Coronavirus Update 4-7

Today’s Features

• Recent Developments and Headlines
• Numbers and Trends
• Projections and Our (Possible) Future–updated IHME Model
• Risk Assessment & Preparation
• Potential New Treatments
• New Scientific Findings
• Observations & Unanswered Questions
• 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 4/06 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 209 countries and territories (+1)
• Worldwide Total Cases:  1,349,823 (+5.9%)
• Worldwide Active Cases = 988,126 (+5.1%)
• US Active Cases = 336,897 (+8.9%)
• NY Active Cases = 113,792 (+5%)
• US deaths = 10,943 (+1,323) (+13.8%)
• NY deaths = 4,758 (+602) (+14.5%)  
• President Trump “optimistic” about Sunday’s data 
• ‘Peak week’ begins in the US
• Revised IHME Model Lowers U.S. Coronavirus Death Projections
• Revised IHME Model projects that 6 States have already peaked
• US coronavirus peak predicted to see over 3,000 deaths in single day
• Revised IHME Model projects NY to peak on April 8
• NY Gov. Cuomo: coronavirus deaths in New York could be hitting apex
• Dr. Anthony Fauci: New York Data Suggests Coronavirus Turnaround 
• NY Gov. Cuomo: ‘We Don’t Need Any Additional Ventilators Right Now’  
• U.S. Coronavirus Hospitalizations Lower than Predicted: NY Marks 75% Drop
• CT, NJ, NY report jump in cases, deaths
• More experts warn deaths being undercounted in NYC
• President Trump says USNS Comfort hospital ship will take coronavirus patients
• Andrew Cuomo Scolds New Yorkers for Slacking Off on Social Distancing; Raises Fine to $1,000
• NYC may temporarily bury coronavirus victims on Hart Island
• De Blasio on coronavirus victims being buried in NYC parks: ‘Totally false’
• Trump Pushes Hydroxychloroquine: ‘I’m Trying to Save Lives’
• Food-Banks Warn They’ll Soon Run Out Of Food As Economic Suffering Explodes All Over America
• ‘Virus Is Deadly But So Is This Shutdown — You Just Won’t See Its Victims in a Neat Little Box on Cable News’
• 430,000 people traveled to US from China during coronavirus outbreak
• Situation in Italy, Spain continues to improve as UK reports biggest jump in fatalities 
• Portugal latest European country to report drop in cases
• South Korea reports fewest new cases in weeks
• Austria Becomes First European State To Start Reopening Its Economy
• Denmark Joins Austria in Easing Virus Curbs as Europe Cases Slow
• Germany releases plan to get “back to normal” by April 19
• Russia reports biggest jump in new cases
• Abe rolls out state of emergency to begin Tuesday
• Iran’s Health Ministry: China’s Coronavirus Numbers a ‘Bitter Joke’
• Netanyahu Announces Full Lockdown Of Israel Ahead Of Passover
• Mumbai hospital shut after surge in cases among staff
• Mexican Coronavirus Cases Spike 21% over Weekend
• Man refusing to wear facemask shot dead in Philippines after president’s threat
• “All The Jobs Are Gone” – Africa Facing ‘Complete Economic Collapse’ As Virus Spreads 
• Boris Johnson ‘conscious’ in ICU but expert warns it is ‘very likely’ he’ll be put on ventilator
• New Zealand PM Adds “The Easter Bunny” & “The Tooth Fairy” To List Of ‘Essential Workers’
• UN: “Horrifying Global Surge In Domestic Violence” Amid Lockdowns
• Canada Lashes Out After US Blocked Export Of Millions Of N95 Masks
• Amid ‘Mandatory Lockdown,’ Baltimore Officials Approve Spy-Plane To “Collect Images Of City”
• “Media Extinction Event”: Print Newspapers Face COVID-19 Death-Knell
• Man Arrested for Holding Massive Block Party: ‘We Don’t Give a F*** About the Coronavirus’    
• Grounded Aircraft, Trains in Europe Converted into Intensive Care Units
• Beijing Peddles Billion-Dollar ‘Traditional Chinese Medicine’ Industry in Australia
• China Floods Facebook with Ads Blaming Trump for Chinese Virus
• Chinese Media to ‘Stupid U.S. Politicians’: ‘Just Shut Up’
• Millions of Chinese-Made Coronavirus Tests — Don’t Work!
• UK Police Break Up ‘Prayer Meeting’ In Birmingham Park
• Sue Communist China for Coronavirus Pandemic, Says British Think Tank
• UK: 4,000 Prisoners to Be Released Early to Curb Coronavirus in Jails
• Thousands Swarm Chinese Tourist Sites as Wuhan Told to Stay Home amid reports of new coronavirus infections in China
• South Africa’s history of TB, HIV prepares country for coronavirus testing
• Airlines halt most NYC flights amid escalating coronavirus fears
• Ecuador orders cardboard coffins for coronavirus victims left in street
• Indian Official: Mosque Instructed Mob to ‘Manhandle’ Coronavirus Health Workers
• Pastor Ordered to Stop Church Services During Pandemic
• Reports: Coronavirus Panic-Buying Sweeps China as Locals Refuse to Believe Communist Party
• Taiwan Donates 2M More Masks to the U.S. for Coronavirus Battle
• Detroit Deploys ‘Plane Flyovers, Video Surveillance’ to Enforce Social Distancing
• Apple Will Produce 1 Million Face Shields a Week for Medical Workers
• Coronavirus: Louisiana Coroner Says 1-Day-Old Infant Died from Illness
• Grocery workers are beginning to die of coronavirus
• Residents Alarmed After Cops use “Purge Siren” to Signal Start of Curfew
• Detroit Deploys ‘Plane Flyovers, Video Surveillance’ to Enforce Social Distancing
• Lightfoot On Chicago COVID-19 Deaths: More Than Half Were African American
• High-income Philadelphians getting tested for coronavirus at far higher rates than low-income residents
• Tourist Towns Say, ‘Please Stay Away,’ During Coronavirus Lockdowns
• Panama archbishop delivers Palm Sunday blessing by helicopter
• Passover, Easter and Ramadan Become Virtual Holidays of Renewal
• NFL readies ‘virtual draft’ this month
• UK hangars made into morgue for coronavirus victims
• NYPD staying away from issuing social distancing summonses
• 20% percentage of NYPD cops out sick as coronavirus spreads
• Brooklyn street vendor says he sells $2K worth of protective equipment a day
• City bus and subway workers account for all 33 MTA coronavirus deaths
• Hundreds of homeless with coronavirus or symptoms housed at NYC hotels
• 64% of NY nurses lack adequate gear, 72% exposed to coronavirus, survey says
• 3D printing firm focuses on ventilator parts in coronavirus fight
• Spain turns to drive-thru funerals for coronavirus victims
• NYC doctor says high ventilator settings damage coronavirus patients’ lungs
• ‘Irresponsible’ Olympian arrested after allegedly breaking coronavirus quarantine
• Iowa teen with coronavirus warns young people not to underestimate disease
• Miss England will return to work as a doctor amid coronavirus outbreak
• Amazon faces another NYC warehouse strike as dozens of workers have coronavirus
• Australian man faces $50K fine for escaping quarantine to visit girlfriend
• Chicago pizzeria using oven to make face shields for healthcare workers
• Swiss resort offering ‘quarantine apartments’ that includes a $500 coronavirus test
• NYC dog parks closed until further notice due to coronavirus
• Reporters Without Masks Grill Trump About Not Wearing a Mask
• Winery Uses Dog to Deliver Booze During 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.]

