Coronavirus Update 4-4

Today’s Features

• Recent Developments and Headlines
• Numbers and Trends
• Projections and Our (Possible) Future
• New Scientific Findings
• Stories From the Frontline
• Innovation
• 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 4/03 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 205 countries and territories (+1)
• Worldwide Confirmed Cases = 1,118,202 (+9.7%)
• Worldwide Active Cases = 829,825 Active Cases (+10.4%)
• US Active Cases = 257,836 (+12.6%)
• NY Active Cases = 91,372 (+10%)
• US deaths = 7,403 (+1,308) (+21.5%)
• NY deaths = 3,218 (+680) (26.8%)
• US coronavirus death projections in doubt as officials question China’s numbers
• “Never Built To Fight A 50-State Pandemic”: DHS Medical Emergency Stockpile Nearly Depleted
• Half of coronavirus patients in Iceland are symptom-free, study shows
• President Trump bans US companies from exporting needed medical supplies
• The CDC recommends Americans wear a face covering when out in public
• Too much to mask? Cuomo questions NYC directive to wear masks outside
• Nearly 9 out of 10 Americans fear getting coronavirus, poll finds
• Google Releases Location Data To Help Authorities Check Lock-downs
• FEMA, racing to provide virus relief, is running short on front-line staff
• Government will pay for uninsured Americans’ coronavirus treatment
• Feds distribute 200,000 N95 masks seized from coronavirus hoarder
• People meeting Trump or Pence must now take rapid coronavirus test
• Death toll in New York soars to nearly 3,000 as state pleads for aid
• NY Governor Cuomo Deploys National Guard to Redistribute Ventilators in NY
• “Emergency Alert: Extreme” text sent to all New Yorkers as NY seeks 45,000 healthcare workers 
• De Blasio: NYC’s Ventilators Will Run Out by ‘Monday or Tuesday’ 
• After outcry from New York, the Pentagon is considering letting two Navy hospital ships take coronavirus patients
• NYC morgues almost full, city allows cremations 24 Hours a Day
• Google data shows New Yorkers doing less social distancing than people in Italy and Spain
• Fauci: “I don’t understand why all don’t have stay at home orders.”
• As virus takes hold, resistance to stay-at-home orders remains widespread — exposing political and social rifts
• Coronavirus spreads in Los Angeles’ homeless community
• Peru enforcing lockdown by gender to curb coronavirus spread 
• CA Gov. Newsom Praises Trump as ‘Proactive’
• Pennsylvania Urges Residents to Wear Masks Outside 
• Delaware Police Authorized To Pull Over Out-Of-State Drivers 
• Volunteers spray Wuhan with disinfectant to help city get back to work
• The dead are being buried, quietly, in China, amid questions over its death toll
• German and French officials accuse Americans of intercepting masks
• Russia reports drop in cases after extending quarantine
• A Russian doctor is detained after challenging the country’s official count of coronavirus cases
• Britain has its deadliest day as the government races for an “immunity passport.”
• Mexico Surpasses 1500 Coronavirus Cases, 50 Fatalities 
• Japan sees resurgence of cases continue
• Singapore launches strict 14-day lockdown to fight virus resurgence
• As Italy enters its 4^th week under lockdown, tensions are building across southern regions as people run out of food and money
• Bodies left in streets as COVID-19 overwhelms Ecuador
• President Duterte says he’ll ‘bury’ coronavirus lockdown protesters in Philippines
• After ignoring warnings, Israeli ultra-Orthodox hit by virus
• Israel seals off ultra-Orthodox town hit by coronavirus
• Sweden’s liberal pandemic strategy questioned as Stockholm death toll mounts
• Sweden introduces new restrictions as cases balloon
• Tunisia ‘robocop’ enforces coronavirus lockdown
• Spain, Germany report encouraging deceleration in new cases
• Italy’s Total Death Toll Exceeds 14,000, but ‘Hospitals are Starting to Breathe’
• Bolsonaro urges country to “go back to work” as Brazil’s governors say opposite
• Brazil’s Bolsonaro turns to prayer in coronavirus crisis
• Mistrustful of state, Brazil slum hires own doctors to fight coronavirus
• Federal Prison System Goes Into Lockdown Mode To Prevent Virus Outbreak  
• Studies Suggest Coronavirus Lockdown Increases Risks of Drug Abuse and Suicide
• Pharmacists See Spike in Threats and Violence During Coronavirus Pandemic
• Why You Should Flush With The Lid Down: Experts Warn Of Fecal-Oral Transmission Of COVID-19
• Coronavirus at beaches? Surfers, swimmers should stay away, scientist says
• Cats can infect each other with coronavirus, study finds
• Coronavirus Strikes 66 of 84 Residents of San Antonio Nursing Home
• Fake drive-thru coronavirus testing sites investigated in Kentucky
• Detroit bus driver, who ranted about a coughing passenger, dies from coronavirus 
• Florida couple, married 51 years, die of coronavirus six minutes apart
• FDNY Deputy Chief Inspector dies of coronavirus
• Andrew Cuomo says state will help coronavirus-stricken NYPD
• WHO experts ‘worried’ about mental health, give tips to stay sane in lockdown
• Scared UPS workers desperately hunt for safety supplies amid coronavirus
• Spanish Actress Marin Returns to Nursing to Treat Coronavirus Patients
• Tampa declares churches ‘essential services’ after pastor’s arrest
• The Supreme Court has postponed the last two weeks of arguments of its term
• Cats can infect each other with coronavirus, study finds
• Another cougar visits Chilean capital amid coronavirus lockdown
• Christopher Cross calls coronavirus ‘worst illness I’ve ever had’
• FedEx delivers 91 percent cut to CEO’s pay
• Coronavirus could worsen US childhood obesity crisis
• Pets are gaining ‘quarantine 15’ weight too, vets say
• San Francisco Bans Reusable Bags To Counter Virus-Contagion Threat
• Canceled SXSW Film Festival will stream on Amazon Prime for free
• Born during lockdown, twins named ‘Corona’ and ‘Covid’
• NYC “Doesn’t Have Any Dogs Left To Foster” 
• Malibu paddle boarder arrested for violating stay-at-home order
• Coronavirus is making couples sick — of each other: divorces surge

