“We’re going to work with the governors. The governors are going to do a good job, and if they don’t do a good job, we’re going to come down on them very hard. We’ll have no other choice.”
— President Trump
“There are over 20 States that are in extremely good shape, and we think we’re going to be able to get them open fairly quickly, and others will follow.” President Trump “I’ll guarantee you, once you start pulling back there will be infections. It’s how you deal with the infections that’s going count.” — Dr. Fauci
- Recent Developments and Headlines
- Numbers and Trends
- New Scientific Findings
- Stories from the Frontline
- Potential New Treatments
- Observations & Unanswered Questions
- Trends and Responses
- 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 4/14 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 = 2,000,542 (+71,024) (+3.7%)
- US Total Cases = 614,246 (+27,073) (+4.6%)
- NY Total Cases = 202,208 (+6,553) (+3.4%)
- Worldwide deaths = 126,858 (+7,079) (+5.9%)
- US deaths = 26,064 (+2,299) (+9.7%)
- NY deaths = 10,834 (+778) (+7.7%)
- Unprecedented: Over 95% of U.S. Residents Ordered to Stay Home
- Another IHME Model Failure: Hospitalization Projections Drop by 34%
- President Trump announces creation of federal ventilator stockpile after ‘scariest’ day of his life
- World Health Organization Stopped Medical Experts from Recommending Coronavirus Travel Bans
- Taiwan releases December email to WHO showing unheeded warning about coronavirus
- Trump slams WHO over coronavirus response, suspends US payments
- Trump says US will have ‘fewer than 100k’ deaths
- Dr. Anthony Fauci: U.S. does not yet have the critical testing and tracing procedures needed to begin reopening the nation’s economy
- Fauci: a May 1 target for easing social distancing is “a bit overly optimistic” for many areas of the country — any easing in much of the country would have to occur on a “rolling” basis
- NY Mayor De Blasio announces NYC will produce its own coronavirus test kits
- De Blasio says large gatherings in NYC may not happen this summer
- Trump’s Plan to Reopen the Economy Will Begin With ‘Authorizing’ Each Governor to Reopen State and Decide Timetable
- CA Gov. Newsom lays out 6 conditions for reopening economy
- NY Gov. Cuomo Announces Working Group of Dem Governors for ‘Smart’ Reopening
- DeWine: I’ll Make the Decision on Reopening State, But Will Consult with W.H.
- Michigan: Angry Residents to Swarm Capitol in ‘Operation Gridlock’
- Covid-19 checkpoints targeting out-of-state residents draw complaints and legal scrutiny
- Coronavirus stay-at-home orders stir protests nationwide amid fears of economic collapse
- Coronavirus lockdowns and civil liberties collide in a remote corner of California
- Almost 600 Theodore Roosevelt sailors have COVID-19, 4 hospitalized, Navy says
- Chairman Of Jt. Chiefs Admits US Intel Has Taken ‘Hard Look’ At Wuhan Lab As Origin Of COVID-19 — “The weight of evidence leans towards natural. But, we don’t know for certain.”
- Pew Poll: 30% Of Americans Say Coronavirus Was Made In A Lab – That Number Is About To Grow
- Social Distancing Efforts Are Now Cemented Into American Life
- Coronavirus Death Toll in Europe Likely Far Higher Than First Reported
- China Tightens Russia Border to Stem Surge of Coronavirus Cases
- China Will Be Hit With Second Coronavirus Wave In November, Top Shanghai Clinical Expert Warns
- Philippines ramps up testing to find thousands of unknown coronavirus infections
- India extends nationwide lockdown, ordering more than 1 billