“We’ll be off for Easter – next update on Monday, April 13.”
— The Coronavirus Update Team
“I have to make a decision. And I only hope to God it is the right decision. But I would say without question it is the biggest decision that I have ever had to make.” — President Trump
“The virus decides when we reopen.” — Dr. Fauci
“Models don’t tell you anything. You can’t really rely upon models. Our policy was based on what we saw happening in other countries, not models.” — Dr. Fauci
“Do it for your abuela. Do it for your granddaddy, do it for your big momma, do it for your poppop.” — Surgeon General Jerome Adams
- Recent Developments and Headlines
- Numbers and Trends
- 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 4/10 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 (+0)
- Worldwide Total Cases: 1,700,406 (+5.8%)
- Worldwide New Cases = 92,494 (+4,153) (+4.7%)
- US New Cases = 33,981 (+246) (+0.73%)
- NY New Cases = 10,854 (+521) (+5%)
- US deaths = 18,747 (+2,050) (+12.3%)
- NY deaths = 7,844 (+777) (+11%)
- Global coronavirus deaths exceed 100,000
- In New York, which is the epicenter of the US outbreak, there are currently more than 159,000 infections and 7,000 deaths
- Peak resource use for US hospitals is projected by IMHE Model to occur on Saturday, April 11
- About 95% of the US is currently on some form of lockdown
- Deaths in US continue to climb [Note: IHME projects deaths to begin declining on April 11]
- Dr. Anthony Fauci: We’ve Had a Bad Week of Deaths; Good Week of Data
- NY Gov. Cuomo said on Friday he was ‘cautiously optimistic’ that New York had ‘seen the worst’ of the pandemic
- CA Gov. Newsom: Trump Has Met ‘Every Single Direct Request That He Was Capable of Meeting’
- Newsom: Trump Has Met ‘Every Single Direct Request That He Was Capable of Meeting’
- Newsom: Trump Has Met ‘Every Single Direct Request That He Was Capable of Meeting’
- CA. Gov. Newsom: Trump Has Met ‘Every Single Direct Request That He Was Capable of Meeting’
- Javits Center, UNSN Comfort mostly empty of patients as hospitalization rate drops
- New York sees negative ICU admissions for first time
- Gov. Cuomo now focusing on getting antibody tests produced on a mass scale to get them to the public
- CDC Director: ‘We’ll See This Outbreak Continue to Decline’
- White House readying plan to start reopening the economy
- Trump Announces ‘Opening the Country Council’ for Restarting Economy
- President Donald Trump said he would unveil the members of his coronavirus economic task force next Tuesday
- Dr. Fauci: it was still too early to relax restrictions on Americans – need to be sure the US is heading in the right direction before opening the country again
- NY Gov. Cuomo: NY needs millions of coronavirus tests before reopening
- NY needs federal help with widespread coronavirus testing if state is to reopen
- Surgeon General Jerome Adams: Most of the U.S. Won’t Be Ready to Open by May 1
- New US government figures show lifting those measures will see a second wave surge in infections and deaths in about June and July
- Surgeon General Jerome Adams pleaded with the African-American community and other communities of color to follow the coronavirus guidelines
- Twice as many black and brown Americans have died of COVID-19 compared to their white counterparts, government data shows
- Seattle’s field hospital to be dismantled before ever treating a patient
- MI Gov. Whitmer bans travel between residences, with a few exceptions
- PA Schools Closed for Remainder of Academic Year
- Fla. Gov. DeSantis Sympathetic to Reopening Schools in Florida: We Will ‘Look at the Evidence’
- Kentucky cops to record churchgoers’ license plates to enforce coronavirus quarantines
- Pop-Up Food Pantry in California Draws Mile-Long Line of Cars During Coronavirus Pandemic
- Report: Peru Quarantined Americans in Hostel, Sprayed Them with Bleach
- Report: China’s Coronavirus Data Off by Millions of Cases
- Italy reports drop in hospitalizations, ICU admissions, as new cases, deaths continue to decline
- Deaths in Spain continue to decline
- UK deaths see another record jump
- Italy Extends Lockdown Until May 3…
- Malaysia extends lockdown as cases in Southeastern Asia spike
- Sweden Resorts To Storing Bodies At Ice-Rinks As COVID-19 Deaths Soar
- Stampede in Kenya as slum residents surge for food aid
- Brazil Builds Its Own Ventilators After China Fails to Deliver Shipments
- Finland Latest Country to Receive Faulty Chinese Protective Equipment
- China delays exports of ventilators and other crucial medical supplies until custom officials perform quality inspections on each shipment
- Amazon tribe’s first coronavirus death sparks fear of ‘wiping them out’
- Survey: Americans won’t attend sports events without a vaccine
- XFL lays off all employees, suspends operations due to coronavirus