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:  1,118,202 Total Cases (+9.7%)
  • New Cases = 98,631 (+16,068) (+19.5%)
• Europe: 572,167 Total Cases (+9.7%)
  • New Cases = 50,688 (+13,857) (+37.6%)
• United States: 277,621 Total Cases  (+13.1%)
  • US New Cases = 32,248 (+2,219) (+7.4%)
• US States:
  • 29 States > 1,000 cases (+1)
  • 18 States > 2,500 cases (+1)
  • 12 States > 5,000 cases
• 7 States > 10,000 cases:  NY, NJ, MI, CA, MA, LA & FL
• Top 5 States: (i) NY: 103,476 (+10,423); (ii) New Jersey: 29,895 (+4,305); (iii) Michigan: 12,744 (+1,953); (iv) California: 12,581 11,207 (+1,374); and (v) Massachusetts: 10,402 (new)
• For more information on US States, see https://ncov2019.live/data
• New York State:
  • NY Total Cases = 103,476 (+11.2%)
  • NY New Cases = 10,423 (+1,271) (+13.9%)
• New York City: 
  • Total Cases = 57,160 (+10.3%)
  • NYC New Cases = 5,351 (+981) (22.8%)

2. Confirmed Active Cases

• Worldwide: 829,825 Active Cases (+10.4%)
  • New Active Cases = 77,997 (+21,247) (+37.4%)
  • Top 5 Countries: (i) US: 257,836 (+28,961); (ii) Italy: 85,388 (+2,339); (iii) Spain: 77,488 (+2,514); (iv) Germany: 65,309 (+4,042), & (v) France: 61,650 (+20,360)
• US Active Cases = 257,836 (+12.6%)
• US New Active Cases = 28,961 (+1,440) (5.2%) 
• NY Active Cases = 91,372 (+10%)
• NY New Active Cases = +8,291 (+750) (+10%)

