New York Healthcare System Bends But Does Not Break
“We should start to see beginning of a turnaround beyond this week – a good sign.” — Dr. Fauci
“The bad news isn’t just bad. The bad news is actually terrible.” — NY Governor Cuomo
“To think we’re close to an endpoint would be dangerous.”
— Hans Kluge, the WHO’s regional director for Europe
- Recent Developments and Headlines
- Numbers and Trends
- Projections and Our (Possible) Future
- Potential New Treatments
- New Scientific Findings
- Stories From the Front Line
- The Road Back
- 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 4/08 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: 1,519,571 (+6.1%)
- Worldwide Active Cases = 1,100,010 (+5%)
- US Active Cases = 397,472 (+8.6%)
- NY Active Cases = 131,537 (+6.5%)
- US deaths = 14,797 (+1,940) (+15.1%)
- NY deaths = 6,268 (+779) (+14.2%)
- WHO again insists lockdowns must stay in effect
- 77% of Americans Blame China for Coronavirus Outbreak
- IHME Model Lowers U.S. Coronavirus Death Projections by 25% to 60,415
- New York State Now Has More Confirmed COVID-19 Cases Than Any Single Country
- Hospitalizations down in NY, but deaths set record
- Gov. Cuomo Orders Flags at Half-Mast as New York Coronavirus Deaths Set Another Record
- NYC Mayor de Blasio: NYC only using fraction of ventilators of what was expected
- Coronavirus was spreading in NYC weeks before first case, researchers say
- Federal government stockpile of protective gear nearly drained
- CDC issues new guidance for essential workers during coronavirus
- Feds eye loosening rules to allow some to return to work
- Hospitals say feds are seizing masks and other coronavirus supplies without a word
- LA mayor orders businesses to enforce social distancing
- DC fights to enforce distancing and braces for looming surge
- China reopens Wuhan
- Wuhan may be celebrating, but another Chinese city has gone into lockdown over coronavirus
- Coronavirus pandemic pushes US and China closer to cold war
- Ethiopia joins growing list of African states by declaring state of emergency
- Asian countries that beat COVID-19 have to do it again as travelers from US and Europe reimport the virus
- Russia reports another record daily jump in new cases
- UK reports another record jump in deaths
- France extends lockdown after April 15
- Italy’s daily coronavirus death toll falls, but new cases accelerate
- Iraq extends border closure with Iran
- Erdogan Under Pressure to Impose Lockdown as Coronavirus Spreads in Turkey
- Mexican Coronavirus Cases Climb 12 Percent in One Day
- Indonesia outbreak continues to accelerate
- In El Salvador, gangs are enforcing the coronavirus lockdown with baseball bats
- Confirmed cases across Africa pass 10k
- Ecuador builds emergency cemeteries due to coronavirus outbreak
- European Medicines Agency Warns of Looming Drug Shortages
- Taiwan: Over 70% of Coronavirus Fake News Comes from China
- Italian Mayor Fines Retiree for Visiting His Daughter During Lockdown
- UK Prime Minister Boris Johnson Improves
- More People Died Of Suicide Last Week In Tennessee Than COVID-19
- Scientists find evidence some recovered don’t have antibodies
- Gavin Newsom: California to Source 200 Million Masks per Month from ‘Asia’
- Pastor says his parishioners would rather DIE than not go to church as he refuses to stop services during lockdown
- Pastor who criticized coronavirus ‘mass hysteria’ dies from illness
- California sheriff warns he can arrest and fine people $1,000 for not wearing masks in public
- California still way behind in coronavirus testing despite recent advances
- NJ Town Resorts to Talking Drones to Enforce Social Distancing
- Broadway To Remain Closed Through June 7, Possibly Ending 2019-2020 Season Early
- Farmers are panic-buying to keep America’s 95 million cows fed
- Doctors Pressuring Senior Citizens to Sign Do Not Resuscitate Forms
- Polish church does drive-thru confession for Easter
- Taiwanese Baseball Team to Use Robot Mannequins as Fans
- Players, Managers Intrigued by MLB’s All-Arizona Option
- As coronavirus fears grow, doctors and nurses face abuse, attacks
- Tested positive for coronavirus? Health workers may share your address with police
- WHO investigating human transmission of virus to pets…
- Disney might check visitors’ temperatures when theme parks reopen, chairman says
- Airlines to Cut Summer Flights Up to 90% With Rebound Remote
- Pot Use Reached All-Time High in March Amid Lockdown Measures
- Chicago Mayor Signs Executive Order Allowing Illegal Immigrants Access To Virus Relief Funds
- NY skyscraper with homes worth up to $60m could be left empty as clause that lets buyers walk away approaches during coronavirus lockdown
- New York’s coronavirus death toll now greater than several countries — including China
- NYC park-goers threaten to spit, cough on cops enforcing social distancing
- Most New Yorkers worried about financial fallout from coronavirus
- More than 30 members of the United Federation of Teachers have died from coronavirus
- Homeless in NYC shelter ‘sitting ducks’ for coronavirus
- NYC park-goers threaten to spit, cough on cops enforcing social distancing
- US medical workers sue China for ‘hoarding’ PPE during coronavirus pandemic
- Grocery clerk dies of coronavirus, leaves goodbye video for family on phone
- Coronavirus threatens to shrink struggling US movie theater chains
- Clinic opens drive-thru coronavirus testing for Amish, Mennonites