- Report: Airbnb Amid Silicon Valley Darlings Facing ‘Reality Check’
- Next potential shortage: Drugs needed to run ventilators
- Philippines Cancels Good Friday Crucifixions, But Flagellations Continue
- 40% of people with severe COVID-19 experience neurological complications
- Coronavirus Crashes Prices for Hotels, Rental Cars, and Women’s Dresses
- WHO Seeks $1 Billion Funding Boost from International Governments
- 50 Coronavirus Cases Confirmed Aboard France’s Only Aircraft Carrier
- Empty churches, online worship expected for Easter amid coronavirus
- Crime drops around the world as coronavirus keeps people inside
- The Paris suburbs were already tense. Now they’re simmering under lockdown
- Apple and Google team up to track the coronavirus
- South Korea plans to strap wristbands on quarantine violators
- At 7 every night, New York City bursts into applause for essential workers
- Pizzeria practices social distancing by using robots for delivery
- Philadelphia Police Drag Man Without Mask Off Bus
- Newborns in Thailand Receive Coronavirus Face Shields at Birth
- FCC Announces $200 Million Telehealth Program
- NYC Increases Burials in Public Cemetery Amid Coronavirus Pandemic
- Ireland’s leader wins praise for heading to the coronavirus front lines — as a doctor
- Amazon moves to create own lab for employee COVID-19 tests
- Hong Kong Court Upholds Prison, Fines for Wearing Masks at Protests
- Argentina’s Funeral Homes Not Given ‘Clear Information’ on Handling Virus Remains
- US Senator Graham: Senate Should Punish China ‘Severely’ for Causing Pandemic
- Israeli woman with coronavirus gives birth to healthy boy while on ventilator
- India: Man Builds Coronavirus-Shaped Car to Spread Awareness
- Sewage shows we’re undercounting coronavirus cases — by a lot, MA researchers say
- COVID antibody test in German town shows 15 percent infection rate
- Rising from sick beds, COVID-19 medics head back to front lines
- Reprieve for lambs as virus scraps Easter lunch
- In Jerusalem, Isolated Christians Mark a Somber Easter
- Tokyo Olympics in Doubt — Even in 2021
- Burning Man festival canceled due to coronavirus pandemic
- NHL has several plans in works for potential coronavirus return
- US, European Cities Turn To “Talking Drones” From China To Enforce Social-Distancing
- Drones: “Where the f**k are you going? Go back home!”
- I cut my partner’s hair in quarantine and it was a total disaster
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: 1,700,406 Total Cases (+5.8%)
- New Cases = 92,494 (+4,153) (+4.7%)
- Europe: 808,312 Total Cases (+5.4%)
- New Cases = 41,421 (+8,441) (+25.6%)
- Asia: 137,165 Total Cases (+2.1%)
- New Cases = 2,797 (+26) (+0.9%)
- United States: 502,876 Total Cases (+7.3%)
- New Cases = 33,981 (+246) (+0.73%)
- US States:
- 39 States > 1,000 cases (+1), plus DC
- 26 States > 2,500 cases (+1)
- 17 States > 5,000 cases (+0)
- 13 States > 10,000 cases (+2): NY, NJ, MI, CA, LA, MA, FL, PA, IL, TX, GA, CT & WA
- Top 5 States: (i) NY: 172,358 (+10,854); (ii) NJ: 54,358 (+3,331); (iii) MI: 22,783 (+1,279); (iv) CA: 21,381 (+1,169); and (v) MA: 20,974 (new)
- Note: PA falls out of Top 5 States
- For more information on US States, see https://ncov2019.live/data
- New York State:
- NY Total Cases = 172,358 (+6.8%)
- NY New Cases = 10,854 (+521) (+5%)
- New York City:
- Total Cases = 87,027 (+6.4%)
- NYC New Cases = 5,224 (+297) (+5.7%)
2. Confirmed Active Cases
- Worldwide: 1,221,084 Active Cases (+5.7%)
- New Active Cases = 66,165 (+11,256) (+20.5%)
- Europe Active Cases = 510,660 (+19,469) (+4%)
- Asia Active Cases = 38,486 (+2,138) (+5.9%)
- US Active Cases = 456,815 (+7.2%)
- US New Active Cases = 30,545 (+1,747) (+6.1%)
3. Serious or Critical Cases
- Worldwide serious or critical cases = 49,827 (+690)
- US series or critical cases = 10,917 (+906)
- US serious or critical cases = 2.2% of Active Cases (-0.1%), compared with worldwide percentage of 4%
[Note: Serious and critical cases give insight into the need for ICU beds and ventilators]
- Worldwide deaths = 102,760 (+6,947) (+7.3%)
- Europe: 70,122 deaths (+4,357) (+6.6%)
- Asia: 4,744 deaths (+87) (+1.9%)
- US deaths = 18,747 (+2,050) (+12.3%)
- NY deaths = 7,844 (+777) (+11%)
- Deaths per 1M population: (i) Italy: 312; (ii) Spain: 344; (iii) US: 57; (iv) France: 202; & (v) Germany: 33
- Worldwide Total Confirmed Case Fatality Rate = 6% (+0%)
- US Total Confirmed Case Fatality Rate = 3.7% (+0.1%) [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 = 357,180 376,572 (+5.4%)
- US recoveries = 27,314 (+5.3%)
C. Potential New Treatments
1. Two-thirds of coronavirus patients improve after drug remdesivir, study says
- More than two-thirds of severely ill COVID-19 patients saw their condition improve after treatment with remdesivir, an experimental drug being developed by Gilead Sciences Inc., according to new data based on patient observation.
