“A lot of very smart people, a lot of professionals, doctors and business leaders are a lot of things that go into a decision about when to reopen our economy. And it’s going to be based on a lot of facts and a lot of instinct also. Whether we like it or not, there is a certain instinct to it.” — President Trump
- Recent Developments and Headlines
- Potential New Treatments
- New Scientific Findings
- Symptoms and Outcomes
- Stories from the Frontline
- The Road Back
- Projections and Our (Possible) Future
- Practical Tips
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Note: As there is a lot of inaccurate information circulating, we only include information that we can confirm from a credible source or that is based on data that we can verify. To the extent that we derive information from an online source, we provide a link to the source, which typically provides more detail that is included in our update. If you have any questions about any information included in an update, or if you have a different view, please let us know and we will supplement or correct as needed.
A. Recent Developments and Headlines
Note: All changes noted in this Update are since the 4/11 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 Cases = 1,854,171
- US Cases = 560,433
- NY Cases = 189,415
- US deaths = 22,151
- NY deaths = 9,385
- Dr. Fauci: ‘Misinformation Right From The Beginning’ Increased Coronavirus Spread
- President Trump declares major disaster in all 50 states, first time in history
- President Trump says decision to reopen the economy will be based on ‘facts’ and ‘instinct’
- New York needs federal help with widespread coronavirus testing if state is to reopen
- NYC Mayor De Blasio says NYC has enough ventilators, PPE for coming week
- NY Gov. Cuomo: curve ‘flattening’ but death tolls remain ‘terribly high’
- NY Gov. Cuomo orders employers to provide face masks to workers
- NYC hospitals ‘days’ away from running out of coronavirus test swabs
- NYC coronavirus cases top 100,000, death toll reaches nearly 7,000
- NJ Gov. Murphy orders NJ Transit to cut capacity by half
- Bodies buried in Potter’s Field as New York’s Coronavirus deaths mount
- Bloomberg Stocked Up on Ventilators and Masks as NYC Mayor, Then de Blasio got rid of them
- US trial of Japanese flu drug for coronavirus gets green light
- China’s new coronavirus cases rise to near six-week high
- UK Could Be Country Worst Affected by Coronavirus in Europe: Govt Scientist
- Coronavirus: Stockholm Police Prepare for Civil Unrest at Overstretched Hospitals
- Italy Begins to Grapple with How to Ease Restrictions
- Turkey Enforces Coronavirus Lockdown While Trying to Shield Economy
- Israel Tightens Quarantine
- Mexico: 39 Virus Fatalities in Single Day
- Russia Sees Over 2,000 New COVID-19 Infections In Biggest Ever Single-Day Spike
- Kremlin says Moscow hospitals flooded as coronavirus death toll passes 100
- Swedish Document Reveals Elderly Coronavirus Patients Will Not Be Prioritized For Intensive Care
- ‘Health Thugs’: El Salvador’s Gangs Reportedly Enforcing Coronavirus Quarantine
- Boris Better! UK PM Released From Hospital
- In Mexico, beach towns block themselves off because of virus
- Sweden faces stricter quarantine as PM admits measures were ‘not good enough’
- Austria is set to begin easing lockdown
- Denmark gets ready to reopen schools
- Iran Reopens ‘Low-Risk’ Economic Activities Over Fears Millions Will Lose Work
- Poorer Nations in Europe’s East Spared Worst of Coronavirus
- Villagers Turn Away Relatives as Virus Scare Grips Rural India
- Inform on Your Neighbors: Northern Ireland Police Launch Lockdown Reporting Site
- The Latest: Electric bands for Koreans who break quarantine
- French to be allowed outside to adopt a pet
- Food banks have been overwhelmed as millions struggle to feed themselves
- Mile-long line of cars outside California grocery giveaway
- Florida inmates will start making masks. For now, only guards will get virus protection
- Army to determine if NYC needs more medical personnel to combat coronavirus
- Woman loses entire family to coronavirus as husband, son die within days
- Courier With Coronavirus Samples Crashes On I-195 In Massachusetts
- NY Gov. Cuomo hails nursing home for donating ventilators to NYC hospitals
- NYC Mayor De Blasio won’t budge on closing NYC schools after heat from Gov. Cuomo, calls decision ‘crystal clear’
- Cuomo Says Decision on Reopening Schools Must Be Coordinated
- The world’s largest pork processor warns US may see meat shortages soon
- Kentucky worshippers met with nails in road as they defy coronavirus lockdown
- Nursing home deaths soar past 3,300 in alarming surge
- New Yorkers are refusing to be hospitalized over fear of getting coronavirus
- Kentucky worshippers met with nails in road as they defy coronavirus lockdown
- Murphy warns that restarting NJ too quickly could backfire
- Kennedy family holds Zoom memorial for RFK granddaughter and son
- NASA astronauts will return to new world ravaged by coronavirus
- Nurses working in dangerous conditions demand PPE from NY Gov. Cuomo
- Red tape adding to NYC funeral directors’ woes amid coronavirus pandemic
- WWE has its first coronavirus case
- Thousands of FDNY first responders to finally undergo coronavirus testing
- Americans are boozing it up while working from home, study shows
- NYC vet does sidewalk acupuncture for animals in pain
- Two Queens hospitals grapple with rising coronavirus deaths