3. Serious or Critical Cases

• Worldwide serious or critical cases = 39,404 (+1,716)
• US series or critical cases = 5,787 in US (+360)
• US serious or critical cases = 2.2% of Active Cases in US (-0.2%), 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 = 59,220 (+5,895) (+11%)
  • Top 5 Countries: (i) Italy: 14,681 (+766); (ii) Spain: 11,198 (+850); (iii) US: 7,403 (+1,308); (iv) France: 6,507 (+1,355); & (v) UK: 3,605 (new) 
  • Deaths per 1M population: (i) Italy: 243; (ii) Spain: 240; (iii) US: 22; (iv) France: 100; & (v) UK: 53
  • Worldwide Closed Case Fatality Rate = 21% (+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 = 7,403 (+1,308) (+21.5%)
• NY deaths = 3,218 (+680) (26.8%)
• NYC deaths = 1,562 

5. Recoveries

• Worldwide recoveries = 229,157 
• US recoveries = 12,283
• NY recoveries = 8,886

C. Projections and Our (Possible) Future

1. IHME (Murray) Model

• Next Update of the IMHE Model will be made public on April 4.  You can see current projections at the IMHE website here.

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 coronavirus epidemic.  The Gates Foundation is funding the development of the IHME Model. The IHME Mode can be found here.

2. Actual Hospitalizations for COVID-19 Significantly Lower than Projected by the IHME Model

• The Institute of Health Metrics and Evaluation (IHME) model cited by White House Coronavirus Task Force officials appears to dramatically overstate the hospitalization of patients with coronavirus in the United States when the model’s projections are compared to actual data.
• Breitbart News compared projections of the number of regular hospital beds needed to treat coronavirus patients made in the Friday, April 3 iteration of the IHME model for nine states to the actual number of cumulative hospitalizations (a number that includes current regular bed hospitalizations, current ICU hospitalizations, previously hospitalized and released patients, and previously hospitalized and deceased patients) reported by the respective health departments in those states as of Thursday, April 2.
• The results showed that the actual number of cumulative hospitalizations as a percentage of regular hospital beds projected by the IHME model ranged from nine percent in Tennessee to 47 percent in Florida.
• Even in New York State, the epicenter of the coronavirus pandemic, the actual number of cumulative hospitalizations as a percentage of regular hospital beds needed projected by the IHME model was only 37 percent.
• These numbers, however, actually understate the degree to which the IHME model overestimates the number of hospital beds currently needed for coronavirus patients because the numerator–cumulative hospitalizations–includes data well in addition to the actual number of current regular hospital beds in use for coronavirus patients, since it also includes current ICU hospital beds in use for coronavirus patients as well as previously hospitalized coronavirus patients either released or deceased.
• Data on cumulative hospitalizations in currently reported by most states, while some provide more detailed information.
• Here is a breakdown of the actual number of cumulative hospitalizations reported by these nine states as of April 2, as compared to the number of regular hospital beds projected for coronavirus patients in those states on April 2 by the IHME model:

State	Actual	IHME Projection	Actual/Projection
Colorado	710	3,141	23%
Ohio	802	2,436	33%
Tennessee	263	2,741	9%
Texas	196	1,968	10%
New York	20,817	56,183	37%
Florida	1,215	2,612	47%
Georgia	1,158	3,098	37%
Iowa	138	384	36%
Minnesota	156	823	19%

• Notably, the IHME model’s current projections of COVID-19 deaths as of April 2 is in line with the actual number of reported deaths on that date.
• Breitbart News provided this data to the media spokesperson for the Institute for Health Metrics and Evaluation on Friday and asked if they could explained why the IHME model’s projections of regular hospital beds needed is so badly off the mark from actual beds required for COVID-19 patients up to April 2 but has not yet received a response.

[Note:  Clearly, the projected needs for hospital beds is substantially overstated in the IHME model (as discussed in the 4/3 update, the same is true for the ICU beds).  In light of the fact the IHME model was initially released on March 26, the margin of error is striking. A number of news programs and stories have started questioning the accuracy of the IHME model regarding the number of hospital beds, ICU beds and ventilators that will be required for COVID-19 patients.  Nevertheless, because the IHME Model is being used by the White House Coronavirus Task Force and the State of New York, we will continue to report on the model as well as its accuracy.]