Source:  Worldometers

1. Confirmed Total Cases and New Cases

• Worldwide:  1,349,823 Total Cases (+5.9%)
  • New Cases = 74,677 (+2,632) (+3.7%) 
• Europe: 666,488 Total Cases (+4.3%)
  • New Cases = 27,372 (-2,936) (-8%) 
    • Trend: 3^rd day of Declining Number of New Cases
• United States: 367,650 Total Cases  (+2.2%)
  • New Cases = 30,799 (+5,584) (+22.1%) 
• US States:
  • 33 States > 1,000 cases (+2), plus DC
  • 21 States > 2,500 cases (+1)
  • 14 States > 5,000 cases (+1)
  • 9 States > 10,000 cases (+0):  NY, NJ, MI, CA, LA, MA, FL, PA & IL
  • Top 5 States: (i) NY: 131,916 (+8,898); (ii) NJ: 41,090 (+3,585); (iii) Michigan: 17,221 (+1,503); (iv) California: 16,363 (+1,162); and (v) Louisiana: 14,867 (+1,857)
  • For more information on US States, see https://ncov2019.live/data
• New York State:
  • NY Total Cases = 131,916 (+7.2%)
  • NY New Cases = 8,898 (+655) (+8%) 
• New York City: 
  • Total Cases = 72,181 (+6.8%)
  • NYC New Cases = 4,603 (+385) (+9.1%) 