- NYC firehouse crippled by coronavirus as 11 firefighters test positive
- Foster dog gives NYC woman ‘a reason to get up’ during pandemic
- Kansas Supreme Court hears arguments via Zoom amid coronavirus
- Central Park carriage horses riding out coronavirus in Amish Country
- Coronavirus could be the death of the anti-vax movement
- NYC homeless man and dog survive on $7 a day during coronavirus
- How Pope Francis is observing Holy Week in isolation
- New Yorkers are dying as ambulance response times surge amid coronavirus
- Hospital accused of exposing cancer patients, babies to coronavirus
- NYC isolating 6,000 homeless people in hotels to slow coronavirus spread
- South Korea to track coronavirus quarantine violators with wristbands
- Spain, France feeling hopeful amid coronavirus as other nations batten hatches
- Hair dye and clippers are the new coronavirus panic buys
- America’s most infamous criminals among the safest from coronavirus
- New York hospitals only getting a fraction of federal coronavirus funds
- Horse racing offers desperate gamblers ray of hope amid coronavirus closures
- FDNY wife: Coronavirus threat ‘walks through our front door’ every day
- Heroic ER doctor loses custody of daughter due to coronavirus
- China targets African travelers amid new wave of coronavirus cases
- NYC homeless shelter in revolt over unsanitary coronavirus conditions
- Doctors believe coronavirus was present in California as early as December
- A chloroquine study ends in Brazil over concerns of fatal heart complications
- Bolsonaro Says Trump ‘Wonder Drug’ Will “Save 1000s Of Lives” In Brazil
- The Israeli spy service has helped the country obtain coveted medical supplies
- Britain surpasses 10,000 deaths, and Boris Johnson is released from the hospital
- Flight attendants and pilots question whether they should still be working
- Auto Giants Trade Drills for Tweezers in Bid to Rush Coronavirus Ventilators
- P&G Toilet-Paper Factory Delivers as Virus Hits Town
- Smithfield CEO Warns of Risks to Pork Supply
- Flood-Prone Cities Face Double-Whammy of High Water and Coronavirus
- ‘Ready for Lunch? Over.’ Walkie-Talkies Make a Comeback.
- Thailand Bans Booze Sales To Stop COVID-19 Spread
B. Potential New Treatments
1. Coronavirus Vaccine Could Be Ready in 6 Months
- A vaccine against the coronavirus could be ready by September, according to a scientist leading one of Britain’s most advanced teams.
- Sarah Gilbert, professor of vaccinology at Oxford University, said she is “80% confident” the vaccine would work, and could be ready by September. Experts have warned the public that vaccines typically take years to develop, and one for the coronavirus could take between 12 to 18 months at best.
- In the case of the Oxford team, however, “it’s not just a hunch, and as every week goes by we have more data to look at,” Gilbert told the London newspaper.
- Gilbert’s team is one of dozens worldwide working on a vaccine and is the most advanced in Britain, she told the Times. As the country looks set to begin its fourth week under lockdown, a vaccine could be fundamental in easing the measures and returning to normal life. Gilbert said human trials are due to start in the next two weeks.
- Her remarks came as the death toll from the virus pushed past 100,000 globally. On Friday, the U.K. reported 980 fatalities, taking the total count from the virus to 8,958, and the government has repeatedly pleaded with the public to obey lockdown rules during the long Easter holiday weekend. As Prime Minister Boris Johnson begins his recovery after a spell in intensive care, Patrick Vallance, the government’s chief scientific adviser, warned he expects the number of deaths to increase for “a few weeks” yet.
- Manufacturing the millions of vaccine doses necessary could take months. Gilbert said she’s in discussions with the British government about funding, and starting production before the final results are in, allowing the public to access the vaccine immediately if it proves to work. She said success by the autumn was “just about possible if everything goes perfectly.”
2. Doctors, pols urge earlier use of ‘miracle’ coronavirus drug cocktail
- For Charles Vavruska, it was nothing short of a miracle cure.
- Days after the 53-year-old City Council staffer arrived at New York Presbyterian-Queens hospital barely able to breathe and tested positive for COVID-19, doctors started him on the controversial drug cocktail of hydroxychloroquine, an anti-malarial, and azithromycin, an antibiotic.
- Although Vavruska said he felt almost immediately better, he wishes the urgent-care doctor he went to see in the early days of his flu-like symptoms in mid-March could have prescribed a similar treatment before he grew progressively worse and ended up in a hospital room, hooked up to an oxygen tank and fighting for his life.
- It’s an opinion shared by President Trump and a growing cadre of physicians and some infectious diseases experts who believe that an effective way to control the spiraling pandemic is to prescribe the anti-malarial at the first sign of symptoms even though it has not gone through the requisite number of clinical trials.
- Last week, the American Society of Thoracic Surgeons issued guidelines for doctors to use the anti-malarial if they are in the advanced stages of the coronavirus, but some physicians say that it needs to be administered long before that.
