NY, New Orleans & Detroit Projected to Peak in Next 6 to 7 days
“This will probably be the toughest week — between this week and next week. There will be a lot of death, unfortunately. But a lot less death than if this wasn’t done.” — President Trump
“US is ‘not even at half-time’ in the fight against coronavirus.”
— Dr. Fauci
“We continue to watch the Chicago and Detroit areas and have some developing concerns around Colorado, the District of Columbia, and Pennsylvania.”
— Dr. Birx
“It’s unbelievable that U.S. can’t make medical protection equipment.”
— NY Governor Cuomo
- Recent Developments and Headlines
- Numbers and Trends
- Potential New Treatments
- New Scientific Findings
- New Information and Unanswered Questions
- Practical Tips — grocery store shopping
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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 4/04 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 = 1,203,101 (+7.6%)
- Worldwide Active Cases = 891,605 (+7.5%)
- US Active Cases = 288,358 (+12%)
- NY Active Cases = 100,383 (+10%)
- US deaths = 8,504 (+1,051) (+14.2%)
- NY deaths = 3,914 (+696) (+21.6%)
- Trump warns “deadliest week” is ahead for US
- President Trump Thinking of 2nd Coronavirus Task Force Focused on Reopening Country
- VP Pence: “We think Italy may be the most comparable area to the United States at this point.”
- Fauci: China’s ‘Delay in Transparency’ ‘Likely’ Prevented Other Countries from Restricting Travel
- Tainted Chinese Data May Be Clouding Coronavirus Modeling Predictions
- NY Gov. Cuomo: Coronavirus ‘apex’ yet to come despite record deaths — and we aren’t ready
- Trump uses DPA act to block export of medical equipment
- Trump Ending Surprise Medical Billing for Uninsured Americans
- Javits Center in NYC converted to COVID-19 hospital (2,500+ beds with federal staffing)
- US death toll tops 7k
- Accidents 170 Times More Deadly than COVID-19’ as Cause of Death in U.S.
- NY reports 10k+ new cases as statewide total nears those of Italy, Spain
- As Coronavirus Hospitalizations Surge, Ventilator Manufacturing Ramps Up but Not Fast Enough
- NY Gov. Cuomo: China sending 2,000 ventilators to New York
- Taiwan Donates 2M More Masks to the U.S. for Coronavirus Battle
- Governors Go To Extraordinary Measures In Hunt For Medical Supplies
- New York, New Jersey Seize Ventilators Before Pandemic Crests
- More than 1,400,000 Americans tested (100,000+ being tested per day)
- Cuomo authorizes medical students slated to graduate in the spring to start practicing now
- De Blasio pleads for ‘national mobilization’ of doctors, nurses to fight coronavirus
- Dr. Birx: This Is Not the Time to Go to the Grocery Store
- TX Gov. Abbott: We’ll ‘Dramatically Increase’ Ability to Test Those Who May Be Immune
- Journalist says more than 800 health-care workers infected in Massachusetts
- Mike Pence: Pray for Our Hero Health Care Workers During Holy Week
- Report: Trump Tells Sports Commissioners NFL Should Start on Time
- 430,000 people have arrived in the United States from China since it disclosed the existence of a pneumonia-like illness to international health experts
- Mainland China sees rise in new coronavirus cases
- UK coronavirus deaths up 20% in one day, lockdown expected through May
- Mexico Says No Benefit to Wearing Face Masks as Coronavirus Cases Reach 1,688
- Bermuda announces two-week lockdown amid coronavirus pandemic
- India quarantines 20k people connected to Islamic missionary movement
- Africa faces ‘imminent surge’ of coronavirus cases, WHO says
- Australian PM orders all foreign tourists home after fury at bad behavior during coronavirus crisis
- Germany reports smallest batch of deaths in 2 weeks
- Italy reports another small slowdown in cases, deaths
- Spain case numbers pass Italy
- Coral Princess reports 2 deaths, presumably from COVID-19
- Portugal reported 638 new cases
- Belgium reported 1,661 new cases and 140 new deaths
- European death toll tops 45k as France reports ~400 new deaths
- France says 600 soldiers infected
- Tokyo reports more than 100 cases in a day, largest jump yet, as Japan’s 2nd wave worsens
- Lung-draining ‘turning teams’ may be the next evolution in COVID-19 care
- NYC Doctor: 90% of Mount Sinai Hospital’s Intake Is Coronavirus Cases
- Coronavirus Threatens Detroit’s Pipeline of Canadian Nurses
- Families watch helplessly as coronavirus hits nursing homes, infects loved one
- In Spanish Nursing Homes, Coronavirus Outbreak Is ‘Out of Hand’
- New Orleans Area Has Worst Coronavirus Death Rate in U.S.
