHME Model for US (Updated on 4/2):

• Our model for the US points to April 15 as the peak day for hospital use. At this peak time, the US is predicted to need 262,092 total hospital beds (39,727 for ICU), and 31,782 ventilators to support COVD-19 patients. This demand on hospital resources could lead to a nationwide shortage of 87,674 total hospital beds and 19,863 ICU beds given current COVID-19 trajectories.
• Today’s estimates show that nationwide, COVID-19 deaths are predicted to peak on April 16, when we predict 2,644 deaths (range of 1,216 to 4,136) in a single day. This projection is very similar to our estimates from yesterday’s release (2,607 deaths, with a range of 1,294 to 4,140). Learn more at at the IMHE website.
• Based on the latest available data, a total of 93,531 COVID-19 deaths (range of 39,966 to 177,866) are currently predicted through the epidemic’s first wave. These estimates correspond with yesterday’s release, where the projected cumulative deaths due to COVID-19 were 93,765 (range of 41,399 to 177,381).
• All estimates presented here assume the continuation of statewide social distancing measures in places where they are already enacted, and future adoption within the next 7 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.

Key Findings of Updated Model for New York (Changes since 4/1)

• 6 days until peak use of hospital beds, ICU beds and ventilators on April 9 (+0), and 7 days until peak deaths on April 10
• 76,130 hospital beds needed (+906), 13,010 beds available (+0), resulting in a shortfall of 63,120 hospital beds (+906)
• 11,782 ICU beds needed (+161), 718 beds available (+0), resulting in a shortfall of 10,903 ICU beds (+161)
• 9,427 ventilators needed (+130)
• 16,261 deaths (range of 9,718 to 20,881) 

[Note:  During his daily briefing on 4/1/20, NY Governor Cuomo said that NY is looking at 5 models in making their projections, including the IHME model.  In his daily briefing on 4/2/20, Governor Cuomo said that, based on the models, the peak is expected to occur between 7 and 30 days.]

Source: IMHE updates here

2. How accurate is the IMHE Model?

• Below is a comparison of the projections made by the IMHE Model for New York as of April 1, 2020 and the actual numbers on that date (actual numbers provided in Governor Cuomo’s daily briefing).

	IMHE Model	Actual	Variance
Hospital beds	50,962	13,383	+37,359
ICU beds	10,050	3,396	+6,654
Ventilators	8,041	N/A	N/A
Deaths	1,951	2,372	-421

• The IMHE Model (i) overestimated the number of hospital beds required for April 1 by 37,359 (281% overestimation), (ii) overestimated the number of ICU beds by 6,654 (195% overestimation), and (iii) underestimated deaths by 421 (17.8% underestimation).  
• The IMHE Model projections of the hospital beds and ICU beds needed by NY for COVID-19 patients on April 1 are materially more than the actual needs for that day, which calls into question the accuracy or usefulness of this model and whether the projected demands on the healthcare system have been substantially overstated.  

[Note: several news programs raised concerns regarding the accuracy of the IMHE projections during the evening of April 2  Others have questioned the accuracy of other projections, including the projections made in the Imperial College report.]

3. Next Virus ‘Hot Spots’ Seen as Michigan, Connecticut, Indiana, Georgia and Illinois 

• The rate of positive coronavirus tests suggests that the next “hot spots” could include Michigan, Connecticut, Indiana, Georgia and Illinois, said White House virus task-force coordinator Deborah Birx.
• “We do have two states that have 35% positives. And that’s New York and New Jersey. So that confirms very clearly that that’s a very clear and an important hot zone.” Birx told reporters at a White House briefing on Thursday evening. Louisiana’s positive test rate is 26%.
• “Michigan, Connecticut, Indiana, Georgia, Illinois — that should tell you where the next hot sports are coming — are at 15% test positive,” she added. “And then Colorado, D.C., Rhode Island and Massachusetts are at 13%.”

