“We’re Working with Real Coronavirus Data Now, Not Models.”
— Surgeon General Jerome Adams
“We are nearing the peak right now.”
— Dr. Robert Redfield, CDC Director
- Recent Developments and Headlines
- Numbers and Trends
- New Scientific Findings
- Observations & Unanswered Questions
- Stories from the Frontline
- New Technologies
- 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 4/12 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 = 1,929,518 (+75,347) (+4.1%)
- US Total Cases = 587,173 (+26,740) (+4.8%)
- NY Total Cases = 195,655 (+3.29%)
- NY New Cases = 6,241 (-2,287) (-26.8%)
- Worldwide deaths = 119,779
- US deaths = 23,765 (+1,650) (+7.5%)
- NY deaths = 10,056 (+671) (+7.2%)
- WHO says it will release new guidelines for countries restarting economies
- US, Europe see decline in new cases
- Surgeon General: ‘confident that some places will start to reopen in May and June’…
- NY Gov. Cuomo: Worst Is Over; We Are Controlling the Spread
- NY reports another drop in hospitalizations
- NY, NJ, CT Governors Plan ‘Regional’ Reopening of Economies
- California, Oregon and Washington Launch Pact to Reopen Economies
- CA Gov. Newsom says he’ll release plan to reopen economy tomorrow
- President Trump’s claim he has power to decide when to reopen the country signals possible clash with governors.
- NY Gov. Cuomo sees vaccine in 12-18 months
- Dr. Fauci Defies The Media, Says Trump Approved ‘Mitigation’ “The First Time I Recommended It”
- Fauci Admits US Was “Given Incorrect Information From The Start”
- Smithfield foods closes world’s largest pork plant
- President Trump: China Will Find Out Consequences for Coronavirus Misinformation
- China, Russia report concerning increases in new cases
- India extends nationwide lockdown for nearly 3 weeks, ordering more than 1 billion people to remain at home.
- Italian death toll passes 20k
- South America, Africa see acceleration in new cases
- Coronavirus Cases Rise 17 Percent in Mexico over Easter
- Macron extends French lockdown until May 11
- Singapore reports record jump in new cases
- Saudi Arabia reports record jump in daily cases
- Senior Israeli rabbi succumbs to virus
- In Ecuador, police move to collect 800 bodies from a hard hit village
- Iran reports 1,600+ new cases, 100+ deaths
- Putin warns outbreak getting worse
- ‘Huge Influx’ of Coronavirus Patients Hits Moscow as Support for Putin Collapses
- Australia, New Zealand keep restrictions in place despite drop in new cases
- Guggenheim Capital Markets Warns Of Coming Emerging Market Apocalypse: “Pandemic Will Be Followed By Food Shortages, Social Unrest”
- Baltimore Streets Flooded With Methadone And Suboxone During Pandemic
- Army’s Seattle Field Hospital Closed After 3 Days, Without Seeing A Single Patient
- China Quietly Reimposes Restrictions On Movement As Outbreak’s ‘Second Wave’ Looms
- Barter Is Back – Locked-Down Americans Are Swapping Malbec For Masks
- Doctors Fear Coronavirus Survivors May Have Lasting Damage To Multiple Organs
- White House Press Corps Demanded President Trump Shut Down Economy, Now Question His Authority to Reopen It
- 2 NYPD detectives die from COVID-19
- Nearly 8-in-10 Americans Want Immigration Moratorium for U.S.
- North Korea Boosts Public Health Budget While Still Claiming Zero Coronavirus Cases
- NY Gov. Cuomo: Fauci Is a ‘National Treasure’ — Americans Have Confidence in Him
- White House: ‘President Trump Not Firing Dr. Fauci’…
- Chinese City Bans Black People from Hotels, Apartments, Restaurants
- China: Racism Against Africans ‘Isolated Incidents’ and ‘Misunderstandings’
- China’s wet markets back in business, despite US calls to keep them shut
- Philippines to Publicly Disclose Virus Patients’ Personal Information
- Maryland Superintendent ‘Not Sure’ School Will Be the Same ‘Going Forward’
- Former Sen. Santorum: Trump Can’t Overrule Governors Forcing States to Reopen
- Dr. Fauci: ‘I Can’t Gurantee’ Physical Vote in November Will Be Safe
- South Dakota to Launch Hydroxychloroquine Clinical Trial
- Boris Johnson After Coronavirus Hospitalization: ‘The NHS Saved My Life’
- UK National Health Service Trials ‘Trump Pills’ to Treat Coronavirus
- USS Theodore Roosevelt Sailor Dies of Coronavirus-Related Complications
- French Economist: E.U. Risks ‘Suicide’, Could Collapse over Coronavirus
- Britain’s Coronavirus Death Toll Surpasses 10,000
- Still Few Coronavirus Restrictions in Sweden as Deaths Rise
- Sweden Approves Animal Anaesthetic for Coronavirus Cases as Supplies Run Low
- Church of England Transports Millions in Valuables over Looting Fears
- San Fran Won’t Move Homeless to Convention Center After 70 Test Positive
- States Move to Coordinate on Reopening Plans.