- Dr. Anthony Fauci, governors top new poll on coronavirus response
- Smokers urged quit over risk of developing severe coronavirus symptoms
- Nike turns sneaker materials into face shields for medical workers
- Mountain biker fined over $1K for ride amid coronavirus restrictions
- Cops bust Texas teen who boasted about spreading coronavirus
- Wuhan marks end of coronavirus lockdown with striking light show
- CDC website removes key information on controversial anti-malarial drugs
- Sailors ordered to clean coronavirus-stricken ship while wearing T-shirt masks
- Northern Irish women told to sail to England for abortions despite pandemic
- NY Gov. Cuomo rejects Broadway’s plan to reopen on June 7
- People are reportedly panic-buying baby chickens
- Engineers convert breast pumps into ventilators to combat coronavirus shortages
- EU’s top scientist quits, ‘extremely disappointed’ in coronavirus response
- Doctor warns against oximeter supply and demand issue
- Florida residents risk coronavirus exposure to line up for unemployment benefits
- Face shields given to newborn babies to fend off coronavirus
- Teen student pilot flies medical supplies to hospitals amid pandemic
- Hundreds dead in Iran after drinking pure alcohol as coronavirus ‘cure’
- Army chief worried soldiers could have already had coronavirus without knowing
- Authorities remind Californians that stay-at-home order means no ‘snowplay’
- Louisiana woman, three sons die from coronavirus days apart
- Amazon sidelines its third-party shipping service
- Broadway theaters to be closed longer than expected due to the coronavirus
- Netflix adds PIN protection to keep your roommate off your account
- Mysterious monkey deaths spark ‘enormous panic’ in India amid coronavirus fears
- Venezuelan doctors can’t get to work because they’re stuck in gas lines
- Chicago shelter runs out of adoptable animals for first time ever
- Landlord changes church locks to stop pastor from defying lockdown
- New Orleans forms ‘death task force’ to handle coronavirus carnage
- Nursing home patient asked Alexa for help before dying from coronavirus
- Keep pet cats indoors to limit spread of coronavirus, vets urge
- Panera Bread pivots to selling groceries as coronavirus slams industry
- Coronavirus outbreak brings sharp drop in fossil fuel emissions
- ‘Totally out of control’: NYC funeral homes buried by COVID-19 death toll
- NBC anchor says his dad died from coronavirus ‘with a stranger holding his hand’
- Thousands leave Wuhan hours after coronavirus lockdown lifted
- Paris bans daytime jogging as coronavirus deaths in France top 10,000
- GM to make 30,000 ventilators to help US fight coronavirus pandemic
- Coronavirus-stricken cruise ship passengers need nearly $10K to fly home
- Hawaii mayor to arrested Florida man: You’re a ‘Covidiot’
- Coronavirus has NYC buildings eyeing new cleanliness and security protocols
- Anthony Fauci bobblehead raises $100,000 to buy coronavirus masks
- Pampered Kuwaitis Quibble in Five-Star Luxury Quarantine
- Pope Francis says coronavirus could be ‘nature’s response’ to climate change
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: 1,519,571 Total Cases (+6.1%)
- New Cases = 86,908 (+4,068) (+4.9%)
- Europe: 733,911 Total Cases (+4.7%)
- New Cases = 33,109 (-1,205) (-3.5%)
- Asia: 131,627 Total Cases (+2.4%)
- New Cases = 3,133
- United States: 435,160 Total Cases (+8.6%)
- New Cases = 34,331 (+1,152) (+3.5%)
- US States:
- 38 States > 1,000 cases (+2), plus DC
- 25 States > 2,500 cases (+1)
- 17 States > 5,000 cases (+2)
- 11 States > 10,000 cases (+2): NY, NJ, MI, CA, LA, MA, FL, PA, IL, TX & GA
- Top 5 States: (i) NY: 151,171 (+8,823); (ii) NJ: 47,437 (+3,021); (iii) Michigan: 20,346 (+1,376); (iv) California: 19,063 (+1,443); and (v) Louisiana: 17,030 (+746)
- For more information on US States, see https://ncov2019.live/data
- New York State:
- NY Total Cases = 151,171 (+6.3%)
- NY New Cases = 8,823 (-1,609) (-15.4%)
- New York City:
- Total Cases = 76,876 (+3.1%)
- NYC New Cases = 2,275 (-145) (-6%)
2. Confirmed Active Cases
- Worldwide: 1,100,010 Active Cases (+5%)
- New Active Cases = 54,783 (-5,318) (-8.9%)
- Europe Active Cases = 491,191 (+6,409) (+1.3%)
- Asia Active Cases = 36,348 (+1,818)
- US Active Cases = 397,472 (+8.6%)
- US New Active Cases = 31,500 (+2,425) (+8.3%)
- NY Active Cases = 131,537 (+6.5%)
- NY New Active Cases = 8,008 (-1,724) (-17.7%)
3. Serious or Critical Cases
- Worldwide serious or critical cases = 48,166 (+251)
- US series or critical cases = 9,279 (+110)
- NY serious or critical = 4,504
- US serious or critical cases = 2.3% of Active Cases (-0.2%), compared with worldwide percentage of 5%
[Note: Serious and critical cases give insight into the need for ICU beds and ventilators]
- Worldwide deaths = 88,550 (+6,429) (+7.9%)
- Europe: 61,181 deaths (+3,864) (+6.8%)
- Asia: 4,512 deaths (+73) (+1.6%)
- US deaths = 14,797 (+1,940) (+15.1%)
- NY deaths = 6,268 (+779) (+14.2%)
- Deaths per 1M population: (i) Italy: 292; (ii) Spain: 316; (iii) US: 45; (iv) France: 167; & (v) Germany: 28
- Worldwide Total Confirmed Case Fatality Rate = 5.8% (0.1%)
- US Total Confirmed Case Fatality Rate = 3.4% (+0.2%) [Note: The number of cases in which infected people recovered without being tested is believed to be a large number, which would substantially reduce the fatality rate. US health officials have estimated that the US actual fatality rate is 1% or less.]