- The analysis, published on Friday by the New England Journal of Medicine, does not detail what other treatments the 61 hospitalized patients were given and data on eight of them were not included — in one case because of a dosing error.
- The paper’s author called the findings “hopeful,” but cautioned that it is difficult to interpret the results since they do not include comparison to a control group, as would be the case in a randomized clinical trial. In addition, the patient numbers were small, the details being disclosed are limited, and the follow-up time was relatively short.
- There are currently no approved treatments or preventive vaccines for COVID-19, the respiratory illness caused by the novel coronavirus that has killed more than 100,000 people worldwide.
- Gilead last month sharply limited its compassionate use program for remdesivir and is conducting its own clinical trials of the antiviral drug, with results expected in coming weeks. Researchers in China as well as the U.S. National Institutes of Health are also testing the drug in COVID-19 patients.
- The new analysis includes patients in the United States, Europe, Canada and Japan who received a 10-day course of intravenous remdesivir.
- Before the treatment, 30 patients were on mechanical ventilators, and four were on a machine that pumps blood from the patient’s body through an artificial oxygenator. After a median follow-up of 18 days, 36 patients, or 68%, had an improvement in oxygen-support class, including more than half of the 30 patients receiving mechanical ventilation who had their breathing tubes removed. A total of 25 patients, or 47%, were discharged from the hospital. Seven patients, 13% of the total, died.
- Twelve patients, 23%, had serious side effects including multiple-organ-dysfunction syndrome, septic shock and acute kidney injury.
- “We look forward to the results of controlled clinical trials to potentially validate these findings,” wrote Dr. Jonathan Grein, the paper’s lead author and director of hospital epidemiology at Cedars-Sinai Medical Center, Los Angeles.
2. Hydroxychloroquine trial for COVID-19 begins amid political debate
- The US National Institutes of Health on Thursday began a clinical trial to treat adult COVID-19 patients with hydroxychloroquine, a malaria drug that President Trump has repeatedly promoted during the pandemic despite a lack of evidence for its effectiveness against the new coronavirus.
- The potential usefulness of these drugs against COVID-19 is now under investigation in numerous clinical trials, including the NIH’s trial that is up and running as of this week.
- The NIH’s trial is a blinded, randomized, placebo-controlled experiment aiming to enroll 500 adult patients with COVID-19 who have been hospitalized or are receiving emergency care and are expected to be admitted to a hospital. Researchers will give people randomized to the treatment group two doses of hydroxychloroquine per day for five days. They’ll then track the patients’ outcomes, looking at hospitalization status moving forward, need for oxygen or invasive mechanical ventilation, and death.
- The first patients were enrolled this week at Vanderbilt University Medical Center in Nashville. It is one of dozens of medical centers in a network organized by the NIH’s National Heart, Lung, and Blood Institute (NHLBI).
- “Many US hospitals are currently using hydroxychloroquine as first-line therapy for hospitalized patients with COVID-19 despite extremely limited clinical data supporting its effectiveness,” Dr. Wesley Self, an emergency medicine physician at Vanderbilt University Medical Center who’s leading the trial, said in a statement. “Thus, data on hydroxychloroquine for the treatment of COVID-19 are urgently needed to inform clinical practice.”
3. Potential Coronavirus Drugs May Cost as Little as $1
- Potential coronavirus treatments could be made for as little as $1, well below their typical price tags in pharmacies, according to an analysis of nine drugs in clinical trials.
- If their promise is confirmed in ongoing studies, medicines for Covid-19, including hydroxychloroquine, which President Donald Trump touted as a treatment, and Gilead Sciences Inc.’s remdesivir could be manufactured from $1 to $29 a course, a study published Friday in the Journal of Virus Eradication found.
- Results of randomized, controlled trials of several new treatments will emerge in the next three months. If the drugs show promise, there is a potential to massively scale up production and provide low-cost generic supplies worldwide, said Andrew Hill, a senior visiting research fellow in the pharmacology department at Liverpool University and a co-author of the paper.
- “At these low prices, anyone needing treatment for coronavirus, in any country, should be able to access the treatment they need,” Hill said in an email. Some of these drugs are sold for hundreds of times more than the cost of production, particularly in the U.S., he added.
- Manufacturing costs were estimated for nine drugs considered to be leading candidates for the treatment of Covid-19 based on recent reviews and analysis of ongoing clinical trials, Hill and his co-authors said.
Estimated manufacturing costs are shown below:
|Drug (Chemical name)||Cost per Treatment (US$)|
- “This pricing study shows clearly that potential medicines to treat COVID-19 are not at all expensive to produce and could be priced such that anyone who needs treatment should be able to access it,” said Jessica Burry, a pharmacist with medical aid group Medecins Sans Frontieres’ Access Campaign, in a statement.