2. Confirmed Active Cases

• Worldwide: 988,126 Active Cases (+5.1%)
  • New Active Cases = 48,375 (+229) (+0.5%)
  • Top 5 Countries: (i) US: 336,897 (+27,643); (ii) Italy: 93,187 (+1,941); (iii) Spain: 82,897 (+1,972); (iv) Germany: 65,484   (-4,355), & (v) France: 71,849 (+3,271)
• US Active Cases = 336,897 (+8.9%)
• US New Active Cases = 27,643 (+6,747) (+32.3%) 
• NY Active Cases = 113,792 (+5%)
• NY New Active Cases = 8,411 (+413) (+5.2%)

3. Serious or Critical Cases

• Worldwide serious or critical cases = 47,409 (+1,510)
• US series or critical cases = 8,983 (+281)
• NY serious or critical = 4,504 (+377)
• US serious or critical cases = 2.7% of Active Cases (+0.1%), compared with worldwide percentage of 5%
• NY serious or critical cases = 4% of Active Cases (+0.2)

[Note: Serious and critical cases give insight into the need for ICU beds and ventilators]

4. Deaths

• Worldwide deaths = 74,820 (+5,317) (+7.7%)
  • Top 5 Countries: (i) Italy: 16,523 (+636); (ii) Spain: 13,341 (+700); (iii) US: 10,943 (+1,323); (iv) France: 8,911 (+203); & (v) UK: 5,373 (+439) 
  • Deaths per 1M population: (i) Italy: 273; (ii) Spain: 285; (iii) US: 33; (iv) France: 137; & (v) UK: 79
  • 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 = 10,943 (+1,323) (+13.8%)
• NY deaths = 4,758 (+602) (+14.5%)  

5. Recoveries

• Worldwide recoveries = 286,877 (+7.9%)
• US recoveries = 19,810 (+10.2%)
• NY recoveries = 13,366 (+27.6%)

C. Projections and Our (Possible) Future

1.Updated IHME (Murray) Model (4/6/20): Major Reductions in Number of (i) Hospital Beds, ICU Beds and Ventilators Required, and (ii) Deaths

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 periodically. The current version of the IHME Model projections can be found at https://covid19.healthdata.org/projections   
• 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.  

April 6 Update

• IHME made significant changes to its predictive model with its April 6 update.
• IHME stated that since its last update on April 2, it has been able to incorporate a number of different data sources into its COVID-19 model, including state-level data on hospital utilization.
• With the release of the revised model on April 6, the COVID-19 deaths and hospital resource use model includes substantial improvements. Key methodological and data updates are summarized below, as well as major results. IHME says it will publish more detailed information including technical appendices on April 7.

Predicting COVID-19 Deaths: What Has Changed and Why?

• The following changes were highlighted:
  • Peak date for daily deaths remains April 16
  • Daily deaths at peak date increased to 3,130 (+485)
  • Cumulative deaths reduced to 81,766 (-11,765)
    • The range of deaths is now 49,431 to 136,401 (the lower end of the range was increased by 9,465 and the upper end of the range was lower by 41,465)

Why did these changes occur?

The IHME indicated there were four major changes in their modeling.

1. Epidemic peak and its relationship to social distancing policies.

• Prior models were based a limited data set of real world examples. The model added has data from an additional seven locations in Italy and Spain. The effects of social distancing from time of implementation to peak of daily deaths have more robust data behind the assumptions
• This is the primary reason why many states have earlier predicted dates of peak daily deaths

2. Weighting of social distancing policies in the COVID-19 death model.

• Prior models provided equal weight to the four primary social distancing policies (school closures, stay-at-home orders, non-essential business closures, and travel limitations). However, only one state-to-date has issued a travel limitation (Alaska). 
• The revised model uses three different weighting schemes to better approximate variation in potential policy impact across social distancing mandates. IHME’s statistical tests suggest that early actions such as school closures may have a larger effect in some communities than expected; in other locations, fully mandated stay-at-home orders may be required for detectable impact. IHME is now weighting the three primary social distancing policies (school closings, stay-at-home orders and non-essential business closures)

3. Uncertainty estimation and out-of-sample predictive validity.

• IHME evaluates model performance both in terms of how many days into the future it estimates and how many data points have been reported for each state. As expected, projection accuracy improves when there are more data on the number of daily deaths in each state and gets worse the farther into the future projections are made. Model projection accuracy is now included in our prediction uncertainty estimates.