Source: MSN News here

4. Antibody tests key to ending COVID-19 lockdowns 

• It’s the key that opens the door from total lockdown: serologic testing, which will show definitively who has contracted COVID-19 and is in theory safe to return to work.
• “Everyone’s waiting for serologic testing, the whole world,” said France’s Health Minister Olivier Veran.
• He said that the global research community was focusing on ways of perfecting the tests, which measure viral antibodies in a person’s blood that signal immunity.
• Veran said that mass production of the tests could start within weeks.
• “It’s a huge factor, especially when we’re trying to reduce confinement,” he said.
• Serologic testing, which only requires a drop of blood to conduct, focuses instead on finding virus antibodies, the presence of which indicates that an individual has had COVID-19 and is now likely immune.
• Antibody testing is so crucial because of the large proportion of people with COVID-19 infections who may not show symptoms but can still pass the virus on to others.
• Such tests already exist for other illnesses. And once they are perfected for the novel coronavirus the results can be analyzed in labs using existing hardware.
• Once widely available, they could be used to determine who gets to return to work and exit the lockdown currently being experienced by billions around the world.

Source: Yahoo News here

D. Potential New Treatments and Testing

1. Coronavirus Survivors Keep Up the Fight, Donate Blood Plasma to Others

• There are 34 institutions around the country participating in the National Covid-19 Convalescent Plasma Project, which is seeking blood-plasma donations from recovered patients who have a confirmed Covid-positive test and are at least 21 days out from the onset of symptoms.
• Researchers want recovered patients to donate plasma, the colorless fluid in blood containing antibodies produced to attack the virus, because it can be given to people who are seriously ill to help fight the disease.
• “The biggest problem is not the lack of donors,” said Arturo Casadevall, a professor at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, and one of the organizers of the national project. “It is the logistics of figuring out how people who want to participate can actually donate.”
• Mount Sinai said it received more than 1,000 inquiries the first day after the call went out for plasma donations. At the Mayo Clinic, in Rochester, Minn., a dedicated email address for volunteers is curated every day to find not only who qualifies but also whether they live locally and can drive to the clinic.
• Plasma donors undergo a procedure similar to blood donation. The blood is filtered in a machine that extracts the plasma; red and white blood cells are returned to the donor. Scientists said preliminary estimates indicate a plasma donation from one person can likely treat two people. Eventually, scientists anticipate there could be a synthetic version of the antibody that specifically targets SARS-CoV-2, the virus that causes Covid-19.
• Houston Methodist Hospital has transfused two Covid-19 patients with convalescent serum in recent days, according to James Musser, chairman of the department of pathology and genomic medicine there. Scientists believe the antibodies neutralize the virus. They are also still studying how much of the antibodies is sufficient and how long any protection might last.
• Prospective donors must be symptom-free, have a documented positive Covid test and take another Covid test to ensure there is no detectable virus. Their blood is tested for the presence of antibodies. The blood is also screened to make sure there are no other viruses, such as HIV or hepatitis. To donate plasma, they also have to meet standard blood-donor requirements, which can include age, health status and recent travel history.
• Ideally, researchers want to identify people with very high levels of antibodies to be donors. They believe the highest levels occur about three to four weeks after symptom onset. “For some infections, antibodies are present for a very long time. For this particular virus, we don’t know how long they are there,” she said.

Source: WSJ here

2. FDA approves first serology test for coronavirus

•  “We’re announcing our first approval of a serology test that will allow labs to determine whether coronavirus antibodies present in a person’s blood,” said FDA Commissioner Dr. Stephen Hahn.
• The serology tests can effectively identify past coronavirus infections, but are less successful at identifying recent ones.
• The authorized test, from manufacturer Cellex Inc., requires blood to be collected through a vein and can only be performed in a certified lab.
• Serology tests can help officials grasp how prevalent the virus is — allowing them to identify people who may have been infected before but showed little to no symptoms.