- “In a pandemic, we need to be using presumptive diagnoses,” said Marvin Lerner, a retired Manhattan-based physician and infectious diseases expert.
- A Rockland County physician said he recently successfully treated 350 patients showing early signs of the coronavirus using a combination of hydroxychloroquine, azithromycin and zinc sulfate in his office. Dr. Vladimir “Zev” Zelenko said the $20 treatment had “100 percent” success in his Monsey practice in a video message he posted to President Trump two weeks ago.
- “If anyone has any political influence please make noise because we need the political status to change and these medications to be used without obstruction,” said Zelenko in a YouTube message last week.
- Although hydroxychloroquine is used to treat malaria, lupus and rheumatoid arthritis, the Federal Drug Administration has only approved it for treatment of COVID-19 in advanced cases of the virus and by the time patients have to rely on ventilators. Pharmacists in New York state are only allowed to fill prescriptions for the FDA-approved uses of the drug.
- Last week New York City Councilman Robert Holden urged Gov. Andrew Cuomo to remove restrictions on the drug. “The anecdotal evidence is too strong to ignore,” the lawmaker wrote in an April 7 letter. “Personally, I have been contacted by a number of my constituents who were treated with the hydroxychloroquine and azithromycin combination in New York hospitals. They reported feeling an immediate improvement … and they have since recovered.”
- One of those recovered patients is Vavruska, who works in the councilman’s Queens office.
- “I kept the packet of the drug when I left the hospital because I wanted to show my friend Sal who had been home with fever for 10 days,” Vavruska told The Post. “I gave Sal the packet but it’s banned from the pharmacies and he couldn’t get it.
- “I really believe if he had gotten the treatment, he would be alive today.”
C. New Scientific Findings and Other Advancements
1. The coronavirus spreads at least 13 feet, travels on shoes
- The coronavirus can travel through the air at least 13 feet — more than twice as far as social distancing guidelines, according to a report from the CDC.
- Research published in the federal agency’s Emerging Infectious Diseases journal shows the contagion spreading far further than previous official suggestions — and also getting spread on people’s shoes.
- “The aerosol distribution characteristics … indicate that the transmission distance of [COVID-19] might be 4 m,” the report says, translating as more than 13 feet.
- “Furthermore, half of the samples from the soles of the ICU medical staff shoes tested positive,” the researchers wrote of samples taken at a hospital in Wuhan. “Therefore, the soles of medical staff shoes might function as carriers.”
- The report, based on research by a team at the Academy of Military Medical Sciences in Beijing, appears to reaffirm fears that the current social distancing guidelines of 6 feet may not be enough.
- It also suggests people — especially medical staff on the frontlines — could inadvertently be spreading the bug away from its source, recommending stringent disinfecting measures.
- High levels of the virus were also found on frequently touched surfaces like computer mice, trashcans and bed rails.
- The CDC recommends 6 feet for social distancing, while the World Health Organization claims just 3 feet should be enough, less than a quarter of the distance the current study suggests it spreads.
- Research last month said the virus could travel up to 27 feet. Dr. Anthony Fauci, the nation’s top infectious disease expert, however called that “terribly misleading,” saying it would require a “very, very robust, vigorous, sneeze” to travel that far and the scenario was “not practical.”
2. About 90% of Coronavirus Hospitalized Patients Have Underlying Conditions
- Nearly 90 percent of U.S. coronavirus patients who have been hospitalized have underlying health problems, or comorbidities, reports the Centers for Disease Control and Prevention (CDC).
- The Morbidity and Mortality Weekly Report (MMWR), released Wednesday, focuses on hospitalization rates and characteristics of patients hospitalized with confirmed coronavirus disease, or COVID-19.
- CDC reports among 1,482 patients from 14 states who were hospitalized with COVID-19 in March, 74.5 percent were 50 years of age or older, and 54.4 percent were male.
- According to Dr. Shikha Garg and associates, during the month of March, among 178 (12%) adult patients with data on underlying conditions, 89.3% had one or more underlying conditions:
- [T]he most common were hypertension (49.7%), obesity (48.3%), chronic lung disease (34.6%), diabetes mellitus (28.3%), and cardiovascular disease (27.8%).
- Medscape provided a bar graph of the data regarding underlying conditions of those hospitalized for the infection caused by the novel coronavirus that originated in China:
- The hospitalization rate during the four-week period was 4.6 per 100,000 population. Those aged 65 or older showed the highest rate of hospitalization (13.8) and the rate increased with age. The rate for those aged 50–64 years was 7.4 and for those aged 18–49 years, the rate was 2.5.
- “These findings suggest that older adults have elevated rates of COVID-19–associated hospitalization and the majority of persons hospitalized with COVID-19 have underlying medical conditions,” said the researchers, explaining further:
- These findings underscore the importance of preventive measures (e.g., social distancing, respiratory hygiene, and wearing face coverings in public settings where social distancing measures are difficult to maintain) to protect older adults and persons with underlying medical conditions, as well as the general public. In addition, older adults and persons with serious underlying medical conditions should avoid contact with persons who are ill and immediately contact their health care provider(s) if they have symptoms consistent with COVID-19.
