“Actual data, rather than models, has become the driving force now in understanding how to move forward together to really have a different future.” Dr. Birx”
“Data is real. The model is hypothesis.” Dr. Fauci
- Recent Developments and Headlines
- Numbers and Trends
- Cytokine Storms
- Potential New Treatments
- New Scientific Findings
- The Road Back
- Projections and Our (Possible) Future
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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 4/09 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 210 countries and territories (+1)
- Worldwide Total Cases: 1,607,912 (+5.8%)
- Worldwide Active Cases = 1,154,919 (+5%)
- US New Active Cases = 28,798 (-2,702) (-8.6%)
- NY Active Cases = 141,071 (+7.2%)
- US deaths = 16,697 (+1,900) (+12.8%)
- NY deaths = 7,067 (+799) (+12.7%)
- Global cases surge past 1.5 million as deaths approaching a grim milestone of 100,000 deaths
- IHME Coronavirus Death Projections Drop Big Again (by approx. 25%)
- Coronavirus Task Force Drills Down on Actual County, Metro Data as Models Lose Credibility
- Dr. Fauci says US deaths might be “closer to 60k”
- Number of patients who have recovered from the virus passes 350,000
- New York is now the coronavirus capital of the world
- President Trump planning to launch second coronavirus task force to focus on economic devastation caused by the pandemic
- Bill Gates: USA Not Back to Normal Unless Vaccine or ‘Miracle Therapeutic’ Gets Broad Usage
- De Blasio says some coronavirus restrictions could end next month
- President Trump says US could reopen in phases “ahead of schedule”
- FDA Commissioner Dr. Stephen Hahn: Coronavirus Antibodies Testing Ramping Up, Plasma-Based Treatments on the Way
- CDC guidance says some essential workers exposed to coronavirus can return to work
- NY Gov. Cuomo: New York’s Hospitalization Rate, ICU Admissions Down: ‘We Are Flattening the Curve’
- NY. Gov. Cuomo: New York coronavirus daily death toll reaches third-straight record at 799
- NY Gov. Cuomo to allow out-of-state funeral directors to help with coronavirus dead as Record 799 Lives Lost in Single Day
- Trump Was Right, Cuomo Was Wrong About Ventilator Needs
- Fauci Says He ‘Fully’ Expects Schools to Reopen in the Fall as Coronavirus Is Brought ‘Under Control’
- 65% of surveyed doctors would prescribe hydroxychloroquine to a family member
- Hungary prolongs coronavirus lockdown indefinitely as infections near 1,000
- As contagion slows, Portugal won’t ease lockdown
- Russia, Tokyo report record jumps in cases
- Italy reports sudden jump in deaths, cases overnight
- South Korea warns risk of virus “reactivating” in cured patients
- Trump approves disaster declarations for Idaho, Alaska
- Penn., Mo. join growing list of states to cancel school for the rest of the academic year
- Sweden reports jump in deaths for second day in a row
- France reports more than 1,300 deaths in a single day
- Over 7,000 Fly Out of Wuhan on First Day After Lockdown Lifted
- Germany weighing plan to financially reward doctors and nurses for work during outbreak
- Italian PM says “EU could fail” if bailout package isn’t handled
- India reports 809 new cases, 46 new deaths
- South Africa extends lockdown as State Department prepares to evacuate Americans
- Oxfam warns outbreak could push 500 million people into poverty
- 19 Syrians have tested positive as health orgs alarmed by outbreak
- Spain has confirmed 153,222 cases of the virus
- Italian PM says lockdown might start to lift at end of April
- Palestinians Fear a Coming Coronavirus Storm
- CDC Extends Cruise Ship “No Sail” Order
- Saudi Hospitals Alerted To “Influx Of VIPs” As 150 Members Of Royal Family Have COVID-19
- Migrant workers have been spreading the virus, creating risks for a vulnerable population
- Tokyo’s governor closes businesses, defying central government’s advice
- South Korea presses ahead with parliamentary polls despite epidemic
- Britain’s pubs, where beer flowed during world wars, have all closed
- Jakarta bans religious gatherings and restricts motorbike taxis to slow the virus
- Iceland aims to test everyone for the coronavirus
- Rising European Cases Raise Doubts Over End to Lockdowns
- In Scramble for Coronavirus Supplies, Rich Countries Push Poor Aside
- India hints at extending a nationwide lockdown as cases rise.
- Research shows N.Y. cases are mainly linked to Europe, not Asia.
- Botswana’s entire Parliament is ordered into quarantine.
- Mexican health care workers face attacks from those who see them as vectors of disease.
- ‘We can’t be reckless,’ Chancellor Merkel warned Germans.