3. Coronavirus crisis raises specter of civil unrest

• The United States has yet to see civil unrest, but looting and rioting are possible as the pandemic sets in for the long haul, according to crime, economic, and behavioral experts. [Note: Classified as PanCon Level 5 in the Pandemic Condition risk assessment system discussed in prior updates].
• “What will likely prompt looting, rioting, civil unrest will be if public services are overloaded,” Andrew Bringuel II, a retired supervisory special agent at the FBI’s Behavioral Analysis Unit and executive director of the Behavioral Science Unit, wrote in an email. “If people lose their public trust in the confidence that the police can maintain social order, they will begin to defend themselves against those who don’t recognize the rule of law. Thomas Hobb[e]s described this as a breakdown of the social contract, and it’s really an imbalance in social equilibrium.”
• If people who were laid off in March go without paychecks for another month or two, they may be unable to support themselves, explained the World Bank’s former lead research economist, Branko Milanovic. People without money still need food and medical supplies.
• Bringuel said crime rates in general have declined recently as the majority of the country’s population is under stay-at-home orders, but property crime has not gone down. He proposed medical supplies may be more immediately desired than food because there is no food shortage as of April 1, but even basic medical supplies such as masks are unavailable to the extent needed nationwide.
• In New York City on Tuesday, 5,600 officers were not working because they were sick, which is almost 15% of the force. But absences in large forces is different than a small sheriff’s department that may have a total of 12 employees and have four out sick. Bigger departments will rely on pacts with others to supplement absences, Johnson said.

Source: Washington Examiner here.

D. New Scientific Findings and Other Advancements

1. Coronavirus Not Spread by Touching Objects

• A leading scientist has cast doubts on how the coronavirus is spreading across the globe as a team of experts prepare to head out to a village that has been dubbed ‘Germany’s Wuhan’, where they hope to unlock vital information about the bug.
• Prof Hendrik Streeck, director of the Institute of Virology at the University Hospital in Bonnhas, said Covid-19 might not be spread as easily as people first believed.
• Research conducted by Prof Streeck in one of Germany’s worst-hit regions showed that the home of one infected family did not have ‘any live virus on any surface’, adding even more questions as to how the virus is spread from person to person.
• Prof Streeck said the virus had not even been found on door knobs or animal fur. He told German TV that there had been ‘no proven infections while shopping or at the hairdressers’. ‘The virus spreads in other places: the party in Ischgl, the club in Berlin, the football game in Bergamo. ‘We know it’s not a smear infection that is transmitted by touching objects, but that close dancing and exuberant celebrations have led to infections.’ He said Germany’s patient zero had only infected her colleagues and not other guests or diners at the hotel she had been staying at.
• According to The Times a team of 40 research will now spend time in the Heinsberg in order to work out how the virus spreads and how people can become infected without knowing. It could also shed light on how the disease could be slowed and its results could be instrumental in stopping the spread of the disease worldwide.
• The research trip led by Prof Streeck will see 1,000 people in the area tested for the virus. This will be instrumental and if it emerges that more people are carrying the disease without showing any symptoms, then governments have a huge task on their hands when it comes to preventing the spread.

Source: DailyMail here.

2. Digestive Symptoms Tied to Worse COVID-19 Outcomes

• In a study in China of 240 COVID-19 patients, approximately 30% of the patients had gastrointestinal symptoms (abdominal pain, nausea, and vomiting).  
• The study found that found that the average time from symptom onset to hospital admission was 9.0 days for patients with GI symptoms compared with 7.3 days for those who did not have digestive symptoms.
• Digestive symptoms appeared to be tied to worse outcomes. Whereas 60% of patients without digestive symptoms recovered and were discharged, only 34.3% of the patients with digestive symptoms recovered.
• An explanation for the longer time between symptom onset and COVID-19 diagnosis might be that patients with only GI symptoms or mild respiratory complaints did not think that they could have the coronavirus.
• “When the patients were admitted to the hospital, no one yet knew they had COVID-19. Almost half, when asked why they were there, mentioned a digestive problem. They may have also had a respiratory symptom, like a cough or shortness of breath, but that’s not what they said was their main complaint. 
• The researchers concluded that clinicians should recognize that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms rather than waiting for respiratory symptoms to emerge.
• The researchers point out that the CDC has yet to include GI symptoms in their guidance, although recommendations are changing rapidly.
• The researchers urge caution in evaluating patients with only GI symptoms. “A large part of the population has diarrhea, abdominal pain, nausea, and vomiting regularly, so it’s clearly impossible and irresponsible to start testing everyone with diarrhea for COVID-19. But if somebody has new fever and diarrhea and suspects they may have had contact with a patient or carrier, I’d want to test them.”
• Limitations of the study include a relatively small sample, the retrospective design, and not testing for SARS-CoV-2 RNA in stool.