- African elite who once sought treatment abroad are grounded
- Migrant-Populated District of Paris Sees 200 Fines Daily for Lockdown Violations
- Homeless still staying in emptier Penn Station amid coronavirus
- Lawmakers demand de Blasio oust NYC Health Commissioner over coronavirus response
- NYC crematories have 10-plus day backup as coronavirus deaths surge
- US accused of ‘piracy’ after mask shipment is diverted from Germany
- Los Angeles prosecutors charge ‘non-essential’ shops for staying open
- Walmart to limit customers in stores to encourage social distancing
- Businesses board up windows with no end to lockdown in sight
- NYC Sees 75% More Burglaries of Businesses Under Emergency Measures
- British 5G towers are being set on fire because of coronavirus conspiracy theories
- With slumping revenue, clinics that treat the poor are facing layoffs
- Pandemic drones” can now detect fever and coughing
- Coronavirus: Corona Beer Deemed ‘Nonessential,’ Suspends Production
- Michigan AG ‘Regrets Not Totally Liquidating’ 401k to Invest in Sex Doll Manufacturer
- “UK Government: Please Do Not Go Out to Enjoy the Nice Weather This Weekend
- Trump to Press: Hold Off Your Fake News Until After Coronavirus Pandemic
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: 1,203,101 Total Cases (+7.6%)
- New Cases = 84,899 (-13,732) (-13.9%) [Declining Growth Rate]
- Europe: 609,348 Total Cases (+6.4%)
- New Cases = 37,181 (-13,507) (-26.6%) [Declining Growth Rate]
- United States: 311,637 Total Cases (+12.3%)
- US New Cases = 34,016 (+1,768) (+5.5%) [Slowing Growth Rate]
- US States:
- 30 States > 1,000 cases (+1)
- 19 States > 2,500 cases (+1)
- 13 States > 5,000 cases (+1)
- 9 States > 10,000 cases (+2): NY, NJ, MI, CA, LA, MA, FL, PA & IL
- Top 5 States: (i) NY: 114,775 (+11,299); (ii) New Jersey: 34,124 (+4,229); (iii) Michigan: 14,225 (+1,481); (iv) California: 13,929 (+1,374); and (v) Louisiana: 12,496 (new)
- For more information on US States, see https://ncov2019.live/data
- New York State:
- NY Total Cases = 114,775 (+10.7%)
- NY New Cases = 11,299 (+876) (+8.4%) [Slowing Growth Rate]
- New York City:
- Total Cases = 63,306 (+10.5%)
- NYC New Cases = 6,146 (+795) (+14.8%) [Slowing Growth Rate]
2. Confirmed Active Cases
- Worldwide: 891,605 Active Cases (+7.5%)
- New Active Cases = 61,780 (-16,217) (-20.7%)
- Top 5 Countries: (i) US: 288,358 (+30,522); (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 = 288,358 (+12%)
- US New Active Cases = 30,522 (+1,440) (+5%)
- NY Active Cases = 100,383 (+10%)
- NY New Active Cases = 9,011 (+720) (+8.7%)
3. Series or Critical Cases
- Worldwide serious or critical cases = 44,095 (+4,691)
- US series or critical cases = 8,206 (+2,419)
- US serious or critical cases = 2.8% of Active Cases in US (+0.6%), compared with worldwide percentage of 5%
[Note: Serious and critical cases give insight into the need for ICU beds and ventilators]
- Worldwide deaths = 64,743 (+5,523) (+9.3%)
- Top 5 Countries: (i) Italy: 15,362 (+681); (ii) Spain: 11,947 (+749); (iii) US: 8,454 (+1,051); (iv) France: 7,560 (+1,053); & (v) UK: 4,313 (+708)
- Deaths per 1M population: (i) Italy: 254; (ii) Spain: 256; (iii) US: 26; (iv) France: 116; & (v) UK: 53
- Worldwide Closed Case Fatality Rate = 21% (+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 = 8,504 (+1,051) (+14.2%)
- NY deaths = 3,914 (+696) (+21.6%)
- NYC deaths = 2,624
- Worldwide recoveries = 246,753 (+7.4%)
- US recoveries = 14,825 (+16.6%)
- NY recoveries = 10,478 (+18%)
C. Projections and Our (Possible) Future
1. IHME (Murray) Model
- An updated version of the IMHE model was scheduled for release on April 4, but it has not yet been released. A new post says that the IMHE model is being revised but does not provide an estimate of when the updated model will be released. We will provide a summary of the updated model as soon possible after its release. In the meantime, you can see the current IHME model projections at https://covid19.healthdata.org/projections.