- Virus cases about 2 million worldwide; few new hot spots
- 42 dead in coronavirus outbreak at Virginia nursing home, more expected
- Charlotte woman hasn’t left her house in three weeks but tested positive for COVID-19
- Police shut down SF nightclub operating during coronavirus crisis
- From the Black Death to AIDS, pandemics have shaped human history. Coronavirus will too
- Due to pandemic, Supreme Court will allow live audio broadcast for first time
- Video Shows Homeless Taking Over Car After Car On No. 2 Subway Line
- Bodies piled up, stored in vacant rooms at Detroit hospital…
- No work, new debt: virus creates perfect storm for slavery in India
- ‘Ghosts’ scare Indonesians indoors and away from coronavirus
- Iran probe theory that coronavirus outbreak is ‘biological warfare’
- Moscow tightens virus lockdown with digital travel permits
- Age, obesity are biggest risk factors for COVID-19 hospitalization
- Coronavirus has now killed Americans in all 50 states
- Private island for the super rich buys thousands of coronavirus tests
- WWE deemed an ‘essential business’ in Florida
- Etsy flooded with Andrew Cuomo-related fan-crafted items
- Researchers find 6 new coronaviruses in bats
- Natural light, fresh air could keep coronavirus out of workplaces, scientists suggest
- Nervous men freezing sperm over coronavirus fears
- The NFL offseason is going virtual
- Crocodiles invade Mexican beach abandoned due to coronavirus
- Viral fan account shares where to buy Dr. Deborah Birx’s famous scarves
- NYC nursing home running out of room for dead bodies amid coronavirus crisis
- New York, five other states unite to plan post-coronavirus reopening
- Woman wakes from coronavirus coma to learn she’s given birth
- Amazon lifts ban on shipments of non-essential items
- UK hospital lets dying coronavirus patients’ relatives say goodbye in person
- Coronavirus kills 30 food workers as shoppers ransack supermarkets
- Will ‘immunity passports’ be the ticket out of coronavirus lockdowns?
- Singapore prepares ‘floating hotels’ for foreign workers to halt coronavirus spread
- Pastor who recently held packed church service dies of coronavirus
- WHO: Coronavirus measures must be ‘lifted slowly and with control’
- California cop dies after being denied a coronavirus test twice
- Baseball league restarts in Taiwan with robot and mannequin ‘fans’ in seats
- Woman with skin disease can’t get meds as pharmacies are ravaged by coronavirus
- Starving rats are resorting to war and cannibalism to survive coronavirus lockdown
- High school students create hotline to help senior citizens in isolation
- Severe winds could wreck NYC’s tented coronavirus field hospitals
- First person in world to get coronavirus vaccine trial describes risky shot
- Dr. Fauci: I’m ‘humble enough’ to know other coronavirus solutions exist
- World’s largest water fight cancelled as Thailand focuses on curbing outbreak
- Billionaires, young women on private jet caught defying lockdown
- Indian police make ‘covidiots’ write ‘I am sorry’ 500 times for violating lockdown
- Muslims in Pakistan disregard mosque ban: ‘God is with us’
- Amazon will not accept new grocery delivery customers amid spike in orders
- Cop’s hand chopped off in sword attack in india during coronavirus lockdown
- Survey: 35 percent say working from home has harmed mental health
- Coronavirus wreaking havoc on four New Jersey psychiatric hospitals
- ‘Going on offense’: South Dakota implements first statewide hydroxychloroquine trial in fight against coronavirus
- China approves human testing for two new vaccines
- In Japan, an office culture that relies on official seals and in-person meetings is hindering remote work
- Millions of children are at risk for measles as coronavirus fears halt vaccines.