Source: WebMD here.

E. Stories from the Frontline

1. Google’s COVID-19 reports show where people are obeying stay-at-home orders

• Google has unveiled the COVID-19 Community Mobility Reports in an effort to help public health officials understand how people are moving about in response to the coronavirus pandemic. The reports show location data from folks who have agreed to share their location history with Google in order to show places that are following instructions to shelter in place — or not.
• “As global communities respond to the COVID-19 pandemic, there has been an increasing emphasis on public health strategies, like social distancing measures, to slow the rate of transmission,” wrote Google Geo SVP Jen Fitzpatrick. “In Google Maps, we use aggregated, anonymized data showing how busy certain types of places are—helping identify when a local business tends to be the most crowded. We have heard from public health officials that this same type of aggregated, anonymized data could be helpful as they make critical decisions to combat COVID-19.”
• The reports are available to all users in 131 countries, and in some regions, you can search for regional state and county data. Once a region is selected, Google will generate the report in a PDF form that’s easy to share with workers in the field, the company said. A link to Google Mobility Reports can be found here.
• The reports cover six categories, including retail and recreation (restaurants, museums, shopping centers, etc.), grocery and pharmacy, parks (including beaches, marinas, etc.), transit stations, workplaces and residences.
• On top of the reports, Google said its also collaborating with epidemiologists to created an updated dataset of anonymized aggregated data, “to better understand and forecast the pandemic,” the company said.

Source: Engadget here.

2. The dark side of ventilators: Those hooked up for long periods face difficult recoveries

• People who survive the most dire cases of disease caused by the novel coronavirus are about to learn one of the cruelest lessons of the pandemic: After defeating the virus, the really hard part begins.
• Those saved through extreme medical interventions, including being attached to mechanical ventilators for a week or two, often suffer long-term physical, mental and emotional issues, according to a staggering body of medical and scientific studies. Even a year after leaving the intensive care unit, many people experience post-traumatic stress disorder, Alzheimer’s-like cognitive deficits, depression, lost jobs and problems with daily activities such as bathing and eating.
• “I think what we’re going to see is a wave, about six weeks after the initial illness,” said Samuel Brown, director of the Center for Humanizing Critical Care at Intermountain Healthcare in Utah. “One to three weeks to get off the ventilator, and a couple of weeks to get their sea legs back to get home — and then to finally realize: What happened? What did I just survive? And how desperately frightening that experience was for a wave of survivors who are going to have really difficult psychological symptoms.”
• By the end of the pandemic, hundreds of thousands of Americans who have survived severe cases of covid-19 are likely to seed the next health-care crisis as many struggle with the physical and psychological effects of long hospital stays, say epidemiologists.
• Patients with covid-19 typically stay on ventilators for prolonged periods which increases the likelihood of long-term complications. The risk of infection means they are cut off from human contact, which also increases the risk of psychological issues: Health-care workers can’t easily interact with patients in the ways they usually would, and their families can’t visit.

ICU Survivors

• A common complication of prolonged stays in intensive care units is something called “ICU delirium,” in which patients become severely confused and may have nightmarish hallucinations — which could be worse if people never see their caregivers’ faces and don’t have family there to help them understand what really happened.
• “When you typically get out of the ICU at the hospital, you get all this support like physical therapy and speech therapy but when you are a covid-19 patient, you get none of that,” he said.