- 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.
D. Potential New Treatments
1. Anti-parasitic Drug Kills Coronavirus cell cultures in 48 hours
- A team of Australian researchers at Monash University in Melbourne have found that Ivermectin — an FDA-approved anti-parasitic drug that has been used to effectively fight viruses including HIV, Influenza, and Zika — was able to stop the SARS-CoV-2 virus from growing in cell cultures.
- While promising, the drug has yet to be shown to have the same effect inside the human body, because the Australian research was conducted “in vitro,” meaning it was in a Petri dish at a lab. The researchers are still trying to nail down funding for pre-clinical testing and clinical trials, after which they’d have to start the long approval process for the trials themselves.
- The results, though, are promising. In just 48 hours, the scientists say, all genetic material of the virus was eradicated.
- “We found that even a single dose could essentially remove all viral RNA by 48 hours and that even at 24 hours there was a really significant reduction in it,” Kylie Wagstaff, lead researcher and co-author of the study published today in Antiviral Research, said in a statement.
- “Ivermectin is very widely used and seen as a safe drug,” Wagstaff said. “We need to figure out now whether the dosage you can use it at in humans will be effective — that’s the next step.”
2. Japan Is Racing to Test a Drug to Treat Covid-19
- On March 28—last Saturday—Prime Minister Shinzo Abe told reporters that his government had begun the formal process for designating Avigan as Japan’s standard treatment for Covid-19.
- A critical step in that process involves clinical trials, one of which will conclude at the end of June. And while there is not yet any detailed data supporting Avigan’s effectiveness as a Covid-19 treatment, there are some reasons for optimism. One of them arrived on March 17, when Zhang Xinmin, an official at China’s ministry of science and technology, said that Favipiravir, the generic version of Avigan, had proved to be effective in treating Covid-19 patients at hospitals in Wuhan and Shenzhen.
- It was, Zhang said, “very safe and clearly effective” for treating Covid-19 patients. And while the data and methodology behind Zhang’s claims have not been made public, he did announce some of the conclusions doctors had drawn from them: At a hospital in Shenzhen, Zhang claimed Covid-19 patients treated with Favipiravir tested negative for the virus after a median of four days, rather than the 11 days it took for members of the study’s control group to test negative; in another study carried out in Wuhan, patients taking the drug allegedly recovered from fever nearly two days earlier than those who did not take the medication.
- Such results, preliminary and unconfirmed as they are, would seem to conform with the way Favipiravir works. Unlike most other influenza treatments, which inhibit the spread of the virus across cells by blocking the enzyme neuraminidase, Favipiravir works by inhibiting the replication of viral genes within infected cells, thereby mitigating the virus’s ability to spread from one cell to another.
- What this means, in practical terms, is that patients who take the drug while their viral load is low or moderate may prevent it from making them any sicker. And there is some evidence that Favipiravir can achieve these same effects in viruses other than influenza. Prime Minister Abe seems to be among the believers, and last weekend announced that Japan will “start to boost production and proceed with clinical research in cooperation with those countries that wish to join us.” He also said that many countries had already expressed an interest in the drug
- Though Abe did not mention any of those countries by name, one of them seems to be the United States. According to a recent report in Politico, Fujifilm has discussed with the FDA and the US Department of Health and Human Services the possibility of Avigan trials in the US, and it is seeking research funding from the US government. After Abe spoke to President Trump by phone about Avigan, the report says, the White House National Security Council began pressuring the government to accept a donation of Avigan from Japan, and asking the FDA to authorize its use on an emergency basis.