Source: NY Post here

3. University of Pittsburgh scientists believe they found potential coronavirus vaccine  

• Scientists at the University of Pittsburgh School of Medicine believe that they’ve found a potential vaccine for the new coronavirus.
• The researchers announced their findings Thursday and believe the vaccine could be rolled out quickly enough to “significantly impact the spread of disease,” according to their study published in EBioMedicine.
• The vaccine would be delivered on a small, fingertip-sized patch. When tested on mice, the vaccine produced enough antibodies believed to successfully counteract the virus.
• The scientists say they were able to act fast because they had already done research on the similar coronaviruses SARS and MERS.
• “These two viruses, which are closely related to SARS-CoV-2, teach us that a particular protein, called a spike protein, is important for inducing immunity against the virus,” read a statement from co-senior author Andrea Gambotto, M.D., associate professor of surgery at the Pitt School of Medicine.
• “We knew exactly where to fight this new virus.”
• The vaccine follows the traditional approach of ordinary flu vaccines, using lab-made pieces of viral protein to build immunity.
• While the mice have not been studied over a long period of time, the vaccine was able to deliver enough antibodies against the coronavirus within two weeks, according to the researchers.
• The study’s authors are now applying for an investigational new drug approval from the US Food and Drug Administration. They hope to start human clinical trials within the next few months.
• Researchers said they sided with using a patch, rather than a traditional needle, to deliver the spike protein to the skin, which elicits the strongest immune reaction.
• The patch contains 400 tiny “microneedles” made of sugar and protein pieces. It would be applied like a Band-Aid with the needles dissolving into the skin.
• The vaccine would be “highly scalable” for widespread use, the researchers said in a news release.
• “For most vaccines, you don’t need to address scalability to begin with,” Gambotto said. “But when you try to develop a vaccine quickly against a pandemic that’s the first requirement.”

Source: NY Post here

4. Questions Regarding the Accuracy of Coronavirus Tests Sow Worry

• Last week, a 16-month-old boy in Florida tested positive for the new coronavirus, a lab report shows. A few days later, he tested negative at a second lab. The chief medical officer at the practice where the tests were ordered is betting that the positive result is the right one.
• “A false negative is problematic because it tells the patient they don’t have the virus”. Meanwhile, that patient can unwittingly spread it.
• Health experts say they now believe nearly one in three patients who are infected are nevertheless getting a negative test result. They caution that only limited data is available, and their estimates are based on their own experience in the absence of hard science.
• That picture is troubling, many doctors say, as it casts doubt on the reliability of a wave of new tests developed by manufacturers, lab companies and the CDC. Most of these are operating with minimal regulatory oversight and little time to do robust studies amid a desperate call for wider testing.
• “The whole testing field is in flux,” said Bill Miller, a physician and epidemiologist at the Ohio State University. “The thing that is different this time is most of these tests are going through a really rapid validation process. As a result we can’t be completely confident in how they will perform.”
• All lab tests have some margin of error, measured in terms of sensitivity— the percent of positive cases a test accurately detects—and specificity, the percent of negative cases it accurately detects.
• Dr. Lozano, an executive at Envision Healthcare Corp., estimates that the sensitivity of the tests is in the neighborhood of 70%, meaning nearly one in three positive patients walks away with a reassuring negative result.
• The technology that underpins the new coronavirus tests so far available, a genetic method called polymerase chain reaction, typically detects over 90% of positive cases accurately, said Tom Taylor, a professor and former CDC statistician. In less dire circumstances, he said, the CDC would typically do a study to verify the accuracy of such tests, which might take a year.
• As demand surged in late February, the agency relaxed the requirements, saying labs could start testing without approval and submit their internal studies later. Published details of those studies are often limited.
• A Labcorp spokesman said that while a positive result is a definitive sign of coronavirus infection, “a negative result does not definitively rule out infection.” He said test accuracy can be affected by how a specimen is collected, and how long an individual has been infected before testing.
• In New York City, “a negative is not clearing anybody who is symptomatic,” said Dara Kass, an emergency-room doctor at New York-Presbyterian, a hospital system. Dr. Kass, who is working from home after she tested positive for coronavirus in mid-March, said all patients with symptoms are being treated as coronavirus-positive, because the disease is so widespread in the city.
• A continuing scarcity of testing materials is probably obscuring the true rate of incorrect results, doctors say. Few say they are willing to waste specimen collection kits double-checking a patient who already tested negative.
• They say incorrect results could be caused by differences in how samples are collected and transported, as well as underlying problems with testing platforms.
• Swabs taken from the front of patients’ noses, for instance, tend to have fewer copies of the virus mixed into the mucus than those taken from the nasopharynx, the intersection of the nasal cavity and throat. Swabbing the nasopharynx, however, requires inserting a long Q-tip through a patient’s nostril and deep into the head.