Psychological risks

• Even when people survive the illness, they will likely reenter a world where much of their support network simply can’t give them a hug due to social distancing guidelines — and where fear of contagion could create stigma, too.
• “I think that’s a dynamic you can’t overemphasize — that it is always bad to be in the ICU, but it’s probably doubly bad to be in the ICU during a pandemic, because of the anxiety that is just fomenting,” said James Jackson, a psychologist at Vanderbilt University. “It’s in the air, if you will. And that all adds to the psychological burden.”
• Centers to support ICU survivors are not at every hospital, and delivering additional care for a person’s physical, cognitive and mental health during a pandemic will be harder. Recovery may also be affected by the absence of family members in the hospital, as people trying to support their loved one may have little idea what they experienced.

Source: Washington Post here.

3. Hospitals report some critical medicines are beginning to run low  

• Across the country, as hospitals confront a harrowing surge in coronavirus cases, they are also beginning to report shortages of critical medications — especially those desperately needed to ease the disease’s assault on patients’ respiratory systems.
• The most commonly reported shortages include drugs that are used to keep patients’ airways open, antibiotics, antivirals and sedatives. They are all part of a standard cocktail of medications that help patients on mechanical ventilators, control secondary lung infections, reduce fevers, manage pain and resuscitate those who go into cardiac arrest.
• Demand for these drugs significantly increased in March as the pandemic took hold. Orders for antibiotics like azithromycin and antiviral medicines like ribavirin nearly tripled. Requests for medicines used for sedation and pain management, including fentanyl, midazolam and propofol, increased by 100 percent, 70 percent and 60 percent respectively.
• Demand for albuterol, a common asthma inhaler medication, also has risen significantly, given its importance in easing the breathing of patients with severe infection.
• “Just like we’re seeing shortages of other materials, like masks and ventilators, medications are right there in the mix of things that we don’t always have enough of on hand,” said Erin Fox, a drug shortage expert at the University of Utah. “So we were not prepared for this kind of surge.”

Source: NY Times here.

F. Innovation

1. With Medical Equipment in Short Supply, 3-D Printing Steps Up

• Health providers are turning to 3-D printers as a stopgap measure to fabricate the equipment they need, from nasal swabs to face masks, in the fight against Covid-19.
• Hospital system Northwell Health is producing nasal swabs in New York, the epicenter of the disease in the U.S. With more cases than any other state, New York has seen the effect of global supply-chain disruptions.
• The nasal swabs that were being sent to health-care providers in the U.S. as recently as a few weeks ago were being manufactured in Italy and China, countries whose supply chains have been disrupted because they are centers of the coronavirus outbreak.
• Doctors from Northwell Health and the University of South Florida recently worked together to test, design and manufacture nasal swabs using 3-D printers from Somerville, Mass.-based Formlabs Inc. The idea came from the health-care providers.
• Northwell Health has the capacity to print as many as 3,000 nasal swabs daily for its hospitals and outpatient facilities. The swabs go through the nose to the back of the throat to collect a viral sample from a person’s nasopharynx that is then sent to a lab for testing.
• The 3-D printing technique “gives us hope that we can tackle this thing head-on, because without testing, we’re not going to be able to quarantine people.” 
• 3-D printers are having a moment during the coronavirus pandemic. Suppliers of basic medical supplies, many located in areas crippled by the pandemic, can’t keep up with rising U.S. demand. And as the mobilization in the U.S. of homegrown production still gears up, health officials and 3-D printing companies are sharing digital files which can be “printed” into potentially lifesaving equipment in a fraction of the time.
• “Rather than waiting weeks to get your supply, you may pay more per unit, but you’re getting parts the same week versus waiting. I think that’s very important to consider.” 
• Recognizing the need for lifesaving components, the FDA last week issued updated guidance for health-care providers around 3-D printing specific medical devices and personal protective equipment. The guidance lists recommendations and precautions hospitals should take when 3-D printing and testing equipment.
• St. Luke’s University Health Network is getting 250 face masks a week from Filament Innovations, a 3-D printing company in Bethlehem, Pa.
• The design for the masks, which can be sterilized and reused, was taken from Thingiverse, a website where people can share digital designs. Filament modified the design to meet St. Luke’s specifications and moved the wraparound band for a better airtight fit. The mask uses a HEPA filter, which is also used in air purifiers.
• The 3-D printing community, from students to 3-D printing companies, has overwhelmingly reached out to offer help in printing equipment.
• One of the advantages of 3-D printing is that many products can be manufactured at a high rate using a single digital design, and the design and quantity can be adjusted as needed.
• The company, which typically prints products such as dental retainers, jewelry and movie props, among other products, can print as many as 100,000 nasal swabs daily from a facility in Ohio to help medical professionals across the country speed up testing for Covid-19.
• Dr. Decker of University of South Florida said she began researching whether 3-D printing could help address the nationwide shortage of testing swabs in early March. 
• In Tampa, a team of radiologists, infectious disease experts and ear, nose and throat physicians finalized the design for the nasal swabs, printed samples and confirmed that they were safe to use in about a week. It could typically take as long as a year to get a new medical product to that stage.
• Tampa General Hospital and New York’s Northwell Health have been performing clinical trials on a small number of patients to measure the performance of the swabs printed by Formlabs.
• “We’ve been able to make some tweaks to the design on the fly.”