3. Long Island doctor tries new twist on hydroxychloroquine for elderly COVID-19 patients
- A New York doctor hopes to help his elderly COVID-19 patients with a treatment plan inspired by the success tentatively being reported with hydroxychloroquine — and which he says shows promising results.
- Dr. Mohammud Alam, an infectious disease specialist affiliated with Plainview Hospital, said 81 percent of infected covid patients he treated at three Long Island nursing homes recovered from the contagion.
- Alam said he decided he could not apply the touted combination of the antimalarial hydroxychloroquine and antibiotic azithromycin because the side effects could be potentially fatal for his high-risk patients, many of whom had underlying heart issues.
- The FDA has warnings that azithromycin “can cause abnormal changes in the electrical activity of the heart that may lead to a potentially fatal irregular heart rhythm.”
- So instead, Alam replaced azithromycin with another decades-old antibiotic that doesn’t pose any known risks to the heart. “Doxycycline is an anti-inflammatory with properties similar to azithromycin but without the safety concerns and without cardiac toxicity,” he said.
- Henry Ford Health System has started using combinations of the three drugs because of apparently fewer side effects, published reports state. Alam began treating his patients, 45 of whom had tested positive for the coronavirus after they developed a high fever, shortness of breath and cough.
- One health expert said using the decades-old doxycycline, which has been studied since the 1960s, is a plausible alternative to azithromycin.
- “Since we’re talking about the elderly being the most vulnerable, or people with underlying conditions, there is a theoretical benefit of doxycycline over azithromycin because doxycycline is not associated with cardiovascular disease,” said Dr. Sten H. Vermund, the dean of the Yale School of Public Health.
- “I am optimistic about this combination, but a well-designed clinical study is urgently needed to identify the appropriate patient population, optimize dosing regimen and assess the side effect profile of this combination therapy,” added Dr. Ryan Saadi, a Yale-trained infectious disease epidemiologist who is currently developing a ventilator technology at Quantaira Health.
E. New Scientific Findings and Other Advancements
1. Researchers may have found coronavirus’ Achilles’ heel
- There may be some good news on the coronavirus horizon, as Scripps Research reported it may have found COVID-19’s Achilles heel. The research shows a specific area of the virus could be “targeted with drugs and other therapies, a finding that also could help with the development of a vaccine,” according to the San Diego Tribune.
- The targeted area, according to biologist Ian Wilson, who led the scientific team, “is crucial to spreading the highly contagious virus, and … its composition suggests that it would be vulnerable to drugs.”
- The discovery was published Friday in the journal Science and comes as scientists globally are working feverishly to find a vaccine or cure for the pandemic that has devastated global markets and caused more than 63,000 deaths worldwide.
- An antibody taken from a SARS patient years earlier was used in the discovery, as researchers realized it had attached itself to a specific part of the virus, and were able to repeat the phenomenon with COVID-19, helping to identify a coronavirus weakness, according to the report.
- “That high degree of similarity implies that the site has an important function that would be lost if it mutated significantly,” Scripps Research said in a statement Friday.
- Sadly, the weak spot isn’t easy to find. “We found that this (spot) is usually hidden inside the virus, and only exposed when that part of the virus changes its structure, as it would in natural infection,” Wilson’s colleague, Meng Yuan, said in a statement.
- The institute is seeking the public’s help and is looking for COVID-19 survivors who would be willing to donate some of their blood, which would then be screened for potentially useful antibodies.
2. Some Coronavirus Patients Show Signs of Brain Ailments
- Neurologists around the world say that a small subset of patients with Covid-19 are developing serious impairments of the brain.
- Although fever, cough and difficulty breathing are the typical hallmarks of infection with the new coronavirus, some patients exhibit altered mental status, or encephalopathy, a catchall term for brain disease or dysfunction that can have many underlying causes, as well as other serious conditions. These neurological syndromes join other unusual symptoms, such as diminished sense of smell and taste as well as heart ailments.