B. Numbers & 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: 1,929,518 Total Cases (+4.1%)
- New Cases = 75,347 (+1,018) (+1.4%)
- Europe: 885,606 Total Cases (+2.4%)
- New Cases = 20,966
- Asia: 148,004 Total Cases (+1.2%)
- New Cases = 4,034
- United States: 587,173 Total Cases (+4.8%)
- New Cases = 26,740
- US States:
- 40 States > 1,000 cases (+1), plus DC
- 28 States > 2,500 cases (+0)
- 19 States > 5,000 cases (+0)
- 13 States > 10,000 cases (+0): NY, NJ, MI, CA, LA, MA, FL, PA, IL, TX, GA, CT & WA
- 9 States > 20,000 cases: NY, NJ, MI, CA, LA, MA, FL, PA & IL
- Top 5 States: (i) NY: 195,655 (+6,241); (ii) NJ: 64,584 (+2,734); (iii) MA: 26,867 (+1,392); (iv) MI: 25,635 (+997); and (v) CA: 24,371 (+1082).
- Notes: (i) Number of new cases in NY, NJ and MA decreased, and (ii) Number of new cases in MI increased by approx. 7.4% and number of new cases in CA increased by approx. 13.4%
- For more information on US States, see https://ncov2019.live/data
- New York State:
- NY Total Cases = 195,655 (+3.29%)
- NY New Cases = 6,241 (-2,287) (-26.8%)
- New York City:
- Total Cases = 104,410 (+1.2%)
- NYC New Cases = 1,202
2. Confirmed Active Cases
- Worldwide Active Cases = 1,356,724 (+3.4%)
- New Active Cases = 44,724
- Europe Active Cases = 562,696 (+1%)
- Asia Active Cases = 44,881 (+1.6%)
- US Active Cases = 526,581 (+4.1%)
- US New Active Cases = 20,887
3. Serious or Critical Cases
- Worldwide serious or critical cases = 51,154 (+298)
- US series or critical cases = 12,772 (+1,006)
- US serious or critical cases = 2.4% of Active Cases (+0.2%), compared with worldwide percentage of 4%
[Note: Serious and critical cases give insight into the need for ICU beds and ventilators]
- Worldwide deaths = 119,779 (+5,488) (+4.8%)
- Europe: 79,848 deaths (+2,925) (+3.8%)
- Asia: 5,150 deaths (+105) (+2.1%)
- US deaths = 23,765 (+1,650) (+7.5%)
- NY deaths = 10,056 (+671) (+7.2%)
- NYC deaths = 6,898 (+181) (+2.7%)
- Deaths per 1M population: (i) Italy: 338 (+9); (ii) Spain: 380 (+12); (iii) US: 71 (+4); (iv) France: 229 (+8); & (v) Germany: 38 (+2)
- Worldwide Total Confirmed Case Fatality Rate = 6.2%
- US Total Confirmed Case Fatality Rate = 4.1% (+0.2%)
- [Note: The number of cases in which infected people recovered without being tested is believed to be a large number, which would substantially reduce the fatality rate. US health officials have estimated that the US actual fatality rate is 1% or less.]
- Worldwide recoveries = 453,015 (+25,135) (+5.9%)
- US recoveries = 36,948 (+13.2%)
- NY recoveries = 13,366
1. Rutgers University gets FDA approval for coronavirus saliva test
- Rutgers University researchers have received U.S. government clearance for the first saliva test to help diagnose COVID-19, a new approach that could help expand testing options and reduce risks of infection for health care workers.
- The FDA authorized the test under its emergency powers to quickly clear new tests and therapies to fight the outbreak, the New Jersey university said Monday. The test initially will be available through hospitals and clinics affiliated with the school. The announcement comes as communities across the U.S. continue to struggle with testing to help track and contain the coronavirus.
- The current approach to screening for COVID-19 requires health care workers to take a swab from a patient’s nose or throat. To lessen infection risks, many hospitals and clinics instruct staff to discard gloves and masks after close contact with anyone who may have the virus. And many institutions are struggling with shortages of basic medical supplies, including gloves, masks and swabs.
- With the new saliva-based test, patients are given a plastic tube into which they spit several times. They then hand the tube back to the health care worker for laboratory processing.
- “This prevents health care professionals from having to actually be in the face of somebody that is symptomatic,” said Andrew Brooks, who directs the Rutgers lab that developed the test.
- An infectious disease expert not involved with the new test said it would help overcome some of the patient discomfort and difficulties in taking swab samples.