4. Incorporating data from States with prior low cumulative COVID-19 deaths

• IHME made adjustments to the model for States that have a limited number of data points. This change doesn’t significantly change the big picture.

Predicting Hospital Resource Use: What Has Changed and Why?

• The following changes were highlighted:
  • Peak date for hospital use remains April 15
  • Total hospital beds need at peak drops significantly to 140,823 (a decline of 121,269)
    • The range has also changed and is now projected to be 73,390 to 284,549 beds, which is a reduction of 123,885 to 417,672
  • ICU beds needed at peak falls to 29,210 (-10,517)
    • The range is remains fairly unchanged at 16,149 to 55,869
  • Invasive ventilators needed at peak declines significantly to 18,992 (-12,791)
    • The range falls to 10,533 to 36,318 ventilators, down from 13,016 to 54,113

Why did these changes occur?

IHME recognized that the changes in predicted hospital resource use and related gaps in states where demand might exceed supply are fairly large. The following reasons for the revisions were provided:

• Inclusion of more up-to-date data for estimating ratios of hospital admission to deaths. These ratios inform model parameters that are used to predict need for hospital beds, ICU beds, and ventilators. 
  • Prior ratios were informed by a CDC report with information on early COVID-19 cases in the US – from February 12 to March 16 – and those patients’ outcomes. Based on these data (509 admissions divided by 46 deaths), the overall ratio was 11.1 hospital admissions per COVID-19 death
  • Over the last few days, we have been able to incorporate data sources, including data provided by state governments, on a substantially larger sample: 16,352 hospital admissions and 2,908 deaths related to COVID-19. [Note: A significantly lower ratio of 5.6]
  • The updated model uses the state-specific ratios noted below and for those states without data, the pooled ratio of 7.1 hospitalizations per death (95% CI 4.0 to 12.7). 
    • NY State’s hospital admission to death ratio is 4.2
  • These lower ratios of admissions to deaths result in predicted peak hospital resource use – total beds, ICU beds, and invasive ventilators – that is lower than previously estimated.
• Based on new data, IHME also re-estimated the length of stay in hospital for COVID-19 patients. 
  • The latest data show that, among hospitalized COVID-19 patients who are discharged alive, patients who require ICU support have longer hospital stays than previously predicted, and patients who do not require ICU support have shorter hospital stays.
  • The long hospital stays for patients requiring an ICU stay mean that the reduction in ICU beds and ventilator use due to the lower admission-to-death ratios is less than for total beds.
  • Some key assumptions for the new model are below:
    • Admission to death – 6 days (non-survivors)
    • Admission to discharge – 20 days (with ICU stay) 
      • ICU length of stay – 13 days
    • Admission to discharge – 8 days (no ICU stay)

Key Findings from the April 6 Release: A Focus on State Level Predictions of Peak Daily COVID-19 Deaths

• While the data and model updates did not have substantial effects on national-level predictions for peak COVID-19 daily deaths (-11,765), some states saw considerable changes from past models to today’s release.

Observations:

• In addition to the changes noted above, several states have had their peak usage of hospital beds change significantly. These changes are primarily due to the decrease in Hospital-to-death ratio based on observed data
• Several states (noted in green) have already passed their peak usage dates. The following chart highlights the new peak days (days change is from the prior update on April 2).