- Reports in the US follow similar observations by doctors in Italy and other parts of the world, of Covid-19 patients having strokes, seizures, encephalitis-like symptoms and blood clots, as well as tingling or numbness in the extremities, called acroparesthesia. In some cases, patients were delirious even before developing fever or respiratory illness.
- The patients who come in with encephalopathy are confused and lethargic and may appear dazed, exhibiting strange behavior or staring off into space. They may be having seizures that require immediate medical care, and experts are warning health care providers who treat such patients to recognize that they may have Covid-19 and to take precautions to protect themselves from infection.
- Much is still unknown about the neurological symptoms, but efforts are underway to study the phenomena, said Dr. Sherry H-Y. Chou, a neurologist at the University of Pittsburgh School of Medicine, who is leading a team of investigators for the Neurocritical Care Society.
- Experts have emphasized that most Covid-19 patients appear to be normal neurologically.
- Neurological specialists also say that it is too early to make definitive statements or identify the specific mechanisms by which the new coronavirus is affecting the neurological system.
- In one recent paper, Chinese scientists noted that there was some evidence that other coronaviruses were not confined to the respiratory tract and invaded the central nervous system, and the authors speculated that this may potentially play a role in acute respiratory failure in Covid-19.
- “We are still in the early days of this, and we don’t really know for sure.”
F. New Information and Unanswered Questions
1. More young people are dying of coronavirus, WHO warns
- More young people are dying of the coronavirus, according to a new warning issued by the World Health Organization.
- “What we are seeing in some countries is that there are individuals in their 30s, who are in their 40s and 50s who are in the ICU and who have died,” said Maria Van Kerkhove, head of WHO’s emerging diseases.
- “It’s still pretty significant even if you don’t require hospitalization. Moderate disease still includes pneumonia.”
- Not all younger victims have underlying health conditions. In Italy, 10 to 15 percent of patients in intensive care are under 50, and in Korea, one in six deaths are of those under the age of 60.
- Although it was initially reported those most likely to die were elderly or those with underlying health issues, The CDC reported nearly 20 percent of severe cases were 20-44 years old in the U.S.
- The “dismissive attitude” that only old or the already sick people would have to worry about death or hospitalization has caused young people to shrug off the pandemic, says Mike Ryan, executive director of WHO emergencies program.
- “We collectively have been living in a world where we’ve tried to convince ourselves that this disease is mild in young people and more severe in older people, and that’s where the problem is,” he said.
2. Map Reveals Hidden U.S. Hotspots
- A team from the University of Chicago has mapped confirmed COVID-19 infections per county—and has adjusted for population sizes. The researchers’ findings reveal significant clusters in parts of Georgia, Arkansas and Mississippi, among other areas. Even though the involved populations may be smaller than those of New York or Seattle, they could be disproportionally hit by the disease.
- “When you flip from just state-level data to county-level data, you get a lot more information,” says Marynia Kolak, assistant director of health informatics at the University of Chicago’s Center for Spatial Data Science, who co-led the team that created the maps. “For example, there are a lot of areas in the South where the population is a lot smaller, but the proportion of people who have [COVID-19] is a lot greater. So that can cause potential challenges, because even though there are less people who have the virus, there are also correspondingly fewer hospital beds, intensive care units or ventilators.”
- The data reveal some surprising patterns in infection rates at the county level after adjusting for population size. For example, many county clusters—such as those around Albany, Ga., Detroit, Nashville, Tenn., and parts of Mississippi and Arkansas—had relatively large numbers of cases per capita. As of March 29, the county cluster encompassing New York State, New Jersey and Massachusetts still had the most confirmed infections both overall and per capita: 76,273 cases, or about 22 per 10,000 people. Yet Albany, Ga., had the second-highest number per capita: 13 cases per 10,000 people. That figure was much higher than those of other well-known hotspots, such as Seattle, which had about eight cases per 10,000, and San Francisco, which had two per 100,000.
- Many of these more rural counties have had far fewer deaths overall, compared with large cities such as New York or Seattle, but higher relative death rates. New York–New Jersey–Massachusetts areas had a fatality rate of 1.4%, whereas that of Albany, Ga. was 7.65% (although these numbers almost certainly do not account for milder cases that were not tested). In several areas, hospital intensive care units are already reaching their capacities.. In addition, according to the researchers, a lot of people in the rural, southern parts of the country tend to be older and have more underlying health conditions, which have been linked to more deadly COVID-19 infections.