- To perform the study, the researchers used COVID-19–Associated Hospitalization Surveillance Network (COVID-NET), which was created to conduct population-based surveillance for laboratory-confirmed COVID-19–associated hospitalizations in the United States. COVID-NET was developed using the existing infrastructure of the Influenza Hospitalization Surveillance Network (FluSurv-NET) (4) and the Respiratory Syncytial Virus Hospitalization Surveillance Network (RSV-NET), the researchers say.
3. Iceland finds that half its citizens with coronavirus have shown no symptoms
- Iceland’s isolated location and sparse population mean that some vital information about the novel coronavirus is coming out of the island nation — especially considering that it’s already tested 10% of its population, which is more than any other country, according to USA Today.
- And the scariest finding: At any given time, about half of its citizens who have the coronavirus — and don’t know it — are not showing any symptoms. That’s double the CDC’s recent estimate that as many as one in four people with COVID-19 may be asymptomatic.
- Granted, the United States hasn’t tested such a high percentage of its population, so it’s not working with as much data. Online statistics site Worldometer crunched the number of coronavirus tests reported by each state — around 2.3 million, by its account, in total — which it equated to about 7,100 tests per 1 million people. By that same scale, it reported Iceland has performed 96,000 tests per million people. (The actual population of Iceland, long a favorite of biotech research because of its relative homogeneity and its centuries’ worth of genealogical records, is 364,134 — roughly the same as that of Tulsa, Okla.)
- President Trump said in an April 6 press briefing that almost 2 million Americans, or 0.6% of the U.S. population, had been tested for COVID-19. The recent report from the Department of Health and Human Services inspector-general also warned of testing-supply shortages and long wait times.
- So that means the “best data” on coronavirus is coming from Iceland at the moment, John P.A. Ioannidis of Stanford University told USA Today. And Kari Stefansson, CEO of deCODE genetics, which is helping to carry out Iceland’s testing efforts, said that Iceland may be one of the best live coronavirus laboratories we have in the world as it continues to randomly test its people.
- And it’s already made some important discoveries. Among them: that between 0.3% and 0.8% of Iceland’s population is infected with the coronavirus, while half of those who tested positive were asymptomatic as the time of their tests.
- “That’s a bit scary,” said Stefansson. “They could be spreading it and not knowing it.”
- But since mid-March, the prevalence of COVID-19 among Iceland’s general population that’s not at the greatest risk — that is, not of advanced age or with underlying health conditions — has either stayed stable or decreased, showing that social-distancing and containment efforts are working.
- While Iceland has not imposed a national lockdown, and many shops and businesses are still open, it has banned gatherings of more than 20 people. It’s otherwise mostly relying on a trust system that its citizens are practicing isolation and social distancing. As of April 10, the country counted more than 1,600 coronavirus infections and six deaths.
1. False Negatives Raise Doctors’ Doubts About Coronavirus Tests
- False-negative results from coronavirus tests are becoming an increasing concern, say doctors trying to diagnose patients and get a grip on the outbreak, as a surprising number of people show up with obvious symptoms only to be told by the tests that they don’t have the disease.
- While still more research is necessary to determine the true prevalence of such false-negative results, experts agree that the problem is significant. False negatives not only impede the diagnosis of disease in individual patients and an accurate understanding of the extent of its proliferation, but also risk patients who think they aren’t ill further spreading the virus.
- Some doctors described situations in which patients show up with clear symptoms such as a cough and fever, test negative, and then test positive later on. It’s a particular issue in New York, where the disease has likely infected far more than the 174,000 people confirmed through limited testing. At Jacobi Medical Center in the Bronx, doctor Jeremy Sperling says so-called false-negative tests are now a frequent occurrence in the emergency room.
- “If a patient presents with classic Covid symptoms, but tests negative, they’ve still got Covid,” said Sperling, who is the chair of emergency medicine at the hospital. “There is just nothing else it could be in New York City in 2020.”
- Concerns about false negatives arise from a mix of factors: quickly created tests from dozens of labs and manufacturers that haven’t been extensively vetted by federal health regulators; a shortage of supplies and material for the tests that may impact results, long incubation times for the infection, and the challenge of getting an adequate sample from a patient.
- Most tests rely on a nasal swab that penetrates deep into the pharynx, the mucous membrane behind the nose and mouth. Even for a trained health worker, it can be difficult: It’s an invasive procedure that often causes patients to squirm. With a shortage of staff to conduct such widespread testing, in many cases people not typically trained to do so are collecting samples.
- Ryan Stanton, an emergency medicine physician in Lexington, Kentucky, said that most people likely aren’t swabbing patients correctly. “They’re not getting far enough back there to get a good sample,” he said.
- Similar measures have been taken around the world, as the U.S. and other health authorities race to build diagnostic capacity and get a handle on the outbreak. That haste, however, may have come at a cost. One study out of China published online prior to peer-review found that for the nasal-swab tests most commonly administered, as many as one in three tests may produce a false-negative result.
- In some cases, lacking tests or not trusting the results, doctors have turned to chest X-rays or CT scans to diagnose patients by looking for signs of infection in the lungs.