- U.S. Repatriates Over 50,000 ‘Stranded’ Americans So Far
- ‘It’s Safer In Beirut’: Americans Decline US Govt Offer To Return Home
- Sweden Resorts To Storing Bodies At Ice-Rinks As COVID-19 Deaths Soar
- Sailor from USS Theodore Roosevelt with coronavirus transferred to ICU as over 400 Crew Infected
- Military Warns of Coronavirus ‘Breakouts’ Aboard Second Aircraft Carrier
- WHO Defends North Korea’s Claim of Zero Coronavirus Cases
- Michigan Gov. Gretchen Whitmer Extends Stay-at-Home Order
- Office of Management and Budget Working on Plan to Cut WHO Funding
- Taiwan’s Foreign Minister Slams Chinese Disinformation
- India Treating Christian Health Workers as ‘Expendable’
- Truckers Delivering Essential Goods Struggle to Find Bathrooms, Rest Stops
- Britain Warned Not To Expect Any Let Up in Lockdown any time soon, as Police Call For Stricter Powers
- Protesters Demand Ohio Gov. DeWine Lift Stay-at-Home Order
- Fla. Gov. DeSantis Encourages Floridians to Wear Masks at Grocery Store
- Virus Hits Homeless Housed in Los Angeles Rec Center
- Oklahoma City Hospital Temporarily Closing Due to Lack of Patients
- Clemson Cracks Down on Social Gatherings After 100 Students Attend Party
- Bill O’Reilly: Many Dead Coronavirus Victims ‘Were on Their Last Legs’
- French Prostitutes Demand Coronavirus Govt Cash Bailout
- Roger Goodell: ‘The NFL Is Planning to Play’
- Chicago Animal Shelter Runs Out of Adoptable Pets for First Time
- Coronavirus traces found in Massachusetts wastewater at levels far higher than expected
- DC mayor: All shoppers at grocery stores must wear masks
- Major US Meat Processors Shutting Down Plants As Employees Get Sick With COVID-19
- White House to require coronavirus tests for journalists covering daily briefing
- More coronavirus patients testing positive again after recovery
- Most New York Coronavirus Cases Came From Europe, Genomes Show
- Couple get married and jailed on same day after flouting coronavirus lockdown rules
- Panicked passengers jump off ferry after hearing some on board have coronavirus
- Immigrants Self-Deporting from U.S. to Avoid Possible Coronavirus Infection
- Workers in full Hazmat suits bury rows of coffins in Hart Island mass grave as NYC officials confirm coronavirus victims WILL be buried there if their bodies aren’t claimed within two weeks after death toll rises to 4,260
- 250-year-old U.S. Easter tradition’s horns silenced by coronavirus pandemic
- One hundred Italian doctors have died of virus: medics
- In Uganda, mothers in labor die amidst coronavirus lockdown
- Burning bodies? Mass graves? Ecuador battles fake news amid the coronavirus pandemic
- China to reclassify dogs as pets, not livestock, in wake of coronavirus
- Dutch woman aged 107 survives coronavirus
- Pollution Recedes Amid Lockdown, And A View Of The Himalayas Emerges For The First Time In 30 Years
- Poll shows sports likely face fan-fear crisis upon return
- Paramedic who retrieved body parts after 9/11 says coronavirus is worse
- 51 patients transferred from Queens hospitals due to oxygen demands
- USNS Comfort, Javits Center are mostly empty as coronavirus strains New York emergency rooms
- MTA taking worker temperatures as coronavirus spreads
- Costco’s sales surge on panic shopping
- Entire Pennsylvania nursing home feared to have coronavirus
- Woman busted for licking $1,800 in groceries during coronavirus crisis
- Grocery store customers tackle man who coughed, spat on food
- New York-area coronavirus outbreak originated primarily in Europe, not China
- Inmates spitting in guards’ faces amid coronavirus outbreak in NYC jails, sources say
- Boris Johnson leaves ICU, still in hospital with coronavirus
- Dermatologists in France have uncovered another unusual coronavirus symptom: cutaneous manifestations including pseudo-frostbite, hives and persistent redness
- Vienna’s horse-drawn carriages now delivering lockdown meals
- Wisconsin parks to close after crowds ignore social distancing mandates
- India seals off coronavirus hot spots to stop spread
- Doctor who warned Boris Johnson of supply shortage dies from coronavirus
- Twin sisters who ‘did everything together’ die of coronavirus days apart
- Only one coronavirus death has been reported in New Zealand amid the country’s stringent lockdown — which orders all residents to stay home for four weeks, with few exceptions
- Social distancing spat may have led to murder of doc, husband
- Couple names baby Lockdown during coronavirus crisis
- De Blasio doesn’t regret telling New Yorkers to visit bars before shutdown
- Shake it off: Fauci calls for end to handshakes after coronavirus
- 3 nurses forced to wear trash bags during gear shortage get coronavirus
- In Europe, wearing masks in public is no longer ‘alien.’