2. Asian Countries That Beat Covid-19 Have to Do It Again

• In any digital dashboard tracking the spread of Covid-19, on any graphic comparing country-by-country case curves or death tolls, they were the champs. Singapore, Hong Kong, Taiwan, South Korea—leaders there saw what was headed their way from China in the early days of the new coronavirus, before it became a pandemic. 
• They remembered what happened two decades ago with SARS: People died, economies suffered. So they locked down their immigration hardest and soonest, deployed public health workers to follow up contacts of cases, got their hospitals shored up, and started publishing clear and consistent information and data. 
• They flattened their curves before the rest of the world understood there would be curves to flatten. But in recent weeks, those curves have taken another chilling turn. The numbers of new cases in these places are creeping upward.
• Hong Kong’s slow and steady case count started going up on March 18, and took an 84-case jump on March 28. After months of new cases barely brushing double digits, Singapore’s count jumped by 47 on March 16, and since then the city-state has had three days with more than 70 new cases each. Taiwan’s new-cases-in-a-day peaked at 5 in late January … and then jumped into the high 20s per day in, again, mid-March. South Korea had 86 new cases on April 3.
• In epidemiological terms, this tension is about taking control of what’s called the reproductive number, the number of people a contagious person goes on to infect. At the top of the curve in Wuhan, where Covid-19 started to spread, that number was something like 2 or 2.5—as it might now be in parts of the US and Europe. After the Chinese government quarantined Wuhan and forced everyone to stay home, it went down to perhaps as low as 0.3. In China, those rules went into effect in January; the government may lift them this week.
• The US and Europe are well into mitigation, riding the exponential curve upward. “Right now they’re in different parts of the graph,” Wang says. “When it’s near the peak, and you have to manage it, you start to do as much of the mitigation strategy as possible, so you flatten the curve. Then you try to wait and see where you are, and if you lift it too early, you get a resurgence.”
• For the US, that’s a scary warning. The peak numbers could be terrifying, and they’ll certainly vary across hot spots. But once the peak is passed? Hundreds of millions of people can’t stay socially distanced forever. 
• Despite the new cases, Singapore, Hong Kong, and Taiwan are still keeping their reproductive numbers around 1—a slow enough spread to follow cases and contain flare-ups. 
• “That may be the long-term strategy for the US and Europe,” Cowling says. “There’s two approaches, maybe. One is test, test, test. Identify cases, isolate them, stop transmission of them into the community. But it’s always difficult to catch every infection, especially the mild ones. So the other approach that is necessary, really important, is to maintain some social distancing.”
• “For the second wave, what we would like to happen is, if there is a growth, it’s much slower,” Cowling says. “Coronavirus is not going away. We’re not going to eliminate it. We’re going to have to face the prospect that it is always going to be around, but hopefully in small numbers until we can identify an effective treatment or vaccine.” It’s a hopeful idea—that doing all the things that slow the virus enough for a public health system to fight it also builds a world even better than the one everyone fled.

Source: The Asian Countries That Beat Covid-19 Have to Do It Again  

D. Risk Assessment and Preparation

1. Pandemic Condition (PanCon) and Preparedness Levels

• As previously discussed, a higher level of risk warrants a higher level of preparedness.
• In order to identify your current level of risk, we have created a Pandemic Condition risk assessment system that rates your condition based on factors that could put your family at risk.   Key factors include mandatory restrictions on activities, the degree to which the food or medical supply chains are impaired, the degree to which the healthcare system is impaired, and the degree to which law enforcement is impaired.  Taking those factors into consideration, each area has a Pandemic Condition (PanCon) Level – the higher the level, the higher the risk
• Based on the PanCon Level in your area, the PanCon risk assessment system provides a recommendation regarding the minimum level of preparedness that you should achieve if at all possible (or as close as possible).
• And, with the IHME Model projections, we can anticipate when the healthcare system in an area may become impaired or overwhelmed, which provides us with a tool to foresee an increase in risk level and prepare accordingly.
• A copy of the PanCon risk assessment system and recommendation for each PanCon Level is attached to this update.  We highly recommend that you review the PanCon risk assessment system, determine your level of risk and prepared accordingly.