Source: WSJ here.

2. D-Wave Opens Quantum-Computing Resources to Research 

• Canadian firm D-Wave is among several technology companies providing free advanced computing resources to researchers working to combat the global pandemic. IBM, for example, in March started offering free remote access to two of the world’s most powerful supercomputers.
• Researchers trying to combat the respiratory illness known as Covid-19 could use quantum-computing system to possibly speed up certain calculations related to drug discovery and hospital logistics. The company’s hybrid machine uses graphics-processing units, commonly found in laptops and cell phones, as well as quantum processors.
• Computations that run on currently available quantum computers don’t exhibit a game-changing speedup for solving practical problems.  Still, researchers are trying to test the technology’s power.
• By harnessing the properties of quantum physics, quantum computers have the potential to sort through a vast number of possibilities nearly instantaneously and come up with a probable solution. While traditional computers store information as either zeros or ones, quantum computers use quantum bits, or qubits, which represent and store information as both zeros and ones simultaneously.
• “What we’re working on right now is on the issue of handoff by allocating patients to medical facilities as close as possible according to the patient’s symptoms, so as not to exceed the capacity of the medical facilities,” Sigma-i Chief Executive Masayuki Ohzeki said in an email.
• This is a mathematical problem that can be done on a quantum-computing system that takes into account the distance from the origin of the patients to the medical facilities as well as the patient’s symptoms and the capacity of each medical facility.
• A quantum computer could also be used to help quickly validate a vaccine for the virus. Such machines, though, are still in their very early stages.
• In the fight against the Covid-19 pandemic, the potential of quantum computing can open up new opportunities.  

Source: WSJ here.

G. Practical Tips and Useful Information

1. What to Put in a Covid-19 Emergency Home-Care Kit

• Most Covid-19 cases don’t require hospitalization, and as intensive-care beds fill, all but the most critical cases are being sent home. So, people should be prepared to care for themselves or their loved ones under their own roof—and that means having the right supplies to nurse the ill patient and keep the rest of the family healthy.

Safety and cleaning

• Isolation and cleaning supplies: bleach; face masks that cover nose and mouth (surgical masks, home-improvement masks or scarfs); gloves for entering sick room and doing laundry (latex or nitrile rubber); hand sanitizer; laundry detergent (wash everything on hot); nail brush; paper towels; soap; tissues.
• The first task is to isolate patients with their own stash of tissues, disinfecting wipes, paper towels, soap and warm water.
• “At the top of my wish list would be an extra bedroom with an attached bathroom. That’s the ideal scenario,” says David Buchholz, senior medical director at Columbia University Irving Medical Center. Most people don’t have that luxury, but it is worth disrupting the rest of the household to try. “If you have a one-bedroom apartment, the sick person gets the bedroom. That’s key. They can’t leave, and nobody can enter. Not even pets,” Dr. Buchholz says.
• Another key piece of equipment: masks. Patients should wear a face mask anytime they leave their room, and these excursions should be limited—in other words, bathroom trips only. Anyone entering the room should also wear a mask, and the sick person should likewise mask up for all visitors, regardless of age.
• You’ll also need gloves—rubber or latex—when you enter the sickroom or when you clean. Stock up on cleaning supplies, because everything the sick person touches—like cutlery, doorknobs or the bathroom sink—must be cleaned. You can make a DIY bleach preparation by diluting five tablespoons of bleach per gallon of water. Regular hand soap is crucial, too.