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: 1,607,912 Total Cases (+5.8%)
- New Cases = 88,341 (+1,433) (+1.6%)
- Trend: 2nd day of lower new case numbers
- New Cases = 88,341 (+1,433) (+1.6%)
- Europe: 766,891 Total Cases (+4.5%)
- New Cases = 32,980 (-129) (-0.3%)
- Trend: 2nd day of lower new case numbers
- New Cases = 32,980 (-129) (-0.3%)
- Asia: 134,398 Total Cases (+2.1%)
- New Cases = 2,771 (-362) (-11.6%)
- United States: 468,895 Total Cases (+7.7%)
- New Cases = 33,735 (-596) (-1.7%)
- Trend: 2nd day of lower new case numbers
- New Cases = 33,735 (-596) (-1.7%)
- US States:
- 38 States > 1,000 cases (+0), plus DC
- 25 States > 2,500 cases (+0)
- 17 States > 5,000 cases (+0)
- 11 States > 10,000 cases (+0): NY, NJ, MI, CA, LA, MA, FL, PA, IL, TX & GA
- Top 5 States: (i) NY: 161,504 (+10,333); (ii) NJ: 51,027 47,437 (+3,590); (iii) MI: 21,504 (+1,158); (iv) CA: 20,212 (+1,149); and (v) PA: 18,546 (new)
- Note: Louisiana falls out of Top 5 States
- For more information on US States, see https://ncov2019.live/data
- New York State:
- NY Total Cases = 161,504 (+6.8%)
- NY New Cases = 10,333 (+1,510) (+17.1%)
- New York City:
- Total Cases = 81,803 (+6.4%)
- NYC New Cases = 4,927 (+2,652) (+117%)
2. Confirmed Active Cases
- Worldwide: 1,154,919 Active Cases (+5%)
- New Active Cases = 54,909 (+126) (+0.2%)
- Europe Active Cases = 510,660 (+19,469) (+4%)
- Asia Active Cases = 38,486 (+2,138) (+5.9%)
- US Active Cases = 426,270 (+7.2%)
- US New Active Cases = 28,798 (-2,702) (-8.6%)
- NY Active Cases = 141,071 (+7.2%)
- NY New Active Cases = 9,534 (+1,526) (+19%)
3. Series or Critical Cases
- Worldwide serious or critical cases = 49,137 (+971)
- US series or critical cases = 10,011 (+732)
- NY serious or critical = 4,504 [Note: not updated since 4/8]
- US serious or critical cases = 2.3% of Active Cases (+0%), compared with worldwide percentage of 4%
[Note: Serious and critical cases give insight into the need for ICU beds and ventilators]
- Worldwide deaths = 95,813 (+7,263) (+8.2%)
- Europe: 65,765 deaths (+4,584) (+7.5%)
- Asia: 4,657 deaths (+145) (+3.2%)
- US deaths = 16,697 (+1,900) (+12.8%)
- NY deaths = 7,067 (+799) (+12.7%)
- Deaths per 1M population: (i) Italy: 302; (ii) Spain: 330; (iii) US: 50; (iv) France: 187; & (v) Germany: 31
- Worldwide Total Confirmed Case Fatality Rate = 6% (+0.2%)
- US Total Confirmed Case Fatality Rate = 3.6% (+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 = 357,180 (+7.9%)
- US recoveries = 25,928 (+13.6%)
- NY recoveries = 13,366 [Note: No update since 4/8]
C. Cytokine Storms – How Your Immune System Can Kill You and Treatments to Stop It
1. Haywire Immune Response Eyed In Coronavirus Deaths and a Potential Treatment
- An immune system gone haywire may be doing more damage than the coronavirus itself in patients with the severest forms of Covid-19, doctors and scientists say, a growing theory that could point the way to potential treatments.
- Much remains unknown about the path the virus takes in the sickest patients, but an increasing number of experts believe a hyperactive immune response, rather than the virus, is what ultimately kills many Covid-19 patients.
- The out-of-control immune response eventually causes the patients’ lungs to stop delivering oxygen to the rest of organs, leading to respiratory failure and in some cases death. The malfunctioning immune system may be driving the rapid decline in lung function experienced by some patients, including younger and relatively healthy ones, after the initial onset of symptoms.
- As scientists race to better understand the phenomena, pharmaceutical companies including Roche Holding AG are partnering with hospitals to explore whether drugs proven to tamp down an out-of-control immune response could help the sickest Covid-19 patients.
- Some doctors are already administering the drugs to patients who are unable to breathe without the support of ventilators, or to prevent deterioration of patients who appear ready to slip into respiratory failure.
- “You remove one piece of the storm, and it can quiet the whole thing,” said Kevin Tracey, president of the Feinstein Institutes for Medical Research at Northwell Health, which is testing Kevzara, an anti-inflammatory drug from Regeneron Pharmaceuticals Inc.
- Doctors have used the term “cytokine storm” to describe an overactive immune response triggered by external pathogens such as bacterial and viral infections.
- Proteins called cytokines are part of the immune system’s arsenal for fighting disease. When too many are released into the bloodstream too quickly, however, it can have disastrous results, including organ failure and death.
- As with other diseases, it is a mystery why cytokine storms are experienced by some but not all Covid-19 patients. Genetics may be a factor.
- In the most severe coronavirus patients, the disease appears to have two stages. First the immune system fails to respond quickly or effectively enough to the virus. Then the immune response becomes too aggressive and floods the body with cytokines.
- The surge of cytokines damages blood vessels and allows fluids to seep into the lungs, filling them up like water balloons.