- “You want to be in all types of situations with all types of options so that we can have as much testing as possible in whatever form is suitable,” said Dr. Amesh Adalja of Johns Hopkins University. Adalja noted that similar saliva tests have helped expand testing for HIV and other conditions.
- Rutgers tested the accuracy of its method by taking both saliva and swab samples from 60 patients. The results from patients’ saliva samples had a 100% match with results from the swabs.
- Rutgers developed the laboratory method for the test using saliva collection kits from Spectrum Solutions, a Utah company that provides similar devices for DNA-based ancestry testing services. The Rutgers lab can currently process 10,000 patient samples per day, according to Brooks.
- In its authorization letter to Rutgers, the FDA said the test should only be performed “in a health care setting under the supervision of a trained health care provider.” The FDA has not cleared any COVID-19 tests for use at home, though several companies have announced plans to make them available.
- Additionally, the FDA said patients who test negative with the saliva-based kit should have their results confirmed with a second testing method.
D. New Scientific Findings and Other Advancements
1. Largest US study of COVID-19 finds obesity the single biggest ‘chronic’ factor in New York City’s hospitalizations
- Doctors at NYU Langone Health center conducted the largest study so far of US hospital admissions for COVID-19, focused on New York City. They found obesity, along with age, was the biggest deciding factor in hospital admissions, which may suggest the role of hyper-inflammatory reactions that can happen in those with the disease.
- For months, scientists have been poring over data about cases and deaths to understand why it is that COVID-19 manifests itself in different ways around the globe, with certain factors such as the age of the population repeatedly popping up as among the most significant determinants.
- Now, one of the largest studies conducted of COVID-19 infection in the US has found that obesity of patients was the single biggest factor, after age, in whether those with COVID-19 had to be admitted to a hospital.
- “The chronic condition with the strongest association with critical illness was obesity, with a substantially higher odds ratio than any cardiovascular or pulmonary disease,” write lead author Christopher M. Petrilli of the NYU Grossman School and colleagues in a paper, “Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City,” which was posted April 11 on the medRxiv pre-print server. (The paper has not been peer-reviewed, which should be kept in mind in considering its conclusions.)
- Among other things, the presence of obesity in the study points to a potentially important role of heightened inflammation in patients — a phenomenon that has been a topic of much speculation in numerous studies of the disease.
- Petrilli and colleagues at the Grossman School, along with doctors at the NYU Langone Health center, studied the electronic patient records of 4,103 individuals who tested positive for COVID-19 in the New York City healthcare system between March 1 and April 2.
- It is “the largest case series from the United States to date,” write Petrilli and colleagues.
- The motivation of the work, they write, was that “understanding which patients are most at risk for hospitalization is crucial for many reasons,” such as how to triage patients and how to anticipate medical needs.
|Researchers looking at New York City health cases split up COVID-19 patients into clusters based on distinguishing features, including obesity, to form a “decision tree” for statistical analysis.|
- Half of those patients were admitted to a hospital. What the researchers found is that “in the decision tree for admission, the most important features were age >65 and obesity.”
- Obesity, in this case, was measured as weight relative to a person’s height. The authors use a metric scale, so a body mass index of 30 and higher is considered obese.
- The “decision tree,” which is shown in the illustration above, refers to the statistical method they used to analyze the patient data. A decision tree is a way to group members of a sample based on their shared characteristics. “For a given population, the decision tree classification method splits the population into two groups using one feature at a time, starting with the feature that maximizes the split between groups relative to the outcome in question.” They keep splitting groups into smaller and smaller groups until they arrive at groups that “[have] similar characteristics and outcomes.”
- Note that in the decision tree, age is the initial determining factor, at the top of the tree, followed by obesity. Hence, obesity is the most significant “chronic” factor, leaving aside age. The authors had to make decisions about the splits in data at different branching points in the tree. For example, there are two buckets for age just below obesity, one being “Age 20 – 44” and another being “Age>35.”
- As co-author Leora Horwitz told ZDNet in an email, “the algorithm found age 35 and age group 20-44 as the most important features that increase the information gain the most, respectively.”
- Bear in mind that age still functions as the biggest overall single determinant. “Age is far and away the strongest risk factor for hospitalization, dwarfing the importance of obesity,” Horwitz told ZDNet in email. “Obesity is the most important of the chronic conditions when considering all such conditions simultaneously.”
- Others have made reference to obesity in conjunction with COVID-19, to a greater or lesser extent, but without the data of the NYU group.