- Worldwide recoveries = 331,011 (+9.5%)
- US recoveries = 22,891 (+5.4%)
- NY recoveries = 13,366
C. Projections and Our (Possible) Future
1. What Does a Coronavirus Peak in New York Mean?
- Trends in key statistics have sparked talk of a decline, but experts say it is far from certain
- The number of new Covid-19 cases in New York appears to be stabilizing, sparking hope among officials that the disease may finally be near its peak in the U.S. epicenter of the pandemic. But health experts caution that the public needs to be clear on what that prospect means.
- Officials track numerous data points related to the new coronavirus, which causes Covid-19, from daily intubations to deaths. A key figure is the number of new hospitalizations, which can overwhelm health-care systems if they exceed capacity.
- That number seems to be peaking in New York, with the three-day hospitalization rate having fallen more than 20% as of Monday, Gov. Andrew Cuomo said in a media briefing Tuesday. Intensive care admissions have been dropping significantly since Friday, according to state data. Deaths plateaued for a couple of days, then increased again, but the decline in fatalities usually lags behind that in cases by days or weeks, health officials say.
- “I like what I’m seeing in New York,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, in an interview with The Journal podcast. “I’d like to see that extended over several more days.”
- A model developed by the Institute for Health Metrics and Evaluation at the University of Washington predicts that peak demand on New York hospitals will occur Wednesday. It projects that the peak number of deaths will occur the following day, with 878 predicted. Thereafter, hospitalizations and deaths are forecast to fall sharply over the remainder of the month.
- The pattern is similar to what researchers have observed in other countries, like Italy and Spain, where the new coronavirus struck earlier.
- “Once you turn that corner and come down, the decline is pretty steep,” Dr. Fauci said.
- That doesn’t mean people can let down their guard, health officials warn. As it stands, hospitals and health-care facilities in New York still lack all the resources needed to care for those infected and are likely to face shortages throughout the peaking period. If jurisdictions loosen restrictions too early, they run the risk of triggering a second wave of contagion and taxing hospital staff and resources even further.
- “As you start to see those cases decrease or cease, you have to wait 14 to 28 days longer before you really say it is all clear,” said Dr. Gregory Poland, who directs the Vaccine Research Group at Mayo Clinic.
- Other states are seeing hopeful signs. Washington Gov. Jay Inslee said Sunday that the state was returning 400 ventilators to the national stockpile because of indications that mitigation efforts were working.
- IHME’s model estimates that peak hospital demand occurred in Washington on April 2 and anticipates the same in Michigan and Ohio on Wednesday. For the U.S. overall, peak hospital demand is forecast to happen on April 15, with demand dwindling by early June. Total deaths across the country are projected to top 81,000. [Note: That number is now projected in the updated IHME model to be approximately 60,000.]
- The institute altered the model based on data showing less time for the pandemic to peak in Italy and Spain after the implementation of social-distancing measures than in Wuhan, China, where the outbreak began. As a result, predicted peaks of hospital demand and deaths in the U.S. were shifted to earlier dates.
- The pandemic is now expected to subside sooner than researchers initially thought, said Dr. Ali Mokdad, chief strategy officer for population health at the University of Washington.
- “That is good news,” he said. “The bad news is…we have less time to prepare.”
- As communities plan for the eventual easing of lockdowns, Dr. Mokdad said he would advise doing so gradually in phases, closely monitoring infection data for any upticks in cases. Such an approach might involve allowing some businesses to reopen while holding off on reopening schools or churches.
- “If no virus is circulating, then maybe you allow a second wave of measures,” he said.
- Mr. Cuomo said despite signs New York is nearing the peak, orders banning unnecessary gatherings and closing schools and nonessential businesses must stay in place to prevent flare-ups.
- “To the extent that we see a flattening or a possible plateau, that’s because of what we’re doing, and we have to keep doing it,” he said.
Source: WSJ here.
2. Dire Predictions of Outbreak Are Greatly Exaggerated as New York’s Healthcare System Bends But Does Not Break
- For much of the month, the NY Governor Cuomo was warning that the New York healthcare system would be overwhelmed at the peak of the outbreak, which he expected to occur in mid-to-late April. Governor Cuomo claimed that New York needs an additional 30,000 ventilators and 90,000 additional hospital beds.