- Given the shortage of testing capacity in the U.S., some areas simply may not know the extent of their outbreaks. New York State has been testing pretty aggressively. Smaller county clusters, however, may lack the resources to do so. Kolak acknowledges that they are only looking at confirmed cases, but comparing the numbers in these hotspots with those in surrounding areas does provide a sense of the outbreaks’ relative severity. The team has started working with other research groups to validate the accuracy of its data, Kolak says. And the next step will be collaborating with health groups around the country to determine what information would be most useful to them.
- The new findings could have critical implications for controlling the spread of the virus. One of the main take-home messages is the importance of policies on social distancing and isolating each outbreak before it gets more serious. “Rather than wait for it to get so extreme that, you know, the whole state emerges as a hotspot,” Kolak says, “try to contain it within a county before it goes further.”
3. Why women are better than men at beating the coronavirus
- As the novel coronavirus cuts its relentless swath across the globe, doctors have identified one grim constant: COVID-19 has men, more than women, in its sights.
- In Italy, men account for at least 70% of all coronavirus deaths. While South Korea has seen more confirmed COVID-19 cases in female patients than in males, a higher percentage of men have been felled by it. Here in New York City, more men than women are testing positive for coronavirus, with 55% of all cases. They also are dying of it at even higher rates. As of Friday, 1,159 men in the five boroughs had been killed by COVID-19 — 62% of the city’s 1,867 deaths.
- The phenomenon has stumped medical experts. In their rush to make sense of the data, many are pointing fingers at men and their behavior. Some speculate that higher male smoking rates leave them vulnerable to the respiratory infection. Others guess that men are blowing off social-distancing guidelines, or are neglecting to wash their hands.
- In fact, the coronavirus’ bull’s-eye on men is consistent across age groups, regardless of underlying risk factors. “What we are actually seeing is that males do not do well once infected,” Moalem said. “So it comes down to genetics. There is a genetic component to this illness.”
- Men, with their single X chromosome, have a far less nimble immunological army at their command. “As a man, I don’t have all those options,” Moalem said. “I can only hope that my one X has the genes that can recognize the virus — and can kill it, too.”
- It gets worse for men in the age of COVID-19: The new coronavirus takes direct aim at their single-X vulnerability.
- “What we researchers are seeing right now is the way this coronavirus gets into our lung cells,” Moalem said. “It has a key: a spike protein we think it uses to break in. And the lock it picks to enter is called ACE2” — an enzyme attached to the outer surface of the cell membrane.
- “The gene that makes ACE2 is on the X chromosome,” he continued. “So if the coronavirus has the right key, it can unlock every one of a male’s lung cells. But females have two X’s — so half of their lung cells use one ACE2 lock, and the other half use a slightly different ACE2 lock. The chance that the virus has the perfect key to unlock both of them is not great. So that’s another enormous advantage for females.”
4. A German Exception? Why the Country’s Coronavirus Death Rate Is Low?
- The virus and the resulting disease, Covid-19, have hit Germany with force: according to John Hopkins University, the country had more than 90,000 laboratory-confirmed infections by Friday evening, more than any other country except the United States, Italy and Spain.
- But with 1,275 deaths, Germany’s fatality rate stood at 1.3 percent, compared with 12 percent in Italy, around 10 percent in Spain, France and Britain, 4 percent in China and 2.5 percent in the United States. Even South Korea, a model of flattening the curve, has a higher fatality rate, 1.7 percent.
- “There has been talk of a German anomaly,” said Hendrik Streeck, director of the Institute of virology at the University Hospital Bonn. Professor Streeck has been getting calls from colleagues in the United States and elsewhere.
- “‘What are you doing differently?’ they ask me,” he said. “Why is your death rate so low?”
- There are several answers to this question, experts say, a mix of statistical distortions and very real differences in how the country has taken on the epidemic.
- The average age of those infected is lower in Germany than in many other countries. Many of the early patients caught the virus in Austrian and Italian ski resorts and were relatively young and healthy, Professor Kräusslich said.