D. New Scientific Findings and Other Advancements
1. Coronavirus patients can suffer lasting bodily damage, even after recovery
- Patients who survive COVID-19 can still suffer lasting bodily damage, including to the liver and heart, researchers are finding.
- Multiple studies of recovered patients from China, where the disease first emerged in November, showed impaired liver and heart function.
- “COVID-19 is not just a respiratory disorder,” Dr. Harlan Krumholtz, a cardiologist at Yale University, told the paper.
- “It can affect the heart, the liver, the kidneys, the brain, the endocrine system and the blood system.”
- Inflammation from the body’s immune response has been linked to strokes and heart attacks.
- Researchers also wonder if the coronavirus that causes COVID-19 might lie dormant in the body for years or even decades — and then spring back to life, in the same way, that the herpes virus that causes chickenpox can reemerge as shingles.
2. Antibody tests for the coronavirus could be available within a week
- The nation’s top infectious disease expert says widespread antibody tests that would confirm whether a person was recently infected with the new novel coronavirus will be available in the coming days.
- “Within a period of a week or so, we’re going to have a rather large number of tests that are available,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
- Instead of detecting the virus itself, the tests identify antibodies the immune system generates to fight COVID-19. The tests could determine who has contracted the disease and recovered.
- Fauci said health officials can then determine how deeply the virus has “penetrated the society,” and whether previously infected people would be vulnerable to reinfection, which he said is particularly “important for health care workers.”
- “It’s very likely that there are a large number of people out there that have been infected, have been asymptomatic and did not know they were infected.”
- Antibody tests would be used in parallel with tests that identify current infections.
3. Smoking Helps Open Gateway to Coronavirus Infection
- Smoking may raise the risk of Covid-19 by elevating enzymes that allow the coronavirus to gain access into lung cells, according to a new study.
- Smokers and people with chronic obstructive pulmonary disease may have elevated levels of an enzyme called ACE-2, which helps the virus enter cells in their lungs, where it replicates, a study published in the European Respiratory Journal Thursday showed.
- Obesity, diabetes, high blood pressure and other chronic conditions have emerged as factors that make people vulnerable to Covid-19, the disease caused by the coronavirus that’s sweeping the world in a pandemic.
- The research, led by Janice Leung, a respirologist at St. Paul’s Hospital in Vancouver, is an observational study based on data emerging from China and was peer reviewed. In China, where the mortality rate is higher for men than women, about half of males smoke, according to the World Health Organization. That compares with some 2% for females.
- “There has never been a better time to quit smoking to protect yourself from Covid-19, ” Leung said.
- Samples were taken from the lungs of 21 patients with COPD and 21 people not suffering from COPD. Higher levels of ACE-2 were found both in COPD patients and current smokers.
- The researchers also cross-referenced their findings with two existing study groups that include more test subjects, and came to the same conclusion.
4. Coronavirus patients report strange new symptom: ‘Fizzing’.
- Add this to the growing list of the coronavirus‘ awful toll on victims: a symptom that produces a strange buzzing sensation throughout their body.
- The side effect, reported by patients sharing their symptoms on Twitter, is now being described as “fizzing,” and is one of the more mysterious marks of the illness. Doctors on the frontlines of treating the illness tell The Post it may be one of the last sensations patients feel as their bodies fight the disease.
- Other symptoms of the deadly disease include a loss of smell and taste, fever, aches, breathlessness, fatigue, a dry cough, diarrhea, strokes and seizures, and for some, no symptoms at all.
- But as more and more patients share the effects of the illness online, many are finding they have the strange new symptom, too. One patient, @miafia, who felt the sensation since the first day of her symptoms, described it as “an electric feeling on my skin.”
- Tarana Burke, known as the founder of the #MeToo movement, shared that her partner had the illness and had a burning feeling on his skin that was so severe, “his skin felt like it was burning.”
- “Even when he barely had a fever of 99+ we literally used aloe gel for sunburn to soothe it,” she wrote on Twitter. “The NP later told us she had heard others say that too.”
- Doctors say the symptom is not terribly common, but may be part of an autoimmune response that affects patients’ nervous system.
- There may be several reasons for it, he and others say. The feeling may be the result of disease-fighting “antibodies interfering with the way nerves work,” but adds that neurologists still aren’t sure if it’s our body’s response to the virus or the virus itself causing the feeling.
- The sensation may also be tied to a fever, says Dr. Vipul Shah, Clinical Director at telehealth service Pack Health.
- For patients experiencing the sensation, Griffin recommends letting the body recover on its own.
- “It’s bothersome but benign,” he says. “[Patients’] cognition seems to be doing better with us just waiting. The human body is a pretty impressive construct and often will get better.”
E. The Road Back?
1. Will an Antibody Test Allow Us to Go Back to School or Work?
- Tests that reveal whether someone has been infected with the coronavirus are on their way. But they’re not perfect. Here’s what you need to know.