Source: WSJ here

E. New Scientific Findings and Other Advancements

1. Experts Warn Talking, Breathing May Spread Coronavirus

• Health experts from the National Academy of Sciences reportedly sent a letter to the White House on Wednesday that  said limited research shows aerosolized droplets produced by talking or simply breathing may spread the novel coronavirus.
• The letter came in response to a White House inquiry about the potential spread of the novel coronavirus illness (COVID-19) by talking. In late February, the White House and NAS established the panel chaired by Fineberg “to build on Trump administration efforts to confront the new coronavirus threat. One goal is to discourage misinformation and panic,” the Associated Press (AP) reported.
• “While the current [coronavirus] specific research is limited, the results of available studies are consistent with aerosolization of virus from normal breathing,” Dr. Fineberg wrote in the letter to the White House.
• Echoing the recent findings of a U.S. National Institutes of Health (NIH) study, the doctor added:
• This letter responds to your question concerning the possibility that [coronavirus] could be spread by conversation, in addition to sneeze/cough – induced droplets. Currently, available research supports the possibility that [coronavirus] could be spread via bioaerosols generated directly by patient exhalation.
• In the letter, Dr. Fineberg reportedly explained that research at a hospital in China shows the coronavirus can be suspended in the air while health care workers remove protective equipment or when the employees move around and clean the floors.
• The letter pointed out that the research, carried out by the University of Nebraska, revealed that genetic material from the disease was present in rooms more than six feet away from coronavirus patients.
• Aerosolized coronavirus droplets can linger in the air and potentially infect an individual who walks by at a later time, Dr. Fineberg told CNN.
• He noted that several factors dictate how long the coronavirus will remain in the air, including “how much virus an infected individual puts out when breathing or talking, and also … the amount of circulation in the air.”
• “If you generate an aerosol of the virus with no circulation in a room, it’s conceivable that if you walk through later, you could inhale the virus,” Fineberg explained. “But if you’re outside, the breeze will likely disperse it.”
• Social distancing guidelines from the CDC and WHO suggest that people stay at least six feet apart from one another if they are contagious or merely concerned about being exposed to someone carrying the virus, noting that the disease can be spread “through respiratory droplets produced when an infected person coughs or sneezes.”
• The CDC noted that the virus spreads from person to person when a carrier coughs or sneezes. Droplets produced by coughs or sneezes can reportedly land inside the mouths or noses of individuals who are nearby. People can also possibly inhale the virus into the lungs.
• The letter to the White House echoed the findings of an NIH study that said the coronavirus illness (COVID-19) “can remain viable and infectious” in the air for at least three hours.
• CDC officials are reportedly mulling recommending widespread use of masks. Some localities have already issued ordinances demanding that the vast majority of residents wear some type of face-cover when out in public, threatening violators with hundreds of dollars in fines.
• Dr. Fineberg told CNN he would wear start wearing something to cover his mouth when he goes to the grocery store.
• “I’m not going to wear a surgical mask, because clinicians need those,” Fineberg declared. “But I have a nice western-style bandana I might wear. Or I have a balaclava. I have some pretty nice options.”
• On Tuesday, Dr. Anthony Fauci, a vital member of the White House Coronavirus Task Force, told CNN that the federal government is actively discussing advising the widespread use of masks to stem the spread of the virus.