E. Symptoms and Outcomes
1. Coronavirus Conundrum: It Hits Some Hard, Others Hardly at All
- The coronavirus invades most bodies the same ways, through the nose or throat via virus-laden droplets. From there, it can run very different courses.
- The strikingly different symptoms that survivors and victims’ families recount present a spectrum that is among the coronavirus’s enigmas. For many people, the infection stays in the upper respiratory tract, causing fever, congestion, a dry cough and a sore throat. It can also move to the lower respiratory tract, inflaming the lungs and turning into a deadly form of pneumonia.
- Some people develop no symptoms, one factor making the virus difficult to detect and contain. Others experience mild symptoms that make it hard to distinguish from a cold or the flu.
- A few factors could explain such different outcomes: viral mutations could unleash more-virulent strains; people could be exposed to different amounts of the virus, and prior health conditions.
- The virus is mutating, but so far there isn’t evidence a particularly deadly strain is emerging. “We haven’t seen changes in the clinical presentation or manifestation of the virus since the epidemic started in December that would lead us to believe that there’s a hypervirulent strain,” said Dr. Albert Ko, professor of epidemiology and medicine at the Yale School of Public Health.
- The other two factors appear significant, he said. The elderly, men and people with chronic diseases have higher Covid-19 mortality rates. Some epidemiologists have suggested part of the explanation could be weakened immune systems among the elderly or higher smoking rates among men that lead to other chronic pulmonary and cardiovascular problems.
- One theory scientists are researching is that the receptors the coronavirus uses to bind to cells—called ACE2 receptors, for Angiotensin converting enzyme 2—play a role, said Dr. Ko. It is possible the receptor in older people is more prevalent or shaped in a way that binds better with the virus, he said.
- In the most severe cases of Covid-19, one factor doctors and scientists are investigating is the response of the immune system itself. The pathogen appears to be triggering an overactive immune response in some people, including relatively healthy ones, in which proteins called cytokines are rapidly released into the bloodstream, damaging the lungs and other organs.
- Scientists are trying to understand why children generally get less sick than adults, a phenomenon that occurred with other diseases caused by coronaviruses, such as SARS and MERS. The ACE2 receptors are thought to be one possible factor. Another theory is that their immune systems are less developed and don’t respond to the virus as aggressively.
- Even though children appear less likely to get severely ill, they aren’t completely immune. And some older adults get only mild cases.
- Many who avoid the most serious lung infections aren’t lucky enough to experience only mild symptoms. Covid-19 can punish even young and relatively healthy people. Ms. Schneider of Seattle said she didn’t know she had it initially. By the time she found out through a flu study, most of her symptoms had subsided.
- It isn’t clear why some patients seem to recover quickly without significant symptoms or the need for oxygen or a ventilator. Dr. Kevin Clerkin, a physician with Columbia University Irving Medical Center, said there is an association between people with cardiovascular conditions and those who get critically ill or die after getting the coronavirus. “The thing that we don’t quite understand yet is if these people are just sicker baseline,” he said, “or if there is something about the interaction of the virus with their underlying condition.”
- Covid-19 can lead to pneumonia, which is when balloon-like structures at the end of the respiratory tract, called alveoli, fill with fluid as a result of the infection. That’s when the ventilators that are in short supply world-wide come in.
2. Heart Conditions Prove Especially Dangerous for Covid-19 Patients
- People with cardiovascular disease face more life-threatening complications and a substantially higher risk of death from the new coronavirus, according to data and reports from doctors in several countries, and even those with simple high blood pressure are being urged to take extra care against infection.
- Among the complications are conditions that put these patients’ already strained hearts under additional stress. While Covid-19 is a respiratory disease, doctors increasingly report that some patients develop cardiovascular complications such as heart-rhythm disorders, blood clots and inflammation causing chest pain that mimics a heart attack.
- Cardiologists say they aren’t surprised that Covid-19 takes a heavier toll on heart-disease patients. So have SARS and MERS, two other coronaviruses, as well as severe influenza.
- Scientists say they don’t fully understand why cardiovascular disease puts people at such increased risk. The American Heart Association is funding research to learn more.
- Many of these patients are older, more prone to hypertension, and already more vulnerable because immune systems naturally weaken with advanced age. But high blood pressure, coronary-artery disease and other heart conditions put many younger people at increased risk, too.
- About 46% of American adults have high blood pressure, according to guidelines by the American College of Cardiology and the AHA. African-Americans, who have the highest mortality from cardiovascular disease of all racial and ethnic groups in the U.S., are being infected and dying from the new virus at disproportionately high rates.
- Cardiologists also worry that patients who are stuck at home or recently unemployed are missing out on medications and care. They are particularly concerned that patients may stop taking blood-pressure medications following reports that certain types—angiotensin-converting enzyme or ACE-inhibitors and angiotensin receptor blockers—could increase the risk of Covid-19 infection. Several medical societies have said patients should remain on the drugs because evidence of increased infection risk is weak.