- “The virus initiated it,” said Ya-Chi Ho, an assistant professor at the Yale School of Medicine who studies infectious diseases. “The second problem is our immune system handled it wrong, and induces this cytokine storm and clogs our lungs. That’s why patients die.”
- Drugs called corticosteroids can be used to treat patients with cytokine storms, but studies are mixed on their effectiveness, with some studies indicating that Covid-19 patients may be at a higher risk of death when treated with steroids. Some doctors are reluctant to use steroids because they broadly dampen the immune response, which is risky in patients fighting infections.
- Drugs targeting specific cytokines rather than the entire immune system may be more effective.
- Among the most promising targeted treatments, doctors say, is Roche’s rheumatoid-arthritis drug tocilizumab, which is marketed under the brand name Actemra. The drug was approved in 2017 to treat cytokine storms caused by cancer treatments known as CAR-T cell therapies.
- On Tuesday, a federal agency that supports health research said it is committing $25 million to accelerate a late-stage study of Actemra in Covid-19 patients.
- Last month, doctors from Seattle’s Swedish Health Services used Actemra to treat a 45-year-old emergency-room physician who was infected while caring for patients from a nursing home in Kirkland, Wash.
- The man was transferred to Swedish and put on life support after his lungs and kidneys began to fail, said Samuel J. Youssef, a cardiothoracic surgeon at Swedish. Lab tests showed the man’s inflammation levels were 200 times greater than the normal range, indicating he might be suffering from a cytokine storm.
- The doctors at Swedish decided to administer Actemra after discussing a small Chinese study that had shown that 21 Covid-19 patients with high levels of inflammation had been successfully treated with the drug.
- Over the next two days, the patient’s inflammation levels began to decline and his blood-oxygen levels increased, Dr. Youssef said. After a week, he was well enough to be taken off life support on March 23, and was released from the hospital on Sunday.
- “All we did was quiet the storm and support his body—his kidneys, his lungs, his heart—to give him the time to fight the virus,” said Dr. Youssef, who attributes the recovery both to Actemra as well as other interventions like being put on life support.
D. Potential New Treatments
1. Head lice drug kills novel coronavirus within 48 hours
- A head lice drug has successfully killed the novel coronavirus within 48 hours in a laboratory setting, as per researchers in Australia.
- The study, conducted by researchers from the Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital in Australia, has found the head lice drug Ivermectin could potentially be used—after further research and human trails—as a possible treatment for the COVID-19 disease.
- This veterinary drug was first introduced to the world back in the 1970s, and it has since been used to treat head lice, scabies, and several other infections caused by parasites.
- To test how it performs against the novel coronavirus, the researchers infected some cells with the COVID-19-causing SARS-CoV-2 virus, and then exposed them to Ivermectin. Subsequently, they found that just a single dose of Ivermectin had successfully killed the virus in a petri dish.
- There was a significant reduction in the virus in just 24 hours, and complete annihilation in less than 48 hours, which is indicative of the drug’s potent antiviral activity.
- While it’s not completely clear how Ivermectin works, the researchers believe it is the drug’s ability to inhibit nuclear transport that makes it effective against the coronavirus. In simple words, it halts the processes that allow proteins to move within a virus. These proteins, when otherwise active and moving, enable the virus to replicate itself and exacerbate the infection, while dampening the body’s antiviral response.
- Ivermectin was discovered in the 1970s and has fast become an essential medicine for a vast number of parasitic infections, such as head lice and scabies.
- It’s branded as Stromectol, an oral tablet for scabies, or Soolantra, a skin cream for rosacea.
- It’s on the World Health Organization’s List of Essential Medicines, the safest and most effective medicines needed in a health system.
- In recent years, researchers have shown ivermectin has anti-viral activity against a broad range of viruses.
2. Pfizer working on promising coronavirus treatment as well as a vaccine
- Drugmaker Pfizer said Thursday that it is working on a promising treatment for coronavirus, as well as a vaccine.
- The drugmaker said preclinical studies showed that an unspecified compound that was originally used to treat SARS — a different coronavirus — has shown potential in battling the dangerous illness.
- Pfizer research chief Mikael Dolsten said the drug blocks COVID-19 from replicating, slowing the spread in mild or moderate cases, the Wall Street Journal reported.
- The company said it will conduct additional preclinical studies and plans to launch human trials in the summer.
- Pfizer also said it will support studies to determine whether its existing medicines, including its rheumatoid arthritis drug Xeljanz, may provide help for those suffering from respiratory problems from the virus.
- The drugmaker has also finalized a plan to work with German company BioNTech to develop a vaccine, which could be tested in human trials as early as the end of the month. The companies hope to produce millions of vaccines by the end of 2020.
- “I feel confident that we will win, battle by battle, to turn around this viral war against our society,” Dolsten told the Journal.
3. US testing of 2nd possible coronavirus vaccine underway
- US researchers have opened another safety test of an experimental COVID-19 vaccine, this one using a skin-deep shot instead of the usual deeper jab.
- The pinch should feel like a simple skin test, a researcher told the volunteer lying on an exam table in Kansas City, Missouri, on Wednesday.