- In the updated version of the IHME Model dated April 8, the model projects that New York would not have enough hospital beds, ICU beds or ventilators at the peak of the outbreak, which the model projected to occur on April 8. NY Governor Cuomo and NYC de Blasio have stated that New York currently has enough hospital resources to deal with the outbreak.
- While it is premature to determine whether New York has reached the peak (or apex) of the outbreak, the number of new cases and hospitalizations in New York have been decreasing. So, it seems likely that New York is approaching the peak if not yet there. We will provide updates on New York’s progress as more data becomes available.
- Although the IHME model’s projections of the number of deaths as so far been reasonably accurate, the model’s projections of hospital beds, ICU beds and ventilators required have been substantially overestimated. While some have argued that the actual numbers are less than the projections because of social distancing, that ignores the fact that the projections assume social distancing measures are in effect.
- As a result, neither the IHME model nor any other projections have provided policymakers or the public with a useful tool in projecting the impact of the outbreak on healthcare systems. But perhaps the silver lining to the projections is that they galvanized (or panicked) policymakers into swift and significant action that appears to have prepared our healthcare systems to handle the outbreak, even if under substantial stress.
3. ‘By December, we are going to go through this again’
- As the United States faces down the dual crises of the Covid-19 pandemic and a widespread shortage of medical supplies and equipment, Dr. Janis Orlowski is working 13-15 hours a day trying to mitigate the damage.
- As the chief health care officer of the Association of American Medical Colleges, she talks with senior government officials daily. She listens to the concerns of some of the biggest hospitals in the country — the shortages of masks and ventilators and ICU beds and doctors and nurses. And she’s sober-minded about the weeks and months ahead. Below are excerpts from an interview with Dr. Orlowski.
- The U.S. needs to continue to prepare ourselves, because the number of cases will continue to rise until mid to late April. My colleagues and I looked at statistics, and we expect that there will be a continual rise until around April 16th, April 17th. The numbers are beginning to say this is likely where the peak of the epidemic is going to be. We need to continue to prepare our health care systems and our health care workforce for what is going to be a continual rise in cases at least for the next two weeks, and then a sustained number of cases probably for, I’d say, seven weeks after that.
- I believe that we’re going to return to a semi-normal life at the end of May — Memorial Day. But the other thing that I would say is that we have to prepare ourselves to go through a similar exercise in the fall, in the late fall. If you take a look at the 1918-1919 influenza pandemic, and if you take a look at how coronavirus is acting, this is not just the winter and spring of 2020. Probably late November, by December, we are going to go through this again.
- Now, what we hope is that we have a vaccine, but there’s not going to be a vaccine that’s going to be ready in 6-8 months. And so the likelihood is that we’re going to spend the summer months having a semi-normal life, but getting ourselves prepared to go through this again and go through it better. Be ready to stay at home. Understand what that means. Everyone get as much toilet paper as they need to have. We’re going to do this again and we’re going to be smarter and better at doing this. And so, let’s start talking about how we make it through the next seven weeks. But then let’s talk about how we’re going to do it smarter, come the winter time.
You can listen to the interview here
4. Updated IHME (Murray) Model (4/8/20): Significant Reductions in the Projected Number of Resources Required and Deaths
- The IHME Projection Model is a model that includes projections of (i) the resources required by each State (e.g., the number of hospital beds, ICU beds and ventilators), (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 8 Update
- Unexpectedly and without any official press releases or explanations, IHME made further significant changes to its predictive model with its April 8 update. This comes on the heels of a significant update on April 6.
- With the release of the revised model on April 8, the COVID-19 deaths and hospital resource use model includes substantial improvements. We will summarize the observable changes here.
Predicting COVID-19 Deaths: What Changed from the April 6 Update?
- The following changes were highlighted:
- Peak date for daily deaths has moved up to April 12 from April 16
- Daily deaths at peak date decreased to 2,212 down from 3,130 (-918)
- Cumulative deaths significantly reduced to 60,415 down from 81,766 (-21,351)
- The range of deaths is now 31,221 to 126,703 (the lower end of the range decreased by 18,210 and the upper end of the range decreased by 9,698)
Predicting Hospital Resource Use: What Has Changed?
- The following changes were highlighted:
- Peak date for hospital use for the US was moved forward to April 11 from April 15
- Total hospital beds needed at peak drops significantly to 94,249 from 140,823 (-46,574)
- The range has also changed and is now projected to be 41,789 to 211,305 beds, which is a reduction from 73,390 to 284,549
- ICU beds needed at peak falls to 19,438 from 29,210 (-9,772)
- The range is dropped to 9,548 to 41,458
- Invasive ventilators needed at peak declines significantly to 16,921 from 18,992 (-2,071)
- The range falls to 8,109 to 35,303
- In addition to the changes noted above, several states have had their peak usage of hospital beds change significantly.
- 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 5.
D. Potential New Treatments
1. More Coronavirus Vaccines and Treatments Move Toward Human Trials
- Just three months after the start of the coronavirus pandemic, several biotech companies are beginning trials of promising vaccines and treatments.
- On Wednesday, Novavax, a Maryland-based biotech company, said it would begin human trials in Australia in mid-May for its vaccine candidate. Novavax is one of more than two dozen companies that have announced promising vaccine programs that are speeding through the early stages of testing unlike ever before.