E. Potential New Treatments

1. A second potential COVID-19 vaccine, backed by Bill and Melinda Gates, is entering human testing

• A new COVID-19 vaccine candidate is entering Phase 1 clinical human testing today, after the U.S. Food and Drug Administration (FDA) accepted an application from Inovio Pharmaceuticals under the regulator’s Investigational New Drug program. Inovio plans to inject its first volunteer test subject with the INO-4800 DNA vaccine candidate it has developed, following promising results from preclinical studies performed on animals that did indicate increased immune response.
• The Inovio DNA vaccine candidate works by injecting a specifically engineered plasmid (a small, independent genetic structure) into a patient so that their cells can produce a desired, targeted antibody to fight off a specific infection. DNA vaccines, while available and approved for a variety of animal infections in veterinary medicine, have not yet been approved for human use.
• That said, Inovio’s work isn’t starting from scratch: The company previously completed a Phase 1 study for a DNA vaccine candidate for Middle East Respiratory Syndrome (MERS), where it showed promising results and a high level of antibodies produced in subjects that persisted for an extended period of time.
• Inovio has been able to scale up quickly, developing and producing “thousands of doses” of INO-4800 in just a few short weeks in order to support its Phase 1 and Phase 2 trials. The company has done so in part thanks to backing from the Bill and Melinda Gates Foundation, as well as funding from other nonprofits and organizations. If clinical trials are successful, Inovio says it will be able to have up to one million doses of the vaccine ready by the end of the year, for use both in additional trials and for potential emergency use pending authorization.
• This is the second vaccine to undertake Phase 1 clinical testing on human subjects: Moderna began its trial in mid-March. Inovio’s trial will be made up of 40 volunteers, all healthy adults selected via screening conducted at either Philadelphia’s Perelman School of Medicine at the University of Pennsylvania, or the Center for Pharmaceutical Research in Kansas City. It’ll span the next several weeks, and the company expects data around the immune responses from test subjects, as well as info pertaining to the safety of the treatment for humans, to be available by late this summer.

Source: A second potential COVID-19 vaccine, backed by Bill and Melinda Gates, is entering human testing 

F. New Scientific Findings and Other Advancements

1. Fifty-one recovered coronavirus patients test positive AGAIN in South Korea amid fears virus can hide in human cells and reactivate

• Fifty-one patients who recovered from coronavirus in South Korea have tested positive again, raising fears the virus can be reactivated.
• The patients – from the country’s worst-hit city, Daegu – were put in quarantine after being diagnosed with the virus, then tested positive again days being released.
• Korea’s Centers for Disease Control and Prevention (KCDC) said the virus was likely ‘reactivated’, rather than patients becoming re-infected.
• Scientists at the Government-run health body believe the virus may lay dormant at undetectable levels in human cells.
• They say that for unknown reasons the viral particles can then be reactivated – but it is unclear if patients become infectious again.
• And they say in cases where patients produce a positive result twice, it is normally because of a test giving the wrong result, which happens one in five times.
• Paul Hunter, an infectious diseases professor at the University of East Anglia, told MailOnline: ‘I agree that these will not be reinfections but I do not think these will be reactivations.
• ‘Personally I think the most likely explanation is that the clearance samples were false negative.’ 
• Professor Hunter highlighted that conventional coronavirus tests can give the wrong result 20 to 30 per cent of the time.
• He believes the test the South Korean patients were given before being released from quarantine wrongly showed they had recovered, when they were actually were still infected.

Source: Coronavirus South Korea: 51 recovered patients test positive

2. Data scientist reveals EYE PAIN may be a symptom of Covid-19 after tracking Google searches in some of the worst-hit American states

• A data scientist has claimed that Google search results from around the world could be key to determining undiscovered coronavirus symptoms as well as locating emerging outbreaks. Seth Stephens-Davidowitz explained how Google searches for the phrase ‘loss of smell’ align with the number of positive cases of coronavirus, and why he believes eye pain could be another unofficial signal of the illness.
• Most researchers now agree that loss of smell and taste is a symptom of Covid-19, affecting up to 60% of those who contract the illness. Searches for the phrase ‘loss of smell’ in the US were highest in New York, New Jersey, Louisiana, and Michigan, which are four cities worst hit by the outbreak. Mr Stephens-Davidowitz went on to predict that Ecuador could become a new epicentre for the virus based on people’s Google searches. 
• Writing in the New York Times, Mr Stephens-Davidowitz said: ‘Searches for “no puedo oler” (“I can’t smell”) are some 10 times higher per Google search in Ecuador than they are in Spain, even though Ecuador officially reports more than ten times fewer Covid-19 cases per capita than Spain does.  Ecuadoreans are also right near the top in searches for fever, chills and diarrhea.’
• Mr Stephens-Davidowitz argued that based on Google’s search history, there is evidence to suggest eye pain could also be considered a symptom of the virus. He explained how the amount of times ‘eye pain’ was searched for in Spain and Iran correlated with the rapid spread of the virus. Mr Stephens-Davidowitz argued that based on Google’s search history, there is evidence to suggest eye pain could also be considered a symptom of the virus.
• ‘Notably, searches for eye pain rose above fourfold in Spain between the middle of February and the middle of March and rose about 50 percent in Iran in March. ‘In Italy, searches for ‘bruciore occhi’ (“burning eyes”) were five times their usual levels in March.’ He continued: ‘I think search data offers suggestive evidence that eye pain can be a symptom of the disease.
• However, it might only affect a small fraction of Covid-19 patients. Overall search volume for eye pain, despite rising substantially in Covid-19 hot spots, remains well below search volume for other symptoms. ‘In New York there are now about one-sixth as many searches related to eye pain as there are searches related to loss of smell.
• ‘Nonetheless, doctors and public health officials should probably look closely at the relationship between Covid-19 and eye pain.’