- “It’s the most important trial that we’ve ever done,” Dr. John Ervin of the Center for Pharmaceutical Research told The Associated Press afterward. “People are beating down the door to get into this trial.”
- The experiment, using a vaccine candidate developed by Inovio Pharmaceuticals, is part of a global hunt for much-needed protection against a virus that has triggered an economic shutdown and forced people indoors as countries try to stem the spread.
- A different vaccine candidate began safety testing in people last month in Seattle, one developed by the US National Institutes of Health. About two-thirds of that study’s participants have gotten the first of two needed doses.
- Inovio’s study is set to test two doses of its vaccine, code-named INO-4800, in 40 healthy volunteers at the Kansas City research lab and the University of Pennsylvania. Inovio is working with Chinese researchers to also begin a similar study in that country soon.
- Dozens of potential vaccines are being designed in labs around the world, expected to begin this testing process over the next several months.
- “The good thing is we’ve got a bunch of candidates,” Dr. Anthony Fauci, the NIH’s infectious diseases chief, said during a podcast for the Journal of the American Medical Association Wednesday.
- The NIH’s vaccine candidate, manufactured by Moderna Inc., works similarly, except it uses a type of genetic code called messenger RNA and is injected deeper — into the muscle.
- Neither NIH’s nor Inovio’s potential vaccines are made using the actual virus, meaning there’s no chance of getting infected from the vaccines — and it’s possible to make far more quickly than traditional shots.
E. New Scientific Findings and Other Advancements
1. Blood tests show 14% of people are now immune to covid-19 in one town in Germany
- How many people have really been infected by the coronavirus? In one German town a preliminary answer is in: about 14%.
- The municipality of Gangelt, near the border with the Netherlands, was hard hit by covid-19 after a February carnival celebration drew thousands to the town, turning it into an accidental petri dish.
- Now, after searching blood from 500 residents for antibodies to the virus, scientists at a nearby university say they have a preliminary idea of how many people were actually infected.
- In a brief report posted online in German, the researchers say one in seven have been infected—a figure that has big implications for how soon that town, and the rest of the world, can come out from lockdown. “To me it looks like we don’t yet have a large fraction of the population exposed,” says Nicholas Christakis, a doctor and social science researcher at Yale University. That means there is a lot more to go even in a hard-hit part of Germany.”
- That’s why the actual infection rate in a region matters: the bigger it is, the less pain still lies ahead. Eventually, when enough people are immune—maybe half to three-quarters of them—the virus won’t be able to spread further, a concept called herd immunity. But the German town isn’t close to that threshold yet, and to Christakis the preliminary figure is “unfortunate” because it means the virus still has more damage to do.
- Globally, the official case count of covid-19 is more than 1.5 million people, but that reckoning mostly includes people who seek medical help and get tested. The true number of people infected, including those without symptoms and who don’t get tested, is far higher.
- The German report is the among the first blood surveys to look for telltale antibodies, but more data should be available soon; sources include US hospitals testing their own staff. On April 6, Stanford Medicine announced it had launched its own serology test and had begun screening doctors, nurses, and others.
- Early results from hospital tests are already circulating among some experts, says Christakis, who thinks these data will get us “closer to the truth” about how far the infection has spread in US cities. “If you see 5% positive in your health-care workers, that means infection rates probably aren’t higher than that in your city.”
- They found that 2% of residents were actively infected by the coronavirus and a total of 14% had antibodies, indicating a prior infection. This group of people, they say, “can no longer be infected with SARS-CoV-2,” as the virus is known to scientists.
- From the result of their blood survey, the German team estimated the death rate in the municipality at 0.37% overall, a figure significantly lower than what’s shown on a dashboard maintained by Johns Hopkins, where the death rate in Germany among reported cases is 2%.
- The authors explain that the difference in the calculations boils down to how many people are actually infected but haven’t been counted because they have mild or no symptoms.
- The presence of previously infected people in the community, Streeck and colleagues believe, will reduce the speed at which the virus can move in the area. They also outline a process by which social distancing can be slowly unwound, especially given hygienic measures, like handwashing, and isolating and tracking the sick. They think if people avoid getting big doses of the virus—which can happen in hospitals or via close contact with someone infected—fewer people will become severely ill, “while at the same time developing immunity” that can help finally end the outbreak.
2. Coronavirus was spreading in NYC weeks before first confirmed case
- The coronavirus was likely spreading in New York City as early as February, weeks before the Big Apple’s first confirmed case.
- Dr. Adriana Heguy, a member of an NYU Grossman School of Medicine team studying the genomes of coronaviruses from city patients, said that early findings indicate the virus was in the city well before a Manhattan woman in her 30s became the city’s first official patient on March 1.
- Heguy and her team learned of the discrepancy by analyzing the different viral mutations between the city cases.
- Certain viruses, Heguy told the paper, shared mutations not seen elsewhere. “That’s when you know you’ve had a silent transmission for a while.”