Medicine

• Medical supplies: cough drops; over-the-counter cold medicines; pulse oximeter and batteries (there is a pulse-oximeter app available for the iPhone, but none of the doctors we spoke to recommended it); saline nasal spray; thermometer; Tylenol/acetaminophen (children’s or infant’s versions if applicable).
• Anyone who falls ill should keep in contact with their doctor and let them know if symptoms worsen. To that end, a thermometer is helpful. Since Covid-19 can affect breathing, several doctors also recommended obtaining an at-home pulse oximeter: a device that clips onto the finger and measures heart rate and blood oxygen levels, which are important indicators of how well the lungs are functioning, says Andra Blomkalns, chair of emergency medicine at Stanford School of Medicine.
• “For the vast majority of kids, you can just stick to the items you would normally use for influenza or other respiratory ailments,” says Danielle Zerr, chief of pediatric infectious diseases at Seattle Children’s Hospital. It is difficult to get children to wear a face mask, so the caregiver must wear one at all times when interacting with the sick child, she says. The child’s Covid-19 symptoms may be mild, but “it’s the same virus, and it’ll be much worse in an adult,” she says.
• For a dry cough, throat lozenges can be helpful, as long as the child is old enough not to choke on them. For younger children, “if they have throat pain, a little bit of warm tea with honey is a nice way to go,” Dr. Zerr says.

Food and drink

• Nutrition supplies: chicken soup; daily multivitamin and vitamin C tablets; electrolyte-replacement drinks (if using sports drinks, cut in half with water); fresh ginger, lemons, dill, fresh or dried oregano; high-calorie, nutrient-rich foods like avocados; honey for throat soothing; pectin-rich foods like bananas and apples.
• As with any flulike virus, it is important that the patient drink plenty of fluids. Occasionally, Covid-19 can cause gastrointestinal distress and diarrhea, and replenishing fluids in those cases is especially important, as dehydration can worsen a fever, Dr. Blomkalns says. Electrolyte-replacement drinks are recommended, but popular sports drinks like Gatorade tend to have high amounts of sugar, so they should be cut in half with water for both children and adults, she says.
• A couple of doctors recommended a daily multivitamin and vitamin C tablets. “And never underestimate the power of chicken soup,” says Mark Hyman, head of innovation at the Cleveland Clinic Center for Functional Medicine. “Protein is very important when fighting viral illnesses.”

Source: WSJ here.

2. How to make DIY no-sew face masks with fabric and hair elastics

• Now that experts suggest that wearing a mask or face covering is helpful against the coronavirus, folks are scrambling to make their own rather than tap into the supply of surgical face masks needed by essential workers.
• This easy face-mask tutorial from DIY blog Japanese Creations has gone viral, and to make one, you don’t need to know how to sew or be even remotely crafty at all!
• The site’s quickie how-to video has more than half a million views on YouTube. Noted entrepreneur Colin Hanks — whose parents, Tom Hanks and Rita Wilson, were among the first A-listers to contract the coronavirus — is a fan of the minimalist method, which uses only a square bandana, handkerchief or scarf (the bloggers use one that’s 18 inches by 18 inches) and two hair elastics.
• What’s more, this method allows for easy washing: Simply toss the handkerchief in the wash when you’re done with it after each wear.
• To make this easy DIY face mask even easier (not to mention more comfortable), use hair elastics that are slightly worn in, so they’re not too tight behind the ears, and pick a scarf made with a cotton blend rather than flimsy silk.
• Here’s how to do it:
  • Place the scarf or handkerchief facedown on a flat surface.
  • Fold the top half down to the midline of the scarf, then fold the bottom half up to the midline.
  • Flip it over so that the seam faces down.
  • Fold the new top half down to the midline, and the bottom half up.
  • Flip it over again so that the seam faces up.
  • Loop a hair tie over each end of the folded rectangle.
  • Fold the free sides of the rectangle in toward the middle, layering one side over the other.
  • Flip it over! Loop the elastics over each ear to wear, making sure the mask covers your mouth and nose.
  • For a demonstration on how to use a scarf to make a mask, Read the article on NY Post here.