- Writing in The Lancet on March 31st, RNA virus researcher Gregory Poland summed-up the conditions aggravating the COVID-19 situation globally: “We have an increasingly older age demographic across virtually all countries, as well as unprecedented rates of obesity, smoking, diabetes, and heart and lung disease, and an ever-growing population of people who are immunocompromised—all comorbidities that lead to significantly higher risks of severe disease and death from coronavirus disease 2019 (COVID-19).”
- And Drs. David S. Ludwig and Richard Malley of Boston Children’s Hospital wrote in The New York Times on March 30 that Americans’ risk from the virus is compounded by the fact that they are generally “too diseased.”
- “The huge burden of obesity and other chronic conditions among Americans puts most of us at direct risk,” they wrote. “In fact, with obesity rates in the US much higher than affected countries like South Korea and China, our outcomes — economic- and health-wise — could be much worse.”
- But what does it mean for obesity to show up as the big deciding factor for hospitalization?
- Obesity is generally known to be associated with inflammation. As the NYU authors observe, “Obesity is well-recognized to be a pro-inflammatory condition.” They focus on the inflammation aspect because it has been cited in several studies as being a possible factor in COVID-19, in particular, inflammations that seem to be in a hyper-activated state. But it’s not entirely clear what role it plays.
- “Hyperinflammatory states are well described in severe sepsis,” the authors note, “however, the degree to which COVID-19 related inflammation is similar to or different than that typically found in sepsis is unknown.”
- Without drawing conclusions, they note that previous studies have shown that patients with COVID-19 have displayed blood clotting, or “hypercoagulability,” in the form of thrombosis and embolisms.
- The authors suggest that inflammation could be explored further in another study. “We did not have inflammatory markers available for non-hospitalized patients; it is possible that these would have been strong predictors for hospitalization risk as well if available.”
- All this is from just one geography, and so its utility may be limited, the authors acknowledge, stating, “factors associated with poor outcomes may differ elsewhere.”
- Given the scale of the outbreak in New York City — the city has had 98,715 confirmed cases as of April 12 and 6,367 deaths, according to data from Johns Hopkins — New York City is becoming its own field of study.
- For example, the same day as the NYU group, scientists at the Icahn School of Medicine at Mount Sinai reported the results of an extensive study of the genome of the virus among New York City cases. What they found was both a melting pot, as it were, of strains of the virus, and peculiar local differences.
- “We find that New York City, as an international hub, provides not only a snapshot of the diversity of disease-causing SARS-CoV-2 at the global level but also informs on the dynamics of the pandemic at the local level,” write the authors.
- That suggests the kinds of clinical data found by the NYU researchers may at some point be combined with genetic data and other factors as scientists look at more and more factors and dig deeper into the nature of the disease.
E. Observations & Unanswered Questions
1. WHO officials say it’s unclear whether recovered coronavirus patients are immune to second infection
- World Health Organization officials said Monday not all people who recover from the coronavirus have the antibodies to fight a second infection, raising concern that patients may not develop immunity after surviving Covid-19.
- “With regards to recovery and then reinfection, I believe we do not have the answers to that. That is an unknown,” Dr. Mike Ryan, executive director of WHO’s emergencies program, said at a press conference at the organization’s Geneva headquarters on Monday.
- A preliminary study of patients in Shanghai found that some patients had “no detectable antibody response” while others had a very high response, said Dr. Maria Van Kerkhove, WHO’s lead scientist on Covid-19. Whether the patients who had a strong antibody response were immune to a second infection is “a separate question,” she added.
- More than 300,000 of the 1.87 million coronavirus cases across the world have recovered, WHO officials noted, adding that they need more data from recovered patients to understand their antibody response, whether that gives them immunity and for how long.
- “That’s something that we really need to better understand is what does that antibody response look like in terms of immunity,” Van Kerkhove said.
- Ryan said there are questions about whether the virus can reactivate after a patient recovers and tests negative for Covid-19.
- “There are many reasons why we might see reactivation of infection either with the same infection or another infectious agent,” he said. In general, “there are many situations in viral infection where someone doesn’t clear the virus entirely from their system.” Some patients can also clear the main infection but develop a secondary bacterial infection, he said.
- The U.S. CDC has said that it is developing a test to detect the presence of coronavirus antibodies to determine if a person could be immune to the disease. While such a test can determine who has been exposed to the virus, it’s not clear if it can identify those immune to reinfection, according to the WHO.
2. Why Are Some People So Much More Infectious Than Others?
- As the coronavirus tears through the country, scientists are asking: Are some people more infectious than others? Are there superspreaders, people who seem to just spew out virus, making them especially likely to infect others?