- A separate group of researchers from the Icahn School of Medicine at Mount Sinai, who are also studying the genomes of city coronavirus patients, determined that early city cases were not linked to later ones, which they found came from Europe.
- Two weeks after the first cases at Mount Sinai Hospital, “we started seeing viruses related to each other,” Ana Silvia Gonzalez-Reiche, a member of the Mount Sinai team, told the Times.
- The newer viruses closely mirrored those found in Europe, the Mount Sinai researchers found, indicating “a period of untracked global transmission between late January to mid-February,” according to their study, which is awaiting peer review.
- The Mount Sinai team analyzed 84 distinct COVID-19 genomes out of 800 confirmed cases treated at the Mount Sinai Health System, the hospital said in a press release.
- The results of their research indicate that the coronavirus “came to New York City and environs predominately via untracked transmission between the United States and Europe, with only limited introduction from China, where the virus originated,” Dr. Viviana Simon said in a statement.
- “Only one of the 78 cases studied was infected with a virus that was a clear candidate for introduction from Asia, and that virus is most closely related to viral isolates from Seattle, Washington,” said Simon.
F. The Road Back
1. Will “immunity passports” get us outside?
- Some countries are taking the idea Immunity Passports seriously. German researchers want to send out hundreds of thousands of tests to citizens over the next few weeks to see who is immune to covid-19 and who is not, and certify people as being healthy enough to return to society.
- The UK, which has stockpiled over 17.5 million home antibody testing kits, has raised the prospect of doing something similar, although this has come under major scrutiny from scientists who have raised concerns that the test may not be accurate enough to be useful. As the pressure builds from a public that has been cooped up for weeks, more countries are looking for a way out of strict social distancing measures that doesn’t require waiting 12 to 18 months for a vaccine (if one even comes).
- So how does immunity testing work? Very soon after infection by SARS-CoV-2, polymerase chain reaction (PCR) tests can be used to look for evidence of the virus in the respiratory tract. These tests work by greatly amplifying viral genetic material so we can verify what virus it comes from. But weeks or months after the immune system has fought the virus off, it’s better to test for antibodies.
- About 6 to 10 days after viral exposure, the body begins to develop antibodies that bind and react specifically to the proteins found on SARS-CoV-2. The first antibody produced is called immunoglobulin m (IgM), which is short-lived and only stays in the bloodstream for a few weeks. The immune system refines the antibodies and just a few days later will start producing immunoglobulins G (IgG) and A (IgA), which are much more specific. IgG stays in the blood and can confer immunity for months, years, or a lifetime, depending on the disease it’s protecting against.
- In someone who has survived infection with covid-19, the blood should, presumably, possess these antibodies, which will then protect against subsequent infection by the SARS-CoV-2 virus. Knowing whether someone is immune (and eligible for potential future certification) hinges on serological testing, drawing blood to look for signs of these antibodies. Get a positive test and, in theory, that person is now safe to walk the street again and get the economy moving. Simple.
- Except it’s not. There are some serious problems with trying to use the tests to determine immunity status. For example, we still know very little about what human immunity to the disease looks like, how long it lasts, whether an immune response prevents reinfection, and whether you might still be contagious even after symptoms have dissipated and you’ve developed IgG antibodies. Immune responses vary greatly between patients, and we still don’t know why. Genetics could play a role.
- “We’ve only known about this virus for four months,” says Donald Thea, a professor of global health at Boston University. “There’s a real paucity of data out there.”
- SARS-CoV-1, the virus that causes SARS and whose genome is about 76% similar to that of SARS-CoV-2, seems to elicit an immunity that lasts up to 3 years. Other coronaviruses that cause the common cold seem to elicit a far shorter immunity, although the data on that is limited—perhaps, says Thea, because there has been far less urgency to study them in such detail. It’s too early to tell right now where SARS-CoV-2 will fall in that time range.
- Even without that data, dozens of groups in the US and around the world are developing covid-19 tests for antibodies. Many of these are rapid tests that can be taken at the point of care or even at home, and deliver results in just a matter of minutes. One US company, Scanwell Health, has licensed a covid-19 antibody test from the Chinese company Innovita that can look for SARS-CoV-2 IgM and IgG antibodies through just a finger-prick blood sample and give results in 13 minutes.
- There are two key criteria we look for when we’re evaluating the accuracy of an antibody test. One is sensitivity, the ability to detect what it’s supposed to detect (in this case antibodies). The other is specificity, the ability to detect the particular antibodies it is looking for. Scanwell’s chief medical officer, Jack Jeng, says clinical trials in China showed that the Innovita test achieved 87.3% sensitivity and 100% specificity (these results are unpublished). That means it will not target the wrong kind of antibodies and won’t deliver any false positives (people incorrectly deemed immune), but it will not be able to tag any antibodies in 12.7% of all the samples it analyzes—those samples would come up as false negatives (people incorrectly deemed not immune).