- In fact, the drugs may provide a benefit against Covid-19, by blocking an enzyme that promotes inflammation in the lung, said Gian Paolo Rossi, chair of internal medicine at Italy’s University of Padua. “The drugs are protective,” he said. “Stopping them is certainly not good for patients.”
- Alarming death rates have been reported from all over the world. The mortality rate of Covid-19 patients who have cardiovascular disease is more than 4 times higher than the rate for patients overall with the illness, according to data from the Chinese Center for Disease Control and Prevention. It is nearly 3 times higher for Covid-19 patients with high blood pressure alone, the Chinese agency found.
- Nearly two-thirds of Covid-19 patients who died in intensive care in Lombardy, Italy, had hypertension, according to a study of 1,591 cases in JAMA Cardiology. Nearly half of U.S. hospitalized Covid-19 patients in a study by the U.S. Centers for Disease Control and Prevention had hypertension, and 27.8% had cardiovascular disease.
- Of particular concern are the cardiovascular complications caused by Covid-19. The heart has to pump more blood than usual to supply the body with adequate oxygen because it doesn’t get enough from its damaged lungs, cardiologists said. In addition, when the body kicks into high gear to fight off the virus, the inflammatory response it mounts can lead to inflammation of the heart muscle, formation of blood clots throughout the body, and heart-rhythm disorders, they said.
- Nearly 20% of a group of 416 hospitalized patients in Wuhan, China, where the virus started spreading in humans, developed cardiac injuries as a result of their illness from the virus, according to another study in JAMA Cardiology. Of them, 51.2% died, compared with 4.5% who died but didn’t suffer cardiac injuries, according to the study.
- Doctors have reported a surprisingly high number of Covid-19 cases in which patients developed symptoms of a heart attack. Instead, they were found to have myocarditis, an inflammation of the heart muscle that can cause a weakening of its function and increase its susceptibility to rhythm disorders, said Dr. Parikh, the Columbia cardiologist.
- “Patients will come to the hospital presenting for all the world like a heart attack,” said Dr. Parikh. Normally, such patients are whisked to a cardiac-catheterization lab to identify and treat blockages. Now, cardiologists take patients who could have Covid-19 to the emergency department first for an assessment.
F. Stories From the Frontline
1. New Yorkers are refusing to be hospitalized over fear of getting coronavirus
- FDNY statistics show that the number of New Yorkers who refuse to be taken to hospitals has more than doubled amid the coronavirus crisis — with EMTs blaming the situation on fear of contracting the deadly disease, The Post has learned.
- Year-to-date data show an overall 73 percent increase in 911 calls that resulted in “refusals of medical aid,” with 37,968 cases compared to 21,982 during the same period in 2019.
- But during March — when COVID-19 began spreading across the city with a vengeance — RMAs jumped by 118 percent, from 6,777 in 2019 to 14,706 this year.
- And during early April, the number skyrocketed from 2,578 to 8,630 — an astonishing 235 percent surge.
- One FDNY paramedic said some 911 calls about potentially life-threatening symptoms — such as chest pain — were resulting in patients willing to risk death rather than go to a hospital.
- “There are numerous patients refusing because of COVID-19. People have underlying conditions and are refusing transport,” EMT Luis Lopez told The Post.
- He added: “We always want them to go because if you are calling 911 you obviously felt it was an emergency. But because of conditions [at the hospitals], people are refusing.”
- “People are afraid…past few days we’ve had 3 #stroke patients delay calling EMS for hours because they were afraid to be brought to a hospital,” Dr. J Mocco wrote on Friday.
- “Right now, people keep hearing they should avoid hospitals for non-emergencies, however, strokes are life-threatening,” Mocco told The Post in a direct message over Twitter on Sunday.
2. ‘I’m Sorry I Can’t Kiss You’ — Coronavirus Victims Are Dying Alone
G. The Road Back?
1. U.S. States Prepare Test-and-Trace Programs to Reopen Their Economies
- Several states have launched new efforts to contain Covid-19, laying plans to test aggressively and track the potentially infected with help from nonprofits, universities and the private sector.
- Massachusetts, Utah and North Dakota are among those working on the kinds of comprehensive strategies that public-health experts agree are needed to arrest the coronavirus’s spread and lift the social-distancing measures that have shuttered much of the U.S. economy.
- “Even if the curve does flatten, we won’t be able to go back to work and school and regular life unless we chase the virus down much more significantly,” said Joia Mukherjee, chief medical officer of Partners in Health, a nonprofit working with Massachusetts to expand the state’s capacity to trace contacts of Covid-19 patients.
- The question is how quickly the efforts that have begun can advance with beleaguered diagnostic testing programs across the U.S. still facing shortages of swabs, chemicals and other supplies that severely limit capacity at many labs.
- Only now does the U.S. have the capacity to do 110,000 to 135,000 tests daily, far short of the 1 million a day that Howard Forman, director of the Yale School of Public Health’s health-care management program, said would make him “feel much more confident in where we’re going.”
- Contact tracing presents its own challenges, requiring armies of trained staff. It’s tedious and time-consuming work to find those who have been near an infected person, direct them to testing or treatment or help them self-isolate, and follow up.