Source: Data scientist reveals EYE PAIN may be a symptom of Covid-19

G. Observations & Unanswered Questions

1. Heart Damage in COVID Patients Puzzles Doctors

• While the focus of the COVID-19 pandemic has been on respiratory problems and securing enough ventilators, doctors on the front lines are grappling with a new medical mystery.
• In addition to lung damage, many COVID-19 patients are also developing heart problems — and dying of cardiac arrest.
• As more data comes in from China and Italy, as well as Washington state and New York, more cardiac experts are coming to believe the COVID-19 virus can infect the heart muscle. An initial study found cardiac damage in as many as 1 in 5 patients, leading to heart failure and death even among those who show no signs of respiratory distress.
• That could change the way doctors and hospitals need to think about patients, particularly in the early stages of illness. It also could open up a second front in the battle against the COVID-19 pandemic, with a need for new precautions in people with preexisting heart problems, new demands for equipment and, ultimately, new treatment plans for damaged hearts among those who survive.
• “It’s extremely important to answer the question: Is their heart being affected by the virus and can we do something about it?” said Dr. Ulrich Jorde, the head of heart failure, cardiac transplantation and mechanical circulatory support for the Montefiore Health System in New York City. “This may save many lives in the end.”

Virus Or Illness?

• The question of whether the emerging heart problems are caused by the virus itself or are a byproduct of the body’s reaction to it has become one of the critical unknowns facing doctors as they race to understand the novel illness. Determining how the virus affects the heart is difficult, in part, because severe illness alone can influence heart health.
• “Someone who’s dying from a bad pneumonia will ultimately die because the heart stops,” said Dr. Robert Bonow, a professor of cardiology at the Northwestern University Feinberg School of Medicine and editor of the medical journal JAMA Cardiology. “You can’t get enough oxygen into your system and things go haywire.”
• But Bonow and many other cardiac specialists believe a COVID-19 infection could lead to damage to the heart in four or five ways. Some patients, they say, might be affected by more than one of those pathways at once.
• Doctors have long known that any serious medical event, even something as straightforward as hip surgery, can create enough stress to damage the heart. Moreover, a condition like pneumonia can cause widespread inflammation in the body. That, in turn, can lead to plaque in arteries becoming unstable, causing heart attacks. Inflammation can also cause a condition known as myocarditis, which can lead to the weakening of the heart muscle and, ultimately, heart failure.
• But Bonow said the damage observed in COVID-19 patients could be from the virus directly infecting the heart muscle. Initial research suggests the coronavirus attaches to certain receptors in the lungs, and those same receptors are found in heart muscle as well.

Initial Data From China

• In March, doctors from China published two studies that gave the first glimpse at how prevalent cardiac problems were among patients with COVID-19 illness. The larger of the two studies looked at 416 hospitalized patients. The researchers found that 19% showed signs of heart damage. And those who did were significantly more likely to die: 51% of those with heart damage died versus 4.5% who did not have it.
• Patients who had heart disease before their coronavirus infections were much more likely to show heart damage afterward. But some patients with no previous heart disease also showed signs of cardiac damage. In fact, patients with no preexisting heart conditions who incurred heart damage during their infection were more likely to die than patients with previous heart disease but no COVID-19-induced cardiac damage.