- A major answer to the question of when — and how — Americans can return to public places like work and school could depend on something called an antibody test, a blood test that determines whether someone has ever been infected with the coronavirus.
- People who are believed to be immune may be able to safely return to work. It would be especially important to know which health care workers are protected from getting infected and could continue to care for sick people.
- The Centers for Disease Control and Prevention recently announced that it would begin using antibody tests to see what proportion of the population has already been infected. On Friday, the National Institutes of Health announced it would test 10,000 healthy volunteers around the country for the presence of antibodies.
- “Within a period of a week or so, we are going to have a rather large number of tests that are available,” Dr. Anthony S. Fauci, the leading infectious disease expert in the U.S., said Friday morning on CNN.
- He said the White House coronavirus task force was discussing the idea of “certificates of immunity,” which could be issued to people who had previously been infected.
What exactly is a serology test?
- A serology test looks for signs of an immune response — in this case, to the new coronavirus.
- When your body encounters a virus, it takes some time for it to recognize the invader and to begin to scale up an immune response. Immune molecules called antibodies are a crucial part of this response.
- The first type of antibody to appear is called immunoglobulin M or IgM, and its levels spike within a few days of infection. But IgM is a generic fighter. To target and destroy a specific virus, the body refines it into a second type of antibody, called immunoglobulin G, or IgG, that can recognize that virus.
- As IgG levels rise, IgM levels drop; IgG levels peak around 28 days after the onset of infection.
- There is a third type of antibody, called IgA, that is present in mucosal tissues — like the inner lining of the lung. IgA is known to be important for fighting respiratory infections such as influenza, and is likely to be central in coronavirus infection, too.
- Many of the tests being developed look for levels of all three antibodies; some look for just IgM and IgG, and still others test for only one type.
What can these tests tell us? And what can’t they?
- Let’s begin with what they can’t tell us. Because the antibodies come up so late, these tests are not helpful for diagnosing an early infection. “For that they are useless,” said Dr. Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai in New York.
- The tests are more effective at detecting the presence of antibody responses across large numbers of people, not just to determine who is immune but how widely the virus has spread in the population.
- From 25 to 50 percent of people who become infected may never develop symptoms, and some may become only mildly ill. Others may have known they were sick, but could not get tested. Serology tests would be able to identify these people and help scientists better estimate the death rate of Covid-19, the disease caused by the virus.
- Governments around the world are also hopeful that serology tests can tell them which people are protected from re-infection and can safely go back to work. Knowing the full scope of the pandemic would help them decide when to end social isolation measures and allow businesses and schools to reopen.
- Tracking the rise and fall of antibody levels may also enable scientists to back-calculate the dates of infection, and help them predict whether the virus shows seasonal fluctuations.
I’m pretty sure I had the coronavirus already. Can I take a test and go back to work?
- Not yet. Most of the tests being developed offer a simple yes-no answer to the question of who has antibodies, and who was exposed to the virus. But simply having antibodies is no guarantee of immunity.
- “Being immune means that if you’re exposed to the virus, your immune system will clear the virus out before it can establish a productive infection,” Dr. Rasmussen said.
- Some people — because they had mild or no symptoms, for example — might have developed antibodies that are too weak to prevent re-infection. Conversely, others who have low levels of IgG may still be protected.
- That’s because antibodies are just one well-understood piece of the immune response. Immune cells called T-cells may also be involved. “A lot less is known about how these different parts of the immune system work together to provide protective immunity,” Dr. Rasmussen said.
When will serology tests be widely available?
- Some are already available and being used, but it’s the early days and it’s unclear how good they are. Last week, the Food and Drug Administration granted an emergency use authorization to one such test. But others are being used in research projects and by hospitals.
- In March, the F.D.A. allowed developers to begin to sell or use antibody tests without first getting the agency’s permission, once the companies had done their own evaluations to ensure the tests were accurate and reliable. Since then, more than 70 test developers have notified the agency that they have serological tests available. But the agency said some companies have falsely claimed that their tests were F.D.A.-approved, or falsely claimed they could diagnose Covid-19.
- But “serological tests are plagued with issues,” Dr. Rasmussen said, and problems are surfacing even as these tests proceed.
- In the U.K., for example, the tests are plagued with false negatives (not picking up antibodies when they’re present) and with false positives (indicating antibodies when there are none). Some of the tests may not be specific enough to the new coronavirus; they may pick up a signal from antibodies made in response to infections with the coronaviruses that cause common colds.
- False positives, in particular, are dangerous because they can lull people into believing they are immune when they are not, and becoming exposed to the virus. “Certainly if somebody thinks that they’re protected and they’re not, that would be a problem,” Dr. Rasmussen said.
If someone is immune to the virus, how long will the immunity last?
- We don’t know.
- This is a new virus, and so we have no way of knowing exactly how long immunity to the virus will last. Our best guess comes from looking at its cousins, the common cold coronaviruses, as well as the more dangerous ones that caused SARS and MERS. Immunity to these viruses persists anywhere from one to eight years.