- Also on Wednesday, the stem-cell company Mesoblast said it was starting a 240-patient clinical trial, supported by the National Institutes of Health, that would test whether cells derived from bone marrow could help patients who developed a deadly immune reaction to the coronavirus.
- Novavax said its vaccine candidate had stimulated a powerful immune response in lab and animal experiments, producing antibodies that could fight off the coronavirus.
- A vaccine made by the biotech company Moderna is already in a clinical trial, which started March 15. Another one, developed by Inovio Pharmaceuticals, was injected into the first adult volunteers on Monday. The health care giant Johnson & Johnson expects to start clinical trials in September, and has received a nearly $500 million partnership via a division of the U.S. Department of Health and Human Services. And experimental vaccines developed by researchers at the University of Pittsburgh and Baylor College of Medicine in Houston are also waiting for permission from the Food and Drug Administration to begin testing in people.
- While many people who are infected with the coronavirus experience mild symptoms, others develop a severe case when their immune systems go into overdrive and begin attacking the body’s organs, which is called a “cytokine storm.” This can set off something called acute respiratory distress syndrome, which damages the lungs and is often deadly. Several other treatments are also being tried to calm this storm and reset the immune system.
- Dr. Silviu Itescu, chief executive of Mesoblast, said the company decided to test its treatment in these Covid-19 patients because its product had shown good results in children who developed a similar deadly immune reaction called acute graph versus host disease, in which the body’s immune cells can attack healthy cells after receiving a bone-marrow transplant. Their treatment is currently being reviewed by the Food and Drug Administration for use in that disease.
- Another stem cell company, Athersys, has said it is also planning a study of stem cells in coronavirus patients with advanced respiratory distress syndrome, but is not as far along.
- Nine coronavirus patients at Mount Sinai Hospital in New York have received the Mesoblast treatment on an emergency basis, and doctors there said the initial response was promising. Six patients were removed from ventilation and others were being weaned off or had remained stable — a welcome development when most patients who need ventilator support do not survive.
- Still, a vaccine would be the best way to stop further spread of the coronavirus because it enhances the immune system’s natural defenses. Of course, many companies are also struggling with ways to partner with manufacturing ventures to produce enough vaccine so that it will be widely available.
2. Israeli COVID-19 treatment shows 100% survival rate
- Six critically ill coronavirus patients in Israel who are considered high-risk for mortality have been treated with Pluristem’s placenta-based cell-therapy product and survived, according to preliminary data provided by the Haifa-based company.
- The patients were treated at three different Israeli medical centers for one week under the country’s compassionate use program and were suffering from acute respiratory failure and inflammatory complications associated with COVID-19. Four of the patients also demonstrated failure of other organ systems, including cardiovascular and kidney failure.
- Not only have all the patients survived, according to Pluristem, but four of them showed improvement in respiratory parameters and three of them are in the advanced stages of weaning from ventilators. Moreover, two of the patients with preexisting medical conditions are showing clinical recovery in addition to the respiratory improvement.
- “We are pleased with this initial outcome of the compassionate use program and committed to harnessing PLX cells for the benefit of patients and healthcare systems,” said Pluristem CEO and president Yaky Yanay. “Pluristem is dedicated to using its competitive advantages in large-scale manufacturing to potentially deliver PLX cells to a large number of patients in significant need.”
- Pluristem’s PLX cells are “allogeneic mesenchymal-like cells that have immunomodulatory properties,” meaning they induce the immune system’s natural regulatory T cells and M2 macrophages, the company explained in a previous release. The result could be the reversal of dangerous overactivation of the immune system. This would likely reduce the fatal symptoms of pneumonia and pneumonitis (general inflammation of lung tissue).
- Previous preclinical findings regarding PLX cells revealed significant therapeutic effects in animal studies of pulmonary hypertension, lung fibrosis, acute kidney injury and gastrointestinal injury.
- Pluristem plans to apply for initiation of a multinational clinical trial for the treatment of complications associated with coronavirus, the release said, noting that it will no longer report on its compassionate use trials but rather on the status and progress of its contemplated clinical trial.
3. Novavax to start human trial for ‘ideal’ coronavirus vaccine candidate
- The biotech company Novavax announced Wednesday that it has identified an “ideal” coronavirus vaccine candidate — and is set to launch the first clinical human trial in mid-May.
- The candidate, NVX-CoV2373, proved its ability to produce immune responses and high levels of antibodies against COVID-19 in pre-clinical animal trials.
- “This is strong evidence that the vaccine created by Novavax has the potential to be highly immunogenic in humans which could lead to protection from COVID-19 and helping to control the spread of this disease.”
- The “ideal vaccine candidate” was “selected from a number of constructs,” Dr. Gregory Glenn, president of research and development at Novavax, said in the statement.
- The company is working with another Gaithersburg firm, Emergent BioSolutions, to help expedite the process of rolling out the vaccine.
- The expected mid-May trial launch is “weeks ahead of schedule,” Stanley C. Erck, president and CEO of Novavax, said in the statement.
- Last month, the Coalition for Epidemic Preparedness Innovations awarded Novavax a $4 million investment to support its efforts, with additional funding discussions underway, according to the statement.