- It seems that the answer is yes. There do seem to be superspreaders, a loosely defined term for people who infect a disproportionate number of others, whether as a consequence of genetics, social habits or simply being in the wrong place at the wrong time.
- But those virus carriers at the heart of what are being called superspreading events can drive and have driven epidemics, researchers say, making it crucial to figure out ways to identify spreading events or to prevent situations, like crowded rooms, where superspreading can occur.
- Just as important are those at the other end of the spectrum — people who are infected but unlikely to spread the infection.
- Distinguishing between those who are more infectious and those less infectious could make an enormous difference in the ease and speed with which an outbreak is contained, said Jon Zelner, an epidemiologist at the University of Michigan. If the infected person is a superspreader, contact tracing is especially important. But if the infected person is the opposite of a superspreader, someone who for whatever reason does not transmit the virus, contact tracing can be a wasted effort.
- “The tricky part is that we don’t necessarily know who those people are,” Dr. Zelner said.
- Two factors are at play, said Martina Morris, emeritus professor of statistics and sociology at the University of Washington.
- “There has to be a link between people in order to transmit an infection,” she said. But, she added, a link “is necessary but not sufficient.” The second factor is how infectious a person is. “We almost never have independent data on those two things,” Dr. Morris said.
- She pointed out that it can be easy to misattribute multiple infections to an individual — possibly exposing the person to public attack — when the spread has nothing to do with the person’s infectiousness.
- “If you are the first person in a crowded room to get infected and if this is an easily spread disease, you will look like a superspreader,” she said. “Anyone in that room could have had the same impact. You were just the first in line.”
- Yet there do seem to be situations in which a few individuals spark large outbreaks. With Covid-19, it is not yet known whether those highly infectious people include individuals with silent infections who do not realize they are sick, said Dr. Thomas Frieden, former director of the Centers for Disease Control and Prevention and chief executive at Resolve to Save Lives, an initiative of Vital Strategies. More likely, he adds, superspreading events may involve people with symptoms that linger but who are not sick enough to stay home.
- Or they could involve infected people who shed an unusual amount of virus — a poorly studied factor that might be due to variations in the amount of virus in the aerosol droplets from a patient’s cough or the amount of infectious virus in feces, for example.
- No matter what the cause, public health measures, like avoiding crowds, and what Dr. Frieden calls cough hygiene, can prevent a superspreading event, he said.
- Superspreading also appears to have driven outbreaks of the new coronavirus.
- One event occurred at the end of February when 175 Biogen executives gathered for a conference at the Boston Marriott Long Wharf Hotel. At least one was infected with the coronavirus. Two weeks later, seventy five percent of the 108 Massachusetts residents infected with the virus were associated with Biogen. The infections rippled out from there, to other states and other Massachusetts residents.
- “Why at that conference?” asked Dr. Eric Topol, director of the Scripps research translational institute in San Diego. “At the time there were so many conferences — it was before social distancing. Something was going on there.”
- Then there was the March 12 birthday party in Westport, Conn. About 50 people attended. Half ended up infected. The cluster of cases expanded so fast health officials gave up contact tracing.
- At a funeral on Feb. 29 in Albany, Ga., someone unwittingly spread the virus among the 200 mourners. At Illinois’s current hot spot, the Cook County jail, at least 400 are known to be infected.
- As grimly alluring as it is to look for viral superspreaders, there are pitfalls.
- There is a good chance that a cluster of infections would be attributed to a superspreader when, instead, public health officials missed some transmissions by other people, Dr. Zelner said. And there are social consequences to superspreader stories.
- “The nature of our society right now is that we are very much interested in the catastrophic,” said Samuel K. Roberts, a medical historian at Columbia. “The best way to do that is to have something that looks like a zombie story. It’s a powerful narrative.”
- The general public doesn’t need to know if an outbreak was traced to one person, he said.
- “What’s more important is, How do we protect ourselves?” he said. “Finding patient zero is not going to help. It only stokes fear of the other.”
F. Stories From the Frontline
1. Doctor gambles on clot-busting drug to save virus patients
- With high-stress, high-stakes decisions, doctors around the world are frantically trying to figure out how COVID-19 is killing their patients so they can attempt new ways to fight back. One growing theory: In the sickest of the sick, little blood clots clog the lungs.
- Exactly what’s going on with blood clots in at least some COVID-19 patients is a mystery.