- The best way to find out, Dr. Krammer said, is to follow people with and without the antibodies and see when they might become reinfected. “Those are the studies that are now needed,” he said. “They will take time.”
2. Dr. Anthony Fauci says White House mulling coronavirus certificates of immunity
- Dr. Anthony Fauci, a key member of President Trump’s coronavirus task force, said Friday that certificates of immunity for Americans have been discussed during White House meetings, according to a report.
- Fauci, head of the National Institute of Allergy and Infectious Diseases, said on CNN that the idea that people carry such certificates to prove they have tested positive for antibodies might “have some merit under certain circumstances.”
- “It’s one of those things that we talk about when we want to make sure that we know who the vulnerable people are and not,” Fauci said, adding that the antibody tests will be available soon.
- The top infectious disease expert added that antibody tests will be important for medical workers on the front line of the pandemic.
- “If their antibody test is positive, one can formulate strategies about whether or not they would be at risk or vulnerable to getting re-infected. This would be important for health care workers, for first-line fighters,” he said on the network.
- “Within a period of a week or so, we’re going to have a rather large number of tests that are available,” Fauci added.
- He said testing of people who currently have COVID-19 and antibody tests will be done concurrently.
- Fauci also predicted there will be many deaths in the next week — but “deaths tend to lag behind what the driving elements of the outbreak are,” and there should be fewer hospitalizations and intubations.
3. Apple and Google are building a coronavirus tracking system into iOS and Android
- Apple and Google announced a system for tracking the spread of the new coronavirus, allowing users to share data through Bluetooth Low Energy (BLE) transmissions and approved apps from health organizations.
- The new system, which is laid out in a series of documents and white papers, would use short-range Bluetooth communications to establish a voluntary contact-tracing network, keeping extensive data on phones that have been in close proximity with each other. Official apps from public health authorities will get access to this data, and users who download them can report if they’ve been diagnosed with COVID-19. The system will also alert people who download them to whether they were in close contact with an infected person.
- Apple and Google will introduce a pair of iOS and Android APIs in mid-May and make sure these health authorities’ apps can implement them. During this phase, users will still have to download an app to participate in contact-tracing, which could limit adoption. But in the months after the API is complete, the companies will work on building tracing functionality into the underlying operating system, as an option immediately available to everyone with an iOS or Android phone.
- Contact tracing — which involves figuring out who an infected person has been in contact with and trying to prevent them from infecting others — is one of the most promising solutions for containing COVID-19, but using digital surveillance technology to do it raises massive privacy concerns and questions about effectiveness. Earlier this week, the American Civil Liberties Union raised concerns about tracking users with phone data, arguing that any system would need to be limited in scope and avoid compromising user privacy.
- Unlike some other methods — like, say, using GPS data — this Bluetooth plan wouldn’t track people’s physical location. It would basically pick up the signals of nearby phones at 5-minute intervals and store the connections between them in a database. If one person tests positive for the novel coronavirus, they could tell the app they’ve been infected, and it could notify other people whose phones passed within close range in the preceding days.
- The system also takes a number of steps to prevent people from being identified, even after they’ve shared their data. While the app regularly sends information out over Bluetooth, it broadcasts an anonymous key rather than a static identity, and those keys cycle every 15 minutes to preserve privacy. Even once a person shares that they’ve been infected, the app will only share keys from the specific period in which they were contagious.
- Crucially, there is no centrally accessible master list of which phones have matched, contagious or otherwise. That’s because the phones themselves are performing the cryptographic calculations required to protect privacy. The central servers only maintain the database of shared keys, rather than the interactions between those keys.
- The method still has potential weaknesses. In crowded areas, it could flag people in adjacent rooms who aren’t actually sharing space with the user, making people worry unnecessarily. It may also not capture the nuance of how long someone was exposed — working next to an infected person all day, for example, will expose you to a much greater viral load than walking by them on the street. And it depends on people having apps in the short term and up-to-date smartphones in the long term, which could mean it’s less effective in areas with lower connectivity.
4. How Much Should the Public Know About Who Has the Coronavirus?
- When the first case of the coronavirus in Silicon Valley was discovered in late January, health officials were faced with a barrage of questions: What city did the patient live in? Whom had he come in contact with? Which health clinic had he visited before he knew he was infected?
- Dr. Sara Cody, the chief health officer for Santa Clara County, which has a population of two million across 15 cities, declined to give details.
- “I can’t give the city,” she said, adding “we are not going to be giving out information about where he sought health care.”
- But medical experts say that how much the public should know has become a critical question that will help determine how the United States confronts this outbreak and future ones.
- Residents are clamoring to see whether the virus has been detected in their neighborhoods so they can take more steps to avoid any contact. American researchers are starved for data, unlike their colleagues in other countries who are harnessing rivers of information from their more centralized medical systems. And local politicians complain that they cannot provide basic information on the spread of the virus to their constituents.
- In the perennial tug-of-war between privacy and transparency in the United States, privacy appears to be winning in the coronavirus pandemic.