Source: Breitbart here

2. NYC Health Department: Overwhelming Majority of Coronavirus Deaths Involve Underlying Conditions 

• Data released by the New York City Department of Health and Mental Hygiene on Wednesday revealed that the vast majority of coronavirus patients, who were treated at NYC facilities but ultimately died as a result of the virus, had at least one underlying health condition.
• The data, which reflects events and activities as of April 1, 2020 at 9:30 a.m. ET, showed that the majority of coronavirus-related deaths in the city — 1,139 based on the data provided in the release —  involved individuals with underlying illnesses or conditions. Those, according to NYC Health, include lung disease, cancer, diabetes, immunodeficiency, heart disease, hypertension, asthma, kidney disease, and GI/ liver disease.
• The data set divides the groups in three categories — age, sex, and borough. It reflected the broader trend of the coronavirus having a more devastating impact on individuals 75 and over. However, it also revealed that, across every age group, the majority of those who passed away as a result of the virus had some type of underlying health condition.
• Of the 66 individuals between the ages of 18-44 who passed away due to the coronavirus, only two had no record of underlying health conditions. Forty-four had underlying conditions, and another 20 are listed as “Underlying Conditions Pending.”
• Of the 271 persons between the ages of 45 and 64, 189 are listed as definitively having underlying health conditions, with 73 remaining under the pending category. Nine in that group had no known underlying illness.
• The results hold steady for those who fell into the 65-74 age group, with 197 of the 268 who passed away also having at least one underlying condition. Seventy-one are pending.
• The majority of those 75 and older who died as a result of the virus, 358 of 533, were also listed as having an underlying medical condition. Only three had no known underlying issue, and the remaining 172 are pending results.

Source: Breitbart here

3. Why is New Orleans’ coronavirus death rate 7 times New York’s? Obesity is a factor  

• The coronavirus has been a far deadlier threat in New Orleans than the rest of the United States, with a per-capita death rate much higher than in New York City. Doctors, public health officials and available data say the Big Easy’s high levels of obesity and related ailments may be part of the problem.
• “We’re just sicker,” said Rebekah Gee, who until January was the Health Secretary for Louisiana and now heads up Louisiana State University’s healthcare services division. “We already had tremendous healthcare disparities before this pandemic – one can only imagine they are being amplified now.”
• Along with New York and Seattle, New Orleans has emerged as one of the early U.S. hotspots for the coronavirus, making it a national test case for how to control and treat the disease. Chief among the concerns raised by doctors working in the Louisiana city is the death rate, which is seven times that of New York and ten times that of Seattle, based on publicly reported data.
• New Orleans residents suffer from obesity, diabetes and hypertension at rates higher than the national average, conditions that doctors and public health officials say can make patients more vulnerable to COVID-19.
• Some 97% of those killed by COVID-19 in Louisiana had a preexisting condition, according to the state health department. Diabetes was seen in 40% of the deaths, obesity in 25%, chronic kidney disease in 23% and cardiac problems in 21%.
• New Orleans, which so far has reported more than 270 coronavirus deaths, could be a harbinger for the potential toll the pandemic could take in other parts of the South and Midwest that also have high rates of obesity, diabetes, and hypertension.
• A host of other factors could contribute to New Orleans’ high death rate for coronavirus, ranging from access to healthcare and hospital quality, to the prevalence of other conditions including lung disease, health officials say.
• But they also add that it is clear that obesity-related conditions are playing a role in the deaths. That could be a warning sign for the United States at large, where chronic obesity is more common than in other developed countries, they said.
• The New Orleans metropolitan statistical area ranks among the worst in the United States for the percentage of residents with diabetes, high blood pressure, and obesity, a Reuters analysis of CDC data shows. An estimated 39% have high blood pressure, 36% are obese and about 15% have diabetes.
• Nationally, the median is 32% with high blood pressure, 31% obese and 11% with diabetes.
• “The burden of disease in Louisiana and the Deep South is higher than in rest of the country,” said Gee. “Invariably that means that the South is going to be hard hit by this.”

Source: NewsTrust.Org here

4. Chinese researchers find coronavirus patient who was contagious for 49 days  

• Chinese researchers say they have discovered a new “chronic” mutation of the coronavirus in a patient who was contagious for a record-breaking 49 days.
• The patient, a middle-aged man, had non-severe symptoms but had a prolonged ability to infect others, said the Chinese military researchers in Wuhan.
• He had an intermittent low fever and no cough, chills, shortness of breath or other typical symptoms of COVID-19.
• CAT imaging showed lesions in both of his lungs, but they disappeared a few days after he was admitted to the hospital, and his body temperature also returned to normal.
• But he kept testing positive for the illness, showing a high viral load similar to patients experiencing severe cases.
• As signs showed that his body couldn’t eliminate the virus through normal therapy and that he could still be infectious, the patient was treated with a plasma transfusion from cured COVID-19 patients. Two days later, his test came back negative.
• The rare case was the longest known duration of “viral shedding” in a patient. The previous record was 37 days.
• Researchers warned there could be other “chronically infected patients,” who were more likely to be neglected but could spread the infection in their surroundings and cause a new outbreak.
• The findings were published on March 27 on MedRxiv, a website for preliminary reports of scientific medical papers that have not yet been peer-reviewed and should not to be taken as a guide for clinical practice.