- Chinese doctors were first to sound the alarm. In March, Chinese heart specialists advised the American College of Cardiology to watch for clots and said certain blood tests showing a rise in clot risk might signal which patients were in greatest danger. Other reports suggested the clots can show up all over the body. But were they a cause of deterioration or an effect?
- Already, many hospitals are attempting preventive doses of blood thinners to keep clots from forming. There’s huge debate over what kind to try, what dose is safe — the drugs can cause dangerous bleeding — and how soon to start.
- It’s an example of how, with no vaccine or approved treatment for the coronavirus, many overwhelmed doctors are following trails of clues to figure out what to try next.
- “We’re taking care of extremely ill patients that are dying in front of us, and we can’t get any diagnostic testing,” yet still have to make treatment decisions, said Dr. Steven Pugliese, a lung specialist at the University of Pennsylvania.
- Poor first noticed oddities as his ICU filled with patients who just weren’t responding to care the way doctors expected. They were on breathing machines after developing ARDS, acute respiratory distress syndrome. It’s an inflammatory form of lung failure that, when caused by other infections, stiffens lungs.
- “It was like ‘Groundhog Day’ with each patient,” he said, referring to the movie where the same events repeat day after day. They had severe abnormalities in oxygen and carbon dioxide levels but “shockingly, their lungs were not stiff.”
- He recalled Italian doctors who spotted the same thing and wrote in an American Thoracic Society journal that COVID-19 was causing atypical ARDS.
- Back in Poor’s hospital, when ventilated patients looked improved enough to let them wake up a bit, alarms would sound as their blood oxygen levels immediately plummeted.
- “The residents would yell at me, ‘So and so is desaturating!’” Poor recalled. “Classically in ARDS, we think that’s because the lung is collapsing.” But it wasn’t.
- Poor often treats an emergency called pulmonary embolism, a large clot in the lungs that can quickly kill. The COVID-19 patients didn’t look quite like that. Nor were their hearts struggling to pump blood into the lungs.
- Then as he was doing laundry at 2 a.m., Poor remembered a rare disease in which some lung blood vessels abnormally dilate even as others are clogged. If that explains the COVID-19 contradictions, he thought, a clot-buster might help.
- “I did a case series of five. This does not prove anything,” he cautioned. “Perhaps it brings light to possibilities where further research can delve into what exactly is going on.”
G. New Technologies
1. Hospital in Canada battles coronavirus with ‘revolutionary’ app
- Jewish General Hospital in Montreal is battling the coronavirus outbreak with what has been described as a “revolutionary” app that can monitor peoples’ vital signs when they look on their smartphone screens.
- In a memo to the staff of the CIUSSS West-Central Montreal, which includes Jewish General, the health system’s CEO Dr. Lawrence Rosenberg said the app would protect staff and provide patients with more effective care.
- “Starting soon, after ongoing evaluation, our CIUSSS is expected to make extensive use of a revolutionary smartphone app: It allows patients to look into their phone’s screen and have their vital signs (early indicators of possible infection that the app has obtained) shared with health care professionals,” he said in the memo, which was obtained by Fox News.
- The health system’s use of the app is the first of its kind anywhere in the world, according to Rosenberg.
- The Montreal Gazette reported that the Jewish General Hospital’s early testing of the app has delivered positive results.
- The app will let staff reduce their contact with infected patients, Rosenberg said, greatly lowering their chances of becoming infected and spreading the virus themselves.
- “For example, triage nurses can check vital signs (heart rate, respiratory rate and the blood’s oxygen saturation) without touching patients; the condition of certain hospitalized patients can be monitored from their beds; and the vital signs of patients at home can be checked remotely,” he explained. “The technology can even detect subtle changes that might otherwise go unnoticed. As a further bonus, with staff entering quarantined rooms less often, stocks of protective equipment will last longer.”
- The memo does not name the companies involved in developing the app, although the Montreal Gazette reported that Israeli firm Binah.ai developed the core technology, which was harnessed by Montreal-based Carebook Technologies for the app. On its website, Carebook writes that its MyVitals COVID-19 app is coming soon to Quebec. The app, it says, was designed in collaboration with the Jewish General Hospital.
- As of Friday evening, at least 10,912 coronavirus cases had been diagnosed in Quebec, including 216 deaths.
- At least 1.68 million coronavirus cases have been diagnosed worldwide, at least 491,358 of which are in the US. The disease has accounted for at least 102,026 deaths around the world, including at least 16,686 people in the US.