4. This potential coronavirus vaccine could be as easy as sticking on a bandage
From an interview with Louis Falo is a professor of dermatology at the University of Pittsburgh.
- Called the PittCoVacc vaccine, it is a simple protein vaccine that is made from a small piece of one of the virus’s proteins, much like some of the flu vaccines that are now on the market.
- There are currently many groups around the world working to develop a vaccine. What’s different with our design is the way the vaccine is delivered to people. Rather than inject the vaccine via a traditional shot, we use a small patch which has hundreds of small needles. We hope this delivery device will be simpler to produce in large numbers and administer to people.
Band-Aid with ‘microneedles’
- Like traditional vaccines, our vaccine uses a small piece of the virus as an antigen, or “target” to stimulate the body’s immune response to make antibodies that recognize and bind to that target on the virus.
- In this case, the target is from the virus’s S1 spike protein. This is the critical part of the virus that recognizes a protein receptor on our own human cells – and works much like putting the virus’s key in our own cells’ lock. Once the spike protein attaches to our cells, it enables the virus to enter our cells and cause the infection.
- Using a simple protein antigen is common in vaccine design. What is new in this vaccine is the way we deliver that antigen: through a new delivery platform called a dissolvable microneedle array.
- This is like a Band-Aid, but with hundreds of small needles, roughly the width of a human hair and just over half a millimeter in length. In this case, the microneedles are made out of a sugar-like substance mixed with the antigen.
- When the vaccine patch is stuck on the skin, the microneedles poke into the skin and dissolve, releasing the antigen without causing pain or bleeding. This delivers the vaccine to a region of the skin that has specialized “scout” cells known as dendritic cells that recognize foreign invaders, and carry that information to the body’s immune system factories where antibodies are made.
Potential to scale quickly
- When we tested this microneedle coronavirus vaccine in mice, we saw that it helped trigger the production of many antibodies which can then respond to the target protein on the virus.
- The advantage of our microneedle delivery system is that it is relatively straightforward to make and uses very little antigen. That means that production can be scaled up very quickly.
- In addition, unlike most vaccines that need to be kept cold from when they are made until they are given to the patient, this vaccine does not require this “cold chain” and can be distributed and stored at room temperature like Band-Aids. Cutting out this cold chain — a goal researchers have been pursuing for years — reduces cost and should facilitate global vaccine distribution.
5. The most promising coronavirus breakthroughs so far, from vaccines to treatments
- For story, see Coronavirus breakthroughs: How close are we to a vaccine?
E. New Scientific Findings and Other Advancements
1. Virus May Spread Twice as Fast as Earlier Thought, Study Says
- The new coronavirus raced through China much faster than previously thought, a U.S. research team said, suggesting that extremely widespread vaccination or immunity will be necessary to end the pandemic.
- Each person infected early in the epidemic in Wuhan probably passed the virus to an average of 5.7 other people, according to a mathematical analysis from Los Alamos National Laboratory. That’s more than twice what the World Health Organization and other public health authorities reported in February.
- The team’s results are specific to the Chinese outbreak. If they hold true elsewhere in the world, the pandemic may be more difficult to control than some authorities had modeled.
- At the rate of spread calculated in the study, some 82% of the population would need to be immune [“Herd Immunity”], either via a vaccine or because they’d already had the disease, in order to stop the virus from spreading, the Los Alamos team said. Without such protection, high levels of social distancing will be needed if more than one out of five infectious people is undiagnosed, the authors said. [Note: Previous studies have indicated Herd Immunity would be achieved at or around 50%-60%]
- Governments around the world are trying to figure out when and how to emerge from weeks of lockdown, even as some parts of China renew restrictions after a fresh flare-up. Nearly 1.5 million people have tested positive globally, including a number of recent cases in China with none of the typical symptoms of Covid-19.
- “To think we’re close to an endpoint would be dangerous,” Hans Kluge, the WHO’s regional director for Europe, said at a briefing on Wednesday. The WHO has said a renewed push to test patients, isolate them and trace their close contacts will be needed as countries gradually loosen restrictions on public life.
- The Los Alamos report, published in Emerging Infectious Diseases, used mobile phone travel data and case reports of coronavirus outside the early epicenter in China’s Hubei province to calculate its spread. The decline in newly confirmed cases in China and South Korea in March shows it can be contained, the report said.
2. Obesity is major COVID-19 risk factor
- Being overweight is a major risk for people infected with the new coronavirus and the United States is particularly vulnerable because of high obesity levels there, France’s chief epidemiologist said on Wednesday.
- Professor Jean-François Delfraissy, who heads the scientific council that advises the government on the epidemic, said as many as 17 million of France’s 67 million citizens were seriously at risk from the coronavirus because of age, pre-existing illness or obesity.
- “This virus is terrible, it can hit young people, in particular obese young people. Those who are overweight really need to be careful.”
- Delfraissy said 88% of those infected with the coronavirus suffered only severe flu-like symptoms.
- The mortality rate for young people entering hospital with severe COVID-19 respiratory disease was about 2%, but that rose to 14% for people who are more fragile.
- “Initial data show that the number of people who may have developed immunity is lower than we imagined, about 10-15%.”
- Obesity has been cited as a possible explanation for higher than average per-capita COVID-19 death rates in the U.S. city of New Orleans and in Mexico.