- By comparison, Cellex, which is the first company to get a rapid covid-19 antibody test approved by the FDA, has a sensitivity of 93.8% and a specificity of 95.6%. Others are also trumpeting their own tests’ vital stats. Jacky Zhang, chairman and CEO of Beroni Group, says his company’s antibody test has a sensitivity of 88.57%, for example. Allan Barbieri of Biomerica says his company’s test is over 90% sensitive. The Mayo Clinic is making available its own covid-19 serological test to look for IgG antibodies, which Elitza Theel, the clinic’s director of clinical microbiology, says has 95% specificity.
- Because we don’t know what the real infection rate is—1%, 3%, 5%, etc.—we don’t know how to truly predict what proportion of the immunity passports would be issued incorrectly. The lower the infection rate, the more devastating the effects of the antibody tests’ inaccuracies. The higher the infection rate, the more confident we can be that a positive result is real.
- Even if the technology is more accurate, it might still simply be too early to start certifying immunity just to open up the economy. Chris Murray from the University of Washington’s Institute for Health Metrics and Evaluation told NPR his group’s models predict that come June, “at least 95% of the US will still be susceptible to the virus,” leaving them vulnerable to infection by the time a possible second wave comes around in the winter. Granting immunity passports to less than 5% of the workforce may not be all that worthwhile.
- Theel says that instead of being used to issue individual immunity passports, serology tests could be deployed en masse, over a long period of time, to see if herd immunity has set in—lifting or easing restrictions wholesale after 60 to 70% of a community’s population tests positive for immunity.
- This would require a massively organized effort to pull off well in highly populated areas, and it’s not clear whether the decentralized American health-care system could do it. But it’s probably worth thinking about if we hope to reopen whole economies, and not just give a few individuals a get-out-of-jail-free card.
- And at the very least, serological testing is potentially useful because many covid-19 cases present, at most, only mild symptoms that don’t require any kind of medical intervention. About 18% of infected passengers on the Diamond Princess cruise ship showed no symptoms whatsoever, suggesting there may be a huge number of asymptomatic cases. These people almost certainly aren’t being tested (CDC guidelines for covid-19 testing specifically exclude those without symptoms). But their bodies are still producing antibodies that should be detectable long after the infection is cleared. If they develop immunity to covid-19 that’s provable, then in theory, they could freely leave the house once again.
- For now, however, there are too many problems and unknowns to use antibody testing to decide who gets an immunity passport and who doesn’t. Countries now considering it might find out they will either have to accept enormous risks or simply sit tight for longer than initially hoped.
2. How San Francisco plans to trace every coronavirus case and contact
- In one of the first such efforts in the country, San Francisco is assembling a task force to interview and trace the interactions of all people who test positive for covid-19. The goal is to find who gave it to them and whom they may have given it to, in the hopes of isolating infected patients, alerting those potentially exposed, and ultimately halting transmissions.
- The task force will interview every patient who tests positive and provide necessary support to ensure that all are completely isolating themselves, down to helping them find and get to shelter if necessary. They also expect to reach out to between three and five people that patients came into contact with in the preceding days. They’ll alert them they may have been exposed, ask them to limit their contacts, and either encourage them to go in for a test or bring one to them. Those who test positive will trigger additional rounds of interviews and contact tracing.
- “We basically realized that if we ever hope to move beyond shelter in place, we need a robust containment strategy that’s sustainable and can identify every new case and contact,” says Michael Reid, an assistant professor of infectious diseases at UCSF, who is coordinating the university’s contributions to the effort. “And that needs to be in place at least, in the medium term, until we’ve got a vaccine.”
An early, aggressive response
- The San Francisco Bay Area saw some of the first covid-19 cases in the US as well as early signs it was spreading in the community, with a case of unknown origin on February 26. On March 16, six counties ordered nearly seven million residents to mostly stay in their homes for weeks. Three days later, California became the first to roll out such measures statewide, as Governor Gavin Newsom ordered nearly 40 million people to shelter in place.
- The measures appear to have helped. Daily deaths across California could peak as early as next week and reach zero by mid-May, according the state-by-state modeling at the University of Washington. New case counts in San Francisco, where more than 600 people have tested positive and nine have died, appear to have slowed down in recent days.
- But the Bay Area’s success in slowing the spread may also mean that a large portion of its population isn’t immune, making the area especially susceptible to reintroduction of the disease from areas that didn’t respond quickly to the dangers, like Texas, says George Rutherford, an epidemiologist at UCSF. “We’re going to have to follow trace counts like a hawk,” he says.
- Ramping up testing will also be critical for effective contact tracing, as researchers will need to be able to test everyone with symptoms as well as everyone they came into contact with, and obtain results quickly. To support that effort and contain the outbreak locally, San Francisco may need to be able to test as many as 130,000 cases per month, Rutherford estimates.
- It’s not clear how many tests the city can process currently, but the number is rapidly building. A partnership between UCSF and the Chan Zuckerberg Biohub is now processing 2,000 samples per day and striving for 4,000 (60,000 to 120,000 per month) [NOTE: NY is testing 7,000 per day]. A number of other groups are also conducting tests, including the Zuckerberg San Francisco General Hospital, the Health Department’s public labs, and commercial operations like Kaiser Permanente and the California Public Medical Center.