- As infections have spread, more older people have been hit and the death rate, only 0.2 percent two weeks ago, has risen, too. But the average age of contracting the disease remains relatively low, at 49. In France, it is 62.5 and in Italy 62, according to their latest national reports.
- But there are also significant medical factors that have kept the number of deaths in Germany relatively low, epidemiologists and virologists say, chief among them early and widespread testing and treatment, plenty of intensive care beds and a trusted government whose social distancing guidelines are widely observed.
- In mid-January, long before most Germans had given the virus much thought, Charité hospital in Berlin had already developed a test and posted the formula online.
- By the time Germany recorded its first case of Covid-19 in February, laboratories across the country had built up a stock of test kits.
- By now, Germany is conducting around 350,000 coronavirus tests a week, far more than any other European country. Early and widespread testing has allowed the authorities to slow the spread of the pandemic by isolating known cases while they are infectious. It has also enabled lifesaving treatment to be administered in a more timely way.
- “At the end of April, health authorities also plan to role out a large-scale antibody study, testing random samples of 100,000 people across Germany every week to gauge where immunity is building up.
- One key to ensuring broad-based testing is that patients pay nothing for it.
- In most countries, including the United States, testing is largely limited to the sickest patients, so the man probably would have been refused a test.
- Not in Germany. “Testing and tracking is the strategy that was successful in South Korea and we have tried to learn from that,” Professor Streeck said.
- Germany also learned from getting it wrong early on: The strategy of contact tracing should have been used even more aggressively, he said.
- All across Germany, hospitals have expanded their intensive care capacities. And they started from a high level.
- Some experts are cautiously optimistic that social distancing measures might be flattening the curve enough for Germany’s health care system to weather the pandemic without producing a scarcity of lifesaving equipment like ventilators.
Trust in Government
- Beyond mass testing and the preparedness of the health care system, many also see Chancellor Angela Merkel’s leadership as one reason the fatality rate has been kept low.
- Ms. Merkel has communicated clearly, calmly and regularly throughout the crisis, as she imposed ever-stricter social distancing measures on the country. The restrictions, which have been crucial to slowing the spread of the pandemic, met with little political opposition and are broadly followed.
- “Maybe our biggest strength in Germany,” said Professor Kräusslich, “is the rational decision-making at the highest level of government combined with the trust the government enjoys in the population.”
G. Practical Tips and Useful Information
1. Safety Advice If You Must Visit the Grocery Store
- With communities across the country virtually shut down, there is still one place nearly everyone needs to visit at some point: the grocery store. Experts say deliveries are safer, but sometimes it can be hard to get one scheduled right away. So if you must go to the store, what’s the best way to navigate the aisles and crowds? Information and guidance about the virus is changing quickly, so we asked the experts.
Is it safe to go to the grocery store?
- Try to minimize visits to the store. “The biggest risk factor is really being around other people,” says Benjamin Chapman, a professor of food safety at North Carolina State University.
- That’s because the novel coronavirus is spread largely through droplets from nearby people coughing or sneezing. If you must go, maintain a buffer around yourself and try to go at off-hours. (The Centers for Disease Control and Prevention recommends a 6-foot buffer, while the World Health Organization says 3 feet will suffice).
- It’s hard to maintain a distance from cashiers, so use self-checkout when possible and use hand sanitizer when you’re done.
Should I wear a mask or gloves to the grocery store?
- The thinking on face masks has shifted recently. Previously experts didn’t recommend wearing them because the only fully protective masks are N95 respirator masks, which should be fitted and reserved for health-care workers. Now, many say wearing a cloth face mask of some sort is useful in preventing the emission of viral particles, which is important since many people may be asymptomatic.
- Gloves don’t help much if you’re going to touch your eyes, nose or mouth with them. Rather, experts say, wash your hands with soap and water before going out and when coming home, and use hand sanitizer when out. If you use gloves, choose disposable ones and throw them away as soon as you get home.
- Try not to use your phone when in the store. If you do, clean it when you get home.
Should I bring wipes with me? What should I wipe down?