Facing Obstacles

• Still, Dr. Sahil Parikh, an interventional cardiologist at Columbia University Irving Medical Center in New York City, said hospitals are making a concerted effort to order the tests needed and to enter findings in medical records so they can sort out what’s going on with the heart.
• Cardiologists in New York, New Jersey and Connecticut are sharing the latest COVID-19 information through a WhatsApp group that has at least 150 members. And even as New York hospitals are operating under crisis conditions, doctors are testing new drugs and treatments in clinical trials to ensure that what they have learned about the coronavirus can be shared elsewhere with scientific validity.
• That work has already resulted in changes in the way hospitals deal with the cardiac implications of COVID-19. Doctors have found that the infection can mimic a heart attack. They have taken patients to the cardiac catheterization lab to clear a suspected blockage, only to find the patient wasn’t really experiencing a heart attack but had COVID-19.
• New protocols now include bringing in a cardiologist and getting an EKG or an ultrasound to confirm a blockage.
• Sorting out how the virus affects the heart should help doctors determine which therapies to pursue to keep patients alive.

Source: Heart Damage in COVID Patients Puzzles Doctors

H. Practical Tips and Useful Information

1. A comprehensive guide to avoiding the grocery store and pharmacy

Here is a list of best practices when you visit the grocery store as a way of keeping yourself and others healthy.

Few and far between

• People should plan their once-every-10-days (or more) visit to Trader Joe’s, Whole Foods, Gristedes or wherever with military precision
• Families should plan meals for their weeks so they can create a comprehensive shopping list of ingredients, and not have to visit the stores for last minute ingredients. At the store, they should practice social distancing, stick to the list of items they have drawn up and choose hours in the early morning or later at night, when the stores are less crowded.
• This also may be a good time to start using all those beans and canned food you stocked up on.

Other delivery options

• If possible, using a delivery service will help you stay inside. Some users report success with popular grocery delivery services such as Fresh Direct by placing orders in the middle of the night. Other services to try out include Instacart, Amazon Fresh and Peapod, though you may experience delays. Mercato is offering free delivery for those 60 years or older with the code OVER60.
• And wholesalers with no restaurants to supply have opened up their stocks to the public, including Baldor Specialty Foods and Chef’s Warehouse. Both are serving areas including New York City.

Dress appropriately

• People should also follow the CDC’s updated advice to wear masks and latex gloves and, according to Ahn, wash every item they buy in soapy water and then rinse them off with cold water the moment they arrive home. [Note: Other guidance has suggested that washing fruits and vegetables with soap can lead to other gastrointestinal issues]
• “You also must be extremely cautious when you take off your gloves and remove them with one flip of the palm and wrist,” she says. “You need to copy the way you see surgeons do this on the TV.”

Cart carefully

• Meanwhile, food scientist Kimberly Baker, food systems and safety program director at Clemson University in South Carolina, explains that wiping down your cart with sanitizing wipes — or paper towels soaked in hand-sanitizer — goes a long way in stopping the spread of COVID-19.
• “A lot of stores have run out of their own supplies of wipes, so bring your own,” says Baker.

Prep safely

• One of Baker’s biggest concerns is people not properly handling the abnormally large amount of groceries they are buying — particularly meat. She warns that foodborne illnesses such as salmonella could land consumers in the hospital. “That’s a place you really want to avoid at the moment,” she adds.
• The answer is to freeze as much food as possible that you are not going to eat over the following days, and then defrost items correctly in the refrigerator, not on the kitchen counter.
• “If you don’t do it in the fridge, then the next best thing is to run the items under cold, running water,” she says. “You can defrost it in the microwave, but then you get those uneven hot spots, so you need to double-check it has been defrosted all the way through.”
• Dr. Ahn is more of a fan of the microwave, insisting that it can be a lifesaver if you heat foods to between 140 and 150 degrees Fahrenheit, as that will kill COVID-19.

Order in

• Ordering takeout remains a safe option during the pandemic, especially with curbside delivery options. But Ahn says to never eat the takeout out of the packaging it came in. “Instead, place the food on a plate or into a bowl and get rid of the boxes or containers,” she says.

Farm-fresh options

• Both experts recommended people shop at open-air farmers’ markets as long as they practice caution with social distancing. Other options are popping up for grocery delivery — from gourmet healthy options to some more affordable local options, such as C-Town and Met Fresh. There’s also several Community Supported Agriculture (CSAs) box options that are now delivering.
• Baker even went so far as to suggest that would-be green thumbs start planting their own provisions.
• “Buy the seedlings now for things like peas, cucumbers and squash and you will reap the benefits in a couple of months,” she adds. “If you’re in a New York City apartment, consider growing your own herb garden in a pot or window box.”

Source: How to avoid the grocery store after feds warn against it