- Critics of the threadbare public reporting say it is striking that even in Silicon Valley, which is home to leading technology companies that thrive off the collection of data, residents are given very little information about the movement and dynamics of the virus.
- Across the United States there is even less consistency. New York is listing cases by age bracket, gender and borough despite calls for more localized reporting. Connecticut lists data by town. Florida provides its residents with a wealth of data on the pandemic. The state’s Department of Health has a detailed dashboard and reports showing the spread of the virus — rich with data on the cities affected, the number of people tested, the age brackets of patients, whether they are Florida residents, and the number of cases in nursing homes.
- “Pandemics increase paranoia and stigma,” said Dr. Rohan Radhakrishna, the deputy health officer of Contra Costa County, across the Bay from San Francisco, which provides only the total number of cases in the county on its website. “We must be extra cautious in protecting individuals and the community.”
- In Santa Clara, health officials say they cannot disclose how many cases are found in each city because of the nation’s strict medical privacy law, the Health Insurance Portability and Accountability Act, or HIPAA, signed by President Bill Clinton in 1996.
- But that law was designed for the protection of personal data at doctors’ offices and in hospitals and includes provisions for the release of otherwise protected information during emergencies.
- Using the law as a justification for limiting the release of aggregate data about the coronavirus is “ridiculous,” according to Arthur L. Caplan, a professor of bioethics at the N.Y.U. School of Medicine in New York City.
- Prof. Caplan is among many experts who say the coronavirus is likely to spur a reassessment of medical privacy laws. Already, the Trump Administration waived some provisions of the law this month.
- “HIPAA was written for a time when there were paper charts,” Prof. Caplan said. The coronavirus, he said, “will cause us to rethink a lot of things.”
- The U.S. approach contrasts sharply with that of Singapore and Taiwan, whose fights against the virus have been praised as among the most effective. Both governments make public the suspected linkages of cases, anonymized by numbers. In Singapore the authorities sometimes list neighborhoods where patients lived, their workplaces and churches or mosques that they attended.
- Moritz Kraemer, a scholar at Oxford University who is leading a team of researchers in mapping the global spread of the coronavirus, says China’s data “provided incredible detail,” including a patient’s age, sex, travel history and history of chronic disease, as well as where the case was reported, and the dates of the onset of symptoms, hospitalization and confirmation of infection.
- Prof. Caplan of the N.Y.U. School of Medicine says it is paradoxical that the United States is providing less precise information to its citizens on the outbreak than Singapore, which puts limits on the spread of information through internet controls.
- “Here we expect to get information so we have our choices and we make our decisions,” he said. “Our notion is information is the oxygen for democracy. Wouldn’t we want to receive more information than them?”
F. Projections and Our (Possible) Future
1. New U.S. Projections Show Summer Spike if Coronavirus Restrictions Lifted
- New U.S. government figures show novel coronavirus infections will spike during the summer if stay-at-home orders are lifted after 30 days as planned, the New York Times reported on Friday.
- If President Donald Trump lifts shelter-in-place orders after 30 days, the death toll is estimated to reach 200,000, the New York Times reported, citing new projections it obtained from the Departments of Homeland Security (DHS) and Health and Human Services.
- Trump said he and his advisers have not seen the new projections reported by the Times.
- He gave a much different projection during the daily White House coronavirus briefing, saying he thinks the United States will lose fewer than the 100,000 lives initially projected to be lost to COVID-19, and suggested the country is nearing its peak infection rate.
- A DHS official confirmed the authenticity of the projections obtained by the New York Times. The official, who requested anonymity to discuss the matter, stressed that the figures were considered a “best guess.”
- A DHS representative did not immediately respond to a request for comment.
- A spokeswoman for the Federal Emergency Management Agency (FEMA) declined to comment on what she called “alleged, leaked documents.”
- U.S. deaths due to the virus topped 18,100 on Friday, according to a Reuters tally.
- The April 9 projections did not have dates for when shelter-in-place orders were delivered or dates for when spikes would hit, the Times said.
- The projections outline different scenarios. Without any restrictions imposed to contain the coronavirus – including school closings, shelter-in-place orders and social distancing, the death toll from the virus could have reached 300,000, it said.
- But if the 30-day stay-at-home order is lifted, the death total is estimated to reach 200,000, the Times said, “even if schools remain closed until summer, 25% of the country continues to work from home and some social distancing continues.”
2. Updated IHME (Murray) Model (4/10/20): Continued revisions in the state projections (updated projected peak days by State included)
- The IHME Projection Model is a model that includes projections of (i) the resources (e.g., the number of hospital beds, ICU beds and ventilators) that will be required by each State, (ii) the date on which the maximum number of resources will be required by each State (the “peak day”), and (iii) the number of deaths for each State. The IMHE Model began making projections on March 26, and the assumptions underlying the model and the projections are updated periodically. The current version of the IHME Model projections can be found at https://covid19.healthdata.org/projections
- The White House Coronavirus Task Force has referenced the model in its daily briefings and appears to be using the model to develop plans and guidance in response to the coronavirus epidemic. The Gates Foundation is funding the development of the IHME Model.