F. Stories From The Frontline
1. Some coronavirus patients on ventilators may not need them, report says
- Some top doctors on the front lines treating COVID-19 patients say that many of them could be effectively treated with less invasive respiratory support than that provided by ventilators.
- If they are right, putting patients on ventilators could offer little help to many and could even be harmful to some of them, according to STAT, a respected health care website.
- The doctors have treated many patients whose blood oxygen levels were so low they should have been dead, but they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of shutting down from lack of oxygen.
- The critical care physicians fighting the spreading pandemic suspect that blood levels of oxygen, which for decades have been used to determine the level of help patients with pneumonia and other respiratory ailments, might be misleading when it comes to COVID-19
- As a result, more doctors are concerned about the use of intubation and mechanical ventilators, a shortage of which still plagues many hospitals and health care facilities across the US, with states struggling to find more and the federal government not having enough to go around.
- The experts argue that more patients could benefit from simpler, less invasive respiratory support, such as the breathing masks used to treat sleep apnea, at least at the beginning and maybe until they recover.
- “I think we may indeed be able to support a subset of these patients” with less invasive breathing support, Sohan Japa, an internal medicine physician at Boston’s Brigham and Women’s Hospital, told STAT.
- This doesn’t mean that ventilators are not needed during the pandemic, which has killed nearly 13,000 Americans.
- But as doctors learn more about the virus, they might be able to substitute simpler and more widely available devices.
- “Most hospitals, including ours, are using simpler, noninvasive strategies first,” including the apnea devices, said Greg Martin, a critical care physician at Emory University School of Medicine and president-elect of the Society of Critical Care Medicine.
- “It doesn’t require sedation and the patient [can remain conscious and] can participate in his care. But if the oxygen saturation gets too low you can achieve more oxygen delivery with a mechanical ventilator.”
- But because in some patients, blood-oxygen levels fall to hardly-ever-seen levels, doctors are still intubating them sooner.
- The problem, critical care physician Cameron Kyle-Sidell told Medscape this week, is that because American physicians had never seen COVID-19 before February, they are basing decisions on conditions that may not be good guides, the website reported.
- “This may be an entirely new disease,” he said, suggesting that ventilator protocols developed for other medical conditions might not be the right guidelines as the mortality rate for patients put on ventilators is high.
- Kyle-Sidell also said in a video this week that turning the pressure up on ventilators can damage peoples’ lungs.
- “We are putting breathing tubes in people and putting them on ventilators and dialing up the pressure to open up their lungs,” he said.
- “I’ve talked to doctors all around the country and it is becoming increasingly clear that the pressure we’re providing may be hurting their lungs, that it is highly likely that the high pressures we’re using are damaging the lungs of the patients we are putting the breathing tubes in,” he said in the 2-minute video.
2. Car company designs ventilator using windshield wiper motor for COVID-19 treatment
- Spanish automaker SEAT has quickly developed a ventilator for the coronavirus fight that uses car parts and is being built on one of its automotive assembly lines near Barcelona.
- Working from an open-source design, The VW-owned company’s engineers repurposed a windshield wiper motor to operate the device’s pump.
- SEAT said it went through 13 prototype stages over the past two weeks before finalizing the design, which shares 90 percent of its materials with the Leon compact car model normally that’s manufactured at the facility.
- The tower computer size-device is made from just over 80 electronic parts and is sterilized by ultraviolet light when completed.
- The Spanish Agency for Medicines and Healthcare Products – Spain’s equivalent to the FDA – has authorized it for clinical trials, and SEAT said it has the capability to build up to 300 per day when it is approved.
- Ford and General Motors have also started work manufacturing ventilators from existing medical designs, while Tesla has incorporated parts from its cars into a prototype it is working on, but hasn’t said when it would submit it for government approval or begin producing it.
G. The Road Back
1. Former FDA chiefs outline plan to reopen the economy — when broad testing in place
- Five healthcare experts — including former top government healthcare officials Scott Gottlieb and Farzad Mostashari — have proposed a plan to build a national COVID-19 surveillance system.
- A system to effectively track and trace COVID is a prerequisite for gradually reopening the economy, the healthcare leaders said in a recent paper issued by the Duke-Margolis Center for Health Policy.
- “We need to implement the tools and policies to conduct more effective surveillance, containment, and case management of COVID-19 for the future,” the co-authors wrote. “Building these capabilities now will accelerate our ability to assure the public’s safety the foundation for a sustainable and secure approach to reopening our communities.”
- The report authors include former Food and Drug Administration Commissioners and physicians Gottlieb and Mark McClellan, along with Mostashari, who served as the National Coordinator for Health IT. Authors also include Lauren Silvis, senior vice president of external affairs at technology company Tempus, and Caitlin Rivers, Ph.D., a senior scholar at the Johns Hopkins Center for Health Security and an assistant professor in the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health.
- The healthcare leaders propose the country to build a national COVID-19 surveillance system to enable the transition from universal stay-at-home orders to case-based, regional options.
- The new national COVID-19 surveillance strategy is designed to ensure a swift, effective response to contain further spread of the virus, especially as the country reduces intensive physical distancing measures and stay-at-home rules, the authors said.