- Dr. Chapman says many grocery stores are providing shoppers with wipes. If not, it’s a good idea to bring your own, mainly to wipe the grocery cart. Just make sure the wipes are on the list registered with the Environmental Protection Agency. Wipes can also be used for other high-touch areas in the store like freezer handles or tongs used in self-serve bins.
Any other precautions I should take?
- Try to avoid exchanging money or credit cards with the cashier. Use a credit-card reader when possible.
- How are you doing your grocery shopping now? Join the conversation below.
If I’m a senior or have an underlying medical condition, should I try to go to the store during special seniors hours?
- People over 65 and those who have medical conditions that put them at greater risk of hospitalization and serious illness should avoid going to the grocery store, if possible. Try to order groceries online or have a family member or friend deliver them while taking precautions. If you must visit the store, go during hours reserved for seniors, when the store is likely to be less crowded.
When I get home, what should I do with any paper or plastic bags or packaging?
- Though there have been no documented cases of transmission of the novel coronavirus through food packaging, a recent NEJM study found that the virus can live on cardboard for up to 24 hours and on hard surfaces such as plastic and stainless steel for two to three days. But experts noted that the studies were done in a laboratory with high doses of the virus, so it’s unknown if in real life the virus can be transmitted that way. Most likely if someone were to sneeze or cough on a cardboard container, the virus would degrade more quickly due to environmental factors, such as sunlight.
- But experts say wiping down cereal boxes and other packages isn’t necessary. “Use the wipes when you need them,” says Dr. Chapman. If you’re home you can easily wash your hands. “That’s going to reduce your risk as much if not more than trying to wipe everything down,” he says.
- Randy Worobo, a professor of food microbiology at Cornell University, says instead of being preoccupied with wiping down packaging and containers, focus on washing your hands. “It’s much better to treat your hands, wash your hands, rather than dealing with all the surfaces,” says Dr. Worobo.
What about food? Can I get Covid-19 from eating contaminated food?
- Your mouth is a gateway to both your respiratory system (your lungs) and your digestive system (stomach). Respiratory viruses like the novel coronavirus are believed to enter the body and reproduce through the respiratory tract, not the digestive tract.
- Experts say it is possible that if the virus rubs off from any object to the inside of your mouth, it could infect you if it goes into your respiratory system. But there doesn’t appear to be any risk of infection via your digestive tract, according to the Centers for Disease Control and Prevention and the Agriculture Department.
- Scientists are still studying the virus, so there is always the chance they could find otherwise. But doctors say getting the virus through ingestion of contaminated food seems unlikely. Gregory Poland, director of the Mayo Clinic’s Vaccine Research Group in Rochester, Minn., speculates that the gastric acid in the stomach would kill it. “My own speculation is that the GI route would be very low likelihood compared to known and efficient methods of infection,” he says.
- To be extra cautious, you could heat food in the oven or microwave, though this hasn’t been specifically studied so it’s unclear if there’s a particular length of time needed.
What if someone coughs or sneezes into your food?
- If you touch virus particles on raw food and then touch your nose, eyes or mouth, that is a potential source of transmission. But experts note that is very unlikely. To be vigilant, thoroughly wash your hands with soap and water, and don’t eat your food with your hands.
Do raw fruits and vegetables need to be washed with anything special?
- Experts urge people not to wash fruits and vegetables with anything but water. The chemicals on wipes and chlorine solutions especially can be dangerous—don’t ingest those.
Will my clothes be contaminated when I come back from the store? Do I need to change my clothes as soon as I get home?
- There’s no evidence that the virus can be transmitted through clothing, but it hasn’t been specifically studied. The good news is it can be killed by doing laundry. So if you were in a grocery store where people near you were coughing, it’s a good idea to remove your clothes when you get home. Don’t shake clothing. Place it in your laundry hamper. The CDC recommends laundering contaminated clothes in the warmest appropriate water setting and drying them thoroughly.
Can I get the virus from food handlers who don’t wash their hands well after going to the bathroom?
- The CDC says there are no known cases of the novel coronavirus being spread through the fecal-oral route, which is a common route of transmission for stomach viruses like the norovirus.
- But a recent study that hasn’t been peer reviewed yet found the virus in the stool of some patients. This route of transmission remains unknown, and experts say it’s unlikely to be contributing significantly to the pandemic.