- To do so, North Dakota has re-purposed an app called The Bison Tracker, built to help fans of the North Dakota State University Bison football team follow their progress on a 1,000-mile drive to the league’s championship game in Texas.
- In Massachusetts, an April 3 announcement about its tracing program attracted 9,000 applicants for about 1,000 positions. Expanding the program may produce a silver lining.
- “Would I be sad if we ended up hiring 40,000 to 50,000 people in Massachusetts to do this? Absolutely not,” said Partners in Health’s Mukherjee. “We could put people to work and end the epidemic.”
- Massachusetts has so far been able to swab roughly 100,000 individuals, an increase made possible with the help of 22 labs. One is the Broad Institute of MIT and Harvard, which pivoted from DNA sequencing to test for Covid-19 in late March. It can now run 2,000 tests a day, and the goal is to get to 10,000 per day — if it can get enough supplies.
- “We’re going to learn a lot about how to do this in the next month,” said Stacey Gabriel, who heads up the testing initiative for the institute.
- Testing and tracing are also the focus in Utah, which expects to be conducting more than 7,000 tests daily by next week, said Kristen Cox, executive director of the governor’s Office of Management and Budget.
- The state is working with the private sector to make that happen. A group called Silicon Slopes secured Covid-19 test kits from the Salt Lake City company Co-Diagnostics Inc. and also helped develop a website, TestUtah.com, that launched on April 2 to allow residents to assess their risk for Covid-19.
- “The state needed help,” said Mark Newman, founder of Nomi Health, a health-care payments startup. He worked to mobilize Utah’s tech and business leaders to launch the testing effort, paid for by companies and the state.
- About 2,000 tests have been conducted so far, said Clint Betts, executive director of Silicon Slopes. The group is in discussions with other states interested in replicating Utah’s approach.
- “If every state did what Utah did and put it up as fast as Utah put it up, they’d have an unbelievable amount of testing horsepower,” said Dwight Egan, chief executive officer of Co-Diagnostics.
- Utah will follow up with those who are positive to trace their movements and contacts; it recently deployed about 1,200 state employees to local health departments for that task. The state may be as close as two to four weeks away from the “stabilization” stage, Cox said.
- “I want to be humble on this. This is a goal, not a guarantee.”
- In North Dakota, Governor Doug Burgum said 250 contact tracers have been trained but that 1,000 or more may be needed.
- “If we can do that, then we can have the right people isolated and quarantined,” the governor said.
- The hope is that the new app will speed up the process. Tim Brookins, a Microsoft engineer in Fargo, tweaked the Bison Tracker to build Care-19, an anonymous location tracker. It had more than 10,000 downloads in its first 36 hours.
- The app can serve as a record for people to remind them where they’ve been if they test positive, and to alert them to possible contacts with infected people. They can choose to share information with state health workers.
- Burgum said he’s been in touch with officials in Iowa, Nebraska and South Dakota who are considering rolling out the technology.
- Yale’s Forman said apps could also be deployed for people to record their symptoms every day, which might help identify outbreaks. But he said any containment plan must include testing and tracing.
- “I would love to see some states be in a position to open May 2,” he said. “But they better have a very, very rigorous plan.”
- States with relatively few confirmed cases, unlike hot spots including New York, Louisiana and Michigan, still have an opportunity to avert widespread transmission, Centers for Disease Control Director Robert Redfield said in an interview.
- “We are preparing to make sure we have the public-health assets so that when that first case gets identified in County A, it’s recognized and then there’s real-time contact tracing and isolation,” Redfield said. “And we need to do that across this whole country so that we can prevent clusters from becoming community transmission.”
2. The Employer Will Test You Now
- The intense measures and restrictions to combat Covid-19 are a necessary hardship to prevent a wider and more devastating epidemic. But even after the epidemic subsides, the virus will remain a threat until there is an effective vaccine. America needs a plan to reduce that threat, and business leaders can play a big part.
- As employees return to work, perhaps as early as May, employers can offer screening at their place of business. Rapid diagnosis and containment will be a critical part of limiting spread. Bringing these activities into the workplace would make them more widespread and routine, and can be done in conjunction with efforts to expand testing throughout the health-care system.
- People who have signs of respiratory illness should see a doctor. But many Covid-19 patients have mild or no symptoms. Without prompt testing to differentiate mild colds from the novel coronavirus, people could spread the virus unknowingly. Portable and relatively inexpensive testing platforms can be brought to businesses in mobile vans or deployed on-site and administered by professionals. Testing companies are ramping up supply, and businesses can start placing orders now.
- This should be part of a broader employer effort to fight respiratory illnesses in the workplace. Employers have long offered flu vaccines and passed out hand sanitizer in the winter. This coronavirus should be treated similarly, with employers invested in protecting workers. Until there is a vaccine, preventing Covid-19 outbreaks will depend mostly on testing, isolation and tracing the contacts of people who test positive. Workplace testing would catch the disease where it spreads—especially for employees who can’t work remotely and risk infection by coming in contact with many others during the day, such as store clerks.