- The healthcare leaders outlined four benchmarks for the development of disease surveillance capabilities:
- Test and Trace Infrastructure: Every region needs to have the capacity for widespread rapid diagnostic testing (PDF) for everyone with COVID-19 symptoms and the ability to share data to enable swift interventions of new cases.
- Real-Time Surveillance: Use the test-and-trace results to feed a national surveillance system to monitor spikes and falls in COVID-19-related symptoms. This syndromic surveillance system will provide timely, transparent reporting of outbreaks and responses.
- Blood (Serological) Testing: Every region needs the capacity to conduct widespread blood testing to identify reliable indicators of immunity in individuals and track virus exposure in communities.
- Rapid Response: Health systems and public health officials need to build the capacity for isolation, contact tracing and quarantine of new COVID-19 cases and the ability to treat patients effectively at home or in a hospital.
- This national effort should be coordinated and largely funded through the Centers for Disease Control and Prevention, in collaboration with state and local public health authorities, according to the authors. The effort could leverage federal funding and oversight through COVID-19 grants to states.
- “The federal government should coordinate goals and resources, while state and local authorities should manage operational details of implementation,” the co-authors wrote.
- The authors also propose that the Centers for Medicare and Medicaid Services (CMS) and private payers should provide support for health care providers, with support tied to high quality reporting on testing.
- Increasing testing capacity throughout the country is a key strategy of the plan. But the authors also focus on other health IT infrastructure requirements to help get the right information to public health officials.
- There needs to be increased investment in electronic data sharing to support test and trace capabilities, for example, they said.
- The CDC should work with CMS and the Office of the National Coordinator to encourage the adoption and widespread use of electronic standards and reporting to enable rapid electronic reporting of COVID-19 related laboratory test results from health care providers, laboratories, or other testing sources using existing automated electronic reporting infrastructures. they said.
- The CDC should also work with state officials and HHS to develop a common platform to query data from hospital electronic health records, health information exchanges, and organizations like CommonWell and Carequality, according to the report.
- Going forward, the CDC should work with healthcare organizations to use technology to manage case-based isolation. The authors noted that some primary care groups and health systems are already using telemedicine services and digital apps supported by electronic algorithms and dashboards to manage their populations.
- Health plans including Humana, United Healthcare, and Blue Cross Blue Shield of North Carolina are also implementing similar supports for their patients who test positive for coronavirus.
- The report also builds on a previous paper published by Gottlieb and McClellan that provides a roadmap for reopening the country.
2. Kushner’s team seeks national coronavirus surveillance system
- White House senior adviser Jared Kushner’s task force has reached out to a range of health technology companies about creating a national coronavirus surveillance system to give the government a near real-time view of where patients are seeking treatment and for what, and whether hospitals can accommodate them, according to four people with knowledge of the discussions.
- The proposed national network could help determine which areas of the country can safely relax social-distancing rules and which should remain vigilant. But it would also represent a significant expansion of government use of individual patient data, forcing a new reckoning over privacy limits amid a national crisis.
- The project — based on interviews with seven tech executives, government officials and other people familiar with its contours — would draw on detailed information collected from multiple private-sector databases. It would allow federal officials to continuously track elements like hospitals’ bed availability and the flow of patients into specific emergency rooms across the country — thereby enabling the government to rush resources to parts of the country before they’re hit by a surge of coronavirus cases.
- “It allows you to be much more targeted and precise in how you engage,” said one person involved in the discussions. “They need data to make the policy decisions, and so that’s what we and others now have been asked to do.”
- Some public health experts, meanwhile, suggested that the administration might instead built out and reorient an existing surveillance system housed within the Centers for Disease Control and Prevention that aided the response to prior epidemics. The system, called the National Syndromic Surveillance Program, is a voluntary collaboration between the CDC and various state and local health departments that draws data from more than 4,000 health care facilities.
- What we’re seeing in the numbers is actually a two-to-three-week echo,” Jeremy Konyndyk, a senior policy fellow at the Center for Global Development and former Obama-era foreign aid official, said in late March. “We still mostly can’t see the enemy.”
- That’s prompted a broad search within the administration for more up-to-date information, with Kushner’s team discussing the prospect of creating a surveillance network that draws together all the pertinent data.
- One memo submitted by a group of health technology companies to Kushner, Vice President Mike Pence and Health Secretary Alex Azar and circulated widely within the administration, predicted it could supply the government with information on where and how many patients are seeking care across 80 percent of the U.S. “in short order.”
H. Practical Tips and Useful Information
1. Use this locator to find a coronavirus test site near you
- A pair of startups from within the Georgetown University Venture Lab has launched a new web tool called the COVID-19 Testing Locator that lets users know how far away they are from testing locations and where they can find the closest site that will test them for the COVID-19 coronavirus.
- Anyone in the US can access the COVID-19 Testing Locator for free starting today by visiting www.covid19testing.today. The locator’s features include showing users how far away they are from testing facilities, allowing users to view contact information for the facility if that data is available, and letting users filter locations based on preferences — such as whether it’s drive-thru only, focused only on children, or geared towards senior citizens.
- After enough data is collected, The COVID-19 Testing Locator team said in a news release it plans to create visualizations and address pain points for testing centers to allow them to better manage their resources when supplying treatment or handling logistics. The initiative is also looking to team up with city governments to help them identify coronavirus hot spots.