Source: NY Post here

F. Stories from the Frontline

1. Largest Statistically Significant Study by 6,200 Multi-Country Physicians on COVID-19 Uncovers Treatment Patterns and Puts Pandemic in Context

• Sermo, the largest healthcare data collection company and global social platform for physicians, leveraged its capabilities to publish results of a COVID-19 study with more than 6,200 physicians in 30 countries. The study was completed in three days. Data covers current treatment and prophylaxis options, timing to the outbreak peak, effectiveness of government responses, and much more.

Treatments & Efficacy

• The three most commonly prescribed treatments amongst physicians treating COVID-19 are:
  • 56% analgesics, 
  • 41% Azithromycin, and 
  • 33% Hydroxychloroquine

Effectiveness of Hydroxychloroquine

• Hydroxychloroquine usage by physicians treating COVID-19 is 72% in Spain, 49% in Italy, 41% in Brazil, 39% in Mexico, 28% in France, 23% in the U.S., 17% in Germany, 16% in Canada, 13% in the UK and 7% in Japan
• Hydroxychloroquine was chosen by the following percentage of physicians treating COVID-19 as the most effective therapy: 75% in Spain, 53% Italy, 44% in China, 43% in Brazil, 29% in France, 23% in the U.S. and 13% in the U.K (37% of all physicians treating COVID-19 choose hydroxychloroquine as the most effective therapy).
• The two most common treatment regimens for Hydroxychloroquine were:
  • (38%) 400mg twice daily on day one; 400 mg daily for five days
  • (26%) 400mg twice daily on day one; 200mg twice daily for four days
• Outside the U.S., Hydroxychloroquine was equally used for diagnosed patients with mild to severe symptoms whereas in the U.S. it was most commonly used for high risk diagnosed patients
• Globally, 19% of physicians prescribed or have seen hydroxychloroquine prophylactically used for high risk patients, and 8% for low risk patients

Second Wave of Outbreak

• The second global outbreak is anticipated by 83% of global physicians and 90% of U.S. physicians, but only 50% of Chinese physicians

Average Testing Time

• On average tests in the U.S. take 4-5 days, and in 10% of cases the wait is more than 7 days
• 14% of U.S. physicians and over 50% in all of Europe and Japan report getting test results in 24 hours; in China 73% of doctors get tests back in 24 hours, while 8% get tests back within the hour
• Prioritizing Treatment if Ventilator Shortage
• In all countries except China, the top criteria for deciding who should receive a ventilator first was patients with the highest chance of recovery (47%) followed by those most ill and at highest risk of death (21%), then first responders (15%)
• In China the priorities were reversed as the most ill and highest risk of death received ventilators
• First responders were more important in the U.S.
• France, Japan, and Italy prioritized age
• Brazil and Russia prioritized higher risk patients

Peak Timing & Restrictions

• In the U.S., 63% of physicians recommend restrictions be lifted six or more weeks from now and 66% believe the peak is at least 3-4 weeks away

Government Effectiveness

• The large majority of physicians globally believe government actions are very to somewhat effective
• A majority of physicians believe state and government are weighing public and economic concerns appropriately

Top Three Equipment Needs

• Top three needs globally are Personal Protective Equipment (PPE), followed by rapid COVID-19 testing kits, then ventilators

Top Three Information Needs

• Physicians are most in need of knowing when rapid tests will become available, when new treatments will become available, and the efficacy of existing medications to treat coronavirus

COVID-19 Concerns

• A majority of physicians are very concerned about spreading it to family members and ~50% are concerned about catching COVID-19 in the next two months
• 81% of physicians have taken special precautions at home, including changing their clothes and showering before joining family; some even stay in isolation
• Close to a quarter of physicians and over a third of patients report extreme stress

Source: Sermo press release here