- Systems on the market are well suited to this mission. The GeneXpert by Cepheid is a highly sensitive machine that uses a chemical process called polymerase chain reaction to test for infection by detecting the viral RNA. This machine doesn’t require complicated sample prep or even a perfect swab of the nose and throat. It can use a relatively small sample of upper-airway secretions to discriminate a positive test from a negative one precisely. Cepheid said it is expanding its production of test kits and the machines that run them. Other testing systems in development may have the same potential.
- For businesses that can’t easily bring testing to the work site, there are other options. They can work with companies developing home collection tests, which would help make this technology available sooner, or could contract with pharmacies running screening programs. States could sponsor collaborative testing programs and allow small businesses to join. Government could financially support these efforts for higher-risk businesses that may not have capital available to expand testing, such as grocery stores.
- Many testing platforms can also distinguish Covid-19 from the flu, which can help employers keep their workplace healthy. If testing for respiratory illnesses becomes a standard business practice, medical companies will respond with more innovation in creating efficient and accurate testing platforms. Companies will invest in developing products that are simple to use, such as swab sticks that screen for viruses and give an immediate, readable result to the user. Greater demand from employers will increase supply of these screening systems.
- Business leaders can help in other ways. When someone is diagnosed with Covid-19 and can be safely managed at home, the prudent course is to allow the patient to self-isolate for the duration of the illness. Workplace testing programs should also work with the local health department to ensure contact tracing. But these employees need to be compensated for missed work, or many will be reluctant to forfeit pay for a mild disease. Business leaders should expand paid sick leave to all employees for the duration of a Covid-19 illness. Nobody should have to fear losing income for doing the right thing of staying at home to reduce the spread.
- As the epidemic is brought under control, and the country begins to contemplate reopening, employers can help Americans return to work—safely.
Source: The Employer Will Test You Now
H. Projections and Our (Possible) Future
1. After Face Masks, Should We Worry About Food?
- If the coronavirus has shown us anything, it is how vulnerable global supply chains really are—both to a pandemic and to the breakdown of trust and cooperation which follows. Widespread limits on exports of medical goods like masks, price gouging and diverted runway cargoes are likely to create permanent changes in the medical equipment supply chain once the pandemic ebbs.
- But what about that even more precious commodity, food?
- The U.S., Europe and other wealthy regions are unlikely to experience serious problems, although prices could rise significantly for some items, like fresh produce. But poorer countries—especially those with existing food scarcity or those that are big importers with falling currencies—could struggle. Unnecessary restrictions on food exports by big producers risk exacerbating the problem.
- In late March, the United Nations Food and Agriculture Organization warned that disruptions to food supply chains could materialize in April and May. Vietnam, the world’s third-largest rice exporter, temporarily banned the signing of new rice export contracts on March 25. Rice futures have surged 12% since early March and are now up nearly 40% from a year ago. Wheat futures also have shot higher. Russia, Ukraine and Kazakhstan have announced or are considering new restrictions on shipments.
- Unlike N95 masks and ventilators, the problem for food supply isn’t a lack of production capacity. Harvests have been good and stockpiles are abundant. Rice inventories are near a record high according to the U.N., and the organization still expects 763 million metric tons of global wheat production in 2020, comparable with 2019.
- Instead, the problem is getting food out of the fields and onto trucks, ships and trains as global logistics networks seize up and agricultural labor becomes scarce. Fresh produce and seafood, which don’t keep well, are particularly vulnerable. Throughout Western Europe, migrant laborers from northern Africa or other areas who usually work fields are locked out of the continent. France’s agriculture minister has publicly asked the country’s newly unemployed—what he called a “shadow army”—to step up and help with the spring harvest. France needs about 200,000 workers over the next three months, according to the country’s main farmers’ union.
- One concern is that a vicious cycle of export controls, limited transport capacity and stockpiling by big food importers could further drive up prices and create problems for the most vulnerable nations, even though overall food production remains robust. The president of Egypt, which is the world’s largest wheat buyer, has ordered officials to boost the size of the nation’s food reserves. Top rice importer the Philippines is also planning to boost purchases, the country’s cabinet secretary said last week.
- The coronavirus pandemic has highlighted how natural disasters tend to do the most damage to those already on precarious ground economically—for instance, working-class service-sector employees who can’t afford to shelter at home without losing their jobs. That goes for countries too. Vulnerable nations—for example, those in the Horn of Africa already struggling with locusts—could find themselves confronting public health, hunger and economic crises all at once as the virus hits local food production, countries with surplus production needlessly hoard abundant supplies and global transport capacity seizes up.
- Investors watching critical medical supplies dry up in the U.S. and Europe shouldn’t worry about similar shortages of food. But tangled supply chains and multiplying export restrictions risk a deeper economic downturn, and a higher human cost, in the developing world.
2. The Pandemic Will Cleave America in Two — Some will emerge from this crisis disrupted and shaken, but ultimately stable while others will come out of it with much more lasting scars
For story, see The Pandemic Will Cleave America in Two
I. Practical Tips and Useful Information
1. You Have a Medical Issue Unrelated to Coronavirus. What Do You Do?
For story, see How to Address Medical Issues Unrelated to Coronavirus