April 10 Update
Modeling Methodology Update from IHME
- The data and knowledge landscape on COVID-19 epidemic patterns, health care demand or resource gaps, government response, and the effects of social distancing measures are rapidly evolving worldwide. At IHME, we strive to incorporate new evidence as soon as it becomes available. Our aim is to produce the best possible predictions given what we know today – and to continuously improve these estimates to support further gains against COVID-19 tomorrow.
- Today’s release of COVID-19 predictions for deaths and hospital use represents a combination of substantial data additions, notably on ICU capacity for many countries in the European Economic Area (EEA), and model refinements.
Predicting COVID-19 deaths: improving projections
- To see a more detailed explanation of the changes, see the IHME udpate page here: http://www.healthdata.org/covid/updates.
- Modeling daily deaths. the IHME noted that with each day of additional data, the model predictions change. It also noted that there are substantial fluctuations in the number of COVID-19 deaths reported each day. To mitigate this impact, it began smoothing the data based on the last three iterations of projections
- Modeling the relationship between social distancing policies and COVID-19 deaths. IHME current models average the effects of three social distancing measures – school closures, stay-at-home orders, and non-essential business closures – by using three different weighting schemes. As also highlighted on April 5, this approach aims to capture, community-by-community, differences in how mandates on social distancing behaviors may be related to COVID-19 epidemic patterns.
Predicted peak for daily COVID-19 deaths
- At the national level, current data suggest that the predicted peak for daily COVID-19 deaths could be approximately April 10 ( moved up from April 10 in the last model], reaching 1,983 deaths (a reduction from 2,212 per day in the last model) (estimate range of 500 to 5,583) . These projections suggest that the US may be nearing its peak for COVID-19 deaths; subsequently, we may soon see the number of daily deaths decreasing at the national level.
- Across the US, it appears that several states – especially those with large COVID-19 epidemics earlier on – may be nearing or have already reached their peaks. For instance, the latest data indicate that New York is reaching or has experienced its peak – at 799 COVID-19 deaths reported on April 9 – as well as New Jersey and Illinois (272 and 154 reported deaths on April 8, respectively).
- Three states with the highest potential daily COVID-19 death peaks in the coming weeks are listed below:
|State||Predicted peak date of daily COVID-19 deaths||Predicted daily COVID-19 deaths at peak: average projection (estimate range)|
|Massachusetts||April 27||201 (29 to 677)|
|Connecticut||April 25||146 (32 to 409)|
|Florida||April 27||112 (29 to 283)|
Predictions for cumulative deaths
- For the US, projected cumulative COVID-19 deaths could reach 61,545 (estimate range of 26,487 to 155,315) across states during the epidemic’s first wave. Today’s release aligns closely with national-level predictions published on April 7, where the cumulative death toll was projected to be 60,415 (estimate range of 31,221 to 126,703).
- Based on the latest data and current model, the following states could have the highest cumulative COVID-19 death toll through the epidemic’s first wave:
- New York, at 13,463 deaths (estimate range of 9,382 to 24,236)
- Massachusetts, at 6,739 deaths (estimate range of 1,269 to 22,854)
- Connecticut, at 4,614 deaths (estimate range of 1,143 to 13,559)
- Florida, at 3,999 deaths (estimate range of 1,218 to 10,293)
- Georgia, at 3,564 deaths (estimate range of 1,300 to 9,020)
Hospital resource use predictions
- Across the US, the predicted peak date for hospital resource use could be around April 11, with COVID-19 patients potentially requiring:
- 86,379 total hospital beds down from 94,249, a decline of 8.4%
- Estimate range of 24,290 to 232,948
- 17,707 ICU beds down from 19,438, a decline of 8.9%
- Estimate range of 7,375 to 42,511
- 15,414 invasive ventilators down from 16,921, a decline of 8.9%
- Estimate range of 5,780 to 38,595
- 86,379 total hospital beds down from 94,249, a decline of 8.4%
- Based on the current data and model, New York and New Jersey may be experiencing their peak hospital use or have recently experienced this peak (April 8).
- Conversely, the following states with high COVID-19 death projections could see hospital resource need peak between April 24 and April 26:
|State||Predicted potential peak date of hospital resource use||Predicted hospital bed need at peak||Predicted ICU bed need at peak||Predicted invasive ventilator need at peak|
|Massachusetts||April 26||8,104 (1,109 to 27,640)||1,873 (274 to 6,213)||1,637 (232 to 5,530)|
|Connecticut||April 26||7,430 (1,572 to 21,167)||1,499 (340 to 4,132)||1,276 (281 to 3,563)|
|Florida||April 24||6,431 (1,695 to 16,238)||1,241 (339 to 3,077)||1,041 (280 to 2,610)|
|Georgia||April 26||5,496 (1,877 to 13,825)||1,048 (373 to 2,573)||877 (308 to 2,164)|
- A total of 13 states (noted in green) have already passed their peak usage dates and another 10 states are expected to peak within the next week. The following chart highlights the new peak days (days change is from the prior update on April 7).