The role of technology
- Contact tracing is mostly an arduous manual task, which means it often can’t capture every infection and contact during peak moments of outbreaks. But there are some tools and technologies that can help.
- The San Francisco task force will use an online and phone-based contact tracing application to send daily text messages to potentially exposed people, asking if they’ve developed symptoms. If so, it’ll flag workers to follow up and provide additional guidance.
- The team will also ask patients for permission to look at their phone location data, which can help to provide a fuller picture of where they’ve been and moments when they may have been in crowded areas. But without access to population-wide phone data, the team won’t be able to see every time they crossed paths with others, or who those people were.
- Given privacy laws and concerns, however, there are greater limits on what kind of location data US health officials can use. The federal government and research groups are exploring a variety of ways to set up voluntary and anonymized digital contact tracing, using mobile phones, apps, and other tools. Among other things, these could tell people if they’ve walked within close proximity of an infected person.
Continued social distancing
- Even if regions do rapidly ramp up contact tracing and testing, and infections and deaths decline, life there won’t simply swing back to normal anytime soon.
- Rutherford says that if the Bay Area hopes to relax its shelter-in-place rules, it’ll have to replace those mitigation measures with “containment on steroids.” Among other actions, he says, high-risk populations like the elderly should continue to stay at home, and the rest of the population should wear masks in public and continue to stay six feet apart. Buildings, workplaces, and restaurants will need to take precautions to keep people safe and separated as well, clearing out tables, staggering shifts, and providing hand sanitizer at the door.
- But even with all these measures, cases will likely continue to flare up on occasion. If areas hope to keep infections low and save as many lives as possible, people and politicians will need to be ready and willing to quickly toggle between stricter and looser measures, possibly for many months to come.
G. Projections and Our (Possible) Future
1. Institute for Health Metrics & Evaluation (IHME) Model – Are The Projections Useful?
- The IHME Model was last updated on April 7
- As discussed in prior updates, the IHME Model’s projections of required hospital resources (e.g., hospital beds, ICU beds and ventilators) have been grossly overstated and, in our view, those projections are not useful – and possibly worse, the magnitude of inaccuracies may have led to overreactions and misallocations
- Although the projections of the number of deaths have thus far been in the ballpark, the total number of projected deaths has dropped substantially over a very short period of time. While the rapid decrease in projected deaths is a welcome development, it further raises questions regarding the usefulness of the projections.
- The usefulness of projections will become a central issue in our plans to restart the economy – for example, why should policies that could destroy an economy and the livelihood of countless Americans be based on reliable projections? While that is a question for another day, that day is quickly approaching, perhaps faster than some anticipate
- In the meantime, the IHME projections regarding the peak days of the US and each State is information that may be useful and, in our view, we should consider projected peak dates as we evaluate the appropriate level of preparedness for our families at the peak of the outbreak in our area. [Note: as used by the IHME Model, the term “peak day” means the day on which the day on which the need for hospital beds, ICU beds and ventilators will be at its greatest.]
- However, so far, the IHME Model has substantially overstated the strain on healthcare systems, which implies that the level of preparedness should be higher than necessary. For example, the IHME Model projected that the NY healthcare system would be overwhelmed, which would create a much risker situation than is actually the case (while the NY healthcare system is under stress, it is not overwhelmed). Having said that, I don’t regret over-preparing as there was no way to know how things would play out, so it was very cheap insurance.
- According to the IHME Model projections, 8 States and the District of Columbia have already passed their peak: Colorado, Delaware, DC, Louisiana, Michigan, New York, Ohio, Vermont and Washington. If correct, then the level of new cases and hospitalizations in those States and DC should have stabilized or be decreasing. On the other hand, deaths are a lagging indicator and may continue to be high or rise for another week or so.
- According to the IHME Model projections, another 12 States will reach their peak within a week (4/16): California, Hawaii, Idaho, Illinois, Indiana, Mississippi, New Hampshire, New Jersey, North Carolina, Pennsylvania, West Virginia and Wisconsin. A complete listing of the peak dates for each State can be found in the 4/9 update.
- The IHME Model also projected that the US will peak on April 11.
- 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.
2. East Asia’s surges show how hard it is to control the pandemic
- Hong Kong, Singapore and Taiwan, which were remarkably successful at limiting the epidemic in its early stages, have had a surge in cases in the last two weeks, showing how hard it is to keep out a contagion that continues to spread worldwide.
- The main culprit is international travel, though all three places were among the earliest to impose restrictions on travel, first from Hubei province in China, then from other hot spots and, by late March, from anywhere in the world.
- In Hong Kong and Taiwan, officials say new infections acquired abroad have far outnumbered those picked up locally. At first, the same was true in Singapore, but then it had a sharp spike in “community transmission” — particularly in dormitories for migrant workers.
- The travel-related cases have primarily been among long-term residents returning from Britain and the United States. Hundreds were students going to school abroad.
- The three places have been among the most vigilant in enforcing social distancing, monitoring people who test positive and tracing their contacts. Despite the recent increases, Taiwan, Singapore and Hong Kong have far lower rates of infection than many developed countries.