H. Projections and Our (Possible) Future
1. Coronavirus Fatality Rate Lower Than Expected, Close To Flu’s 0.1%
- The fatal and very contagious novel coronavirus has spread a lot quicker but is much less fatal than formal data indicate, the Economist journal noted in excess of the weekend, citing a new research.
- On Saturday, the Economist noted that the truth that the sickness caused by the coronavirus (COVID-19) has spread across the United States could be “good information.”
- “If hundreds of thousands of men and women have been infected weeks in the past without the need of dying, the virus ought to be significantly less fatal than formal details suggest,” the journal established, using graphs to advise the speedier the illness spreads and hits its peak, the less persons will die.
- The Economist post cited a new examine by Justin Silverman and Alex Washburne that applied knowledge on influenza-like ailment to clearly show that the coronavirus (SARS-COV-2) is now widespread in the US.
- Silverman and Washburne found that the coronavirus mortality rate could be as very low as .1 %, “similar to that of flu.”
- The Economist further discussed:
- COVID-19 takes 20-25 days to kill victims. The [Silverman and Washburne] paper reckons that 7,000,000 US residents had been contaminated from March 8th to 14th, and formal knowledge demonstrate 7,000 fatalities a few weeks afterwards. The ensuing fatality rate is .1%, related to that of flu. That is astonishingly small, just a tenth of some other estimates. Probably it is just mistaken, probably for the reason that the loss of life toll has been underneath-reported. Possibly, however, New York’s hospitals are overflowing simply because the virus is so contagious that it has crammed the equal of a year’s truly worth of flu instances into 1 week.
- The dying price could be larger offered that men and women with asymptomatic or moderate coronavirus probable unsuccessful to report non-flu influenza-like ailments to their physicians, the journal acknowledged.
- Silverman and Washburne reportedly gleaned their info from weekly reviews by 2,600 American medical practitioners on the amount of their sufferers who have ili, the Economist discussed, introducing:
- The authors believe that the share of these providers’ individuals with ili who do have the flu matches the charge of flu assessments that are positive in the exact condition and 7 days. This allows them estimate how a lot of individuals have ili very seriously plenty of to contact a doctor, but do not have the flu—and how quite a few additional individuals have had non-flu ili in 2020 than in prior years.
- Of system, the flu is frequently the trigger of ili, but there several other illnesses that develop influenza-like health issues, such as typical colds, move throat, and now coronavirus.
- The new study’s coronavirus death level estimate is a lot reduce than what Dr. Anthony Fauci, the director of the U.S. Countrywide Institute of Allergy and Infectious Disorders and member of the White Household Coronavirus Taskforce, predicted in early March.
- “If you glimpse at the circumstances that have appear to the focus of the health-related authorities in China, and you just do the math, the math is about two percent,” Fauci said.
- A study from Britain posted at the end of last month in the health-related journal Lancet Infectious Diseases also found that fewer folks are dying from the novel coronavirus than beforehand estimated.
- That research approximated the coronavirus loss of life price could be as low as .66 p.c and as high as 1.38 percent. Fauci’s estimate is larger than each figures.
- The coronavirus has contaminated over 560,000 people and killed almost 23,000 throughout all 50 states, the District of Columbia, Guam, Puerto Rico, the Northern Mariana Islands, and the U.S. Virgin Islands, the Johns Hopkins University tracker confirmed as of Monday afternoon.
2. WHO warns against reopening businesses too quickly
- WHO officials also warned Monday against lifting social distancing restrictions and reopening businesses, even as U.S. political leaders, from President Donald Trump to New York Gov. Andrew Cuomo, have said they hope to reopen businesses as soon as it is safe to do so.
- “While Covid-19 accelerates very fast, it decelerates much more slowly. In other words, the way down is much slower than the way up,” WHO Director-General Tedros Adhanom Ghebreyesus said at a press conference at the organization’s Geneva headquarters on Monday. “That means control measures must be lifted slowly and with control. It cannot happen all at once.”
- Tedros outlined a checklist for countries before they should consider lifting social distancing measures:
- Transmission of the virus should be controlled.
- A surveillance system should be in place to detect, isolate and treat patients.
- Outbreaks in hospitals and nursing homes should be minimized.
- Preventive measures in essential locations such as schools and workplaces should be in place.
- The risk of importing the disease from abroad should be under control.
- “Control measures can only be lifted if the right public health measures are in place, including significant capacity for contact tracing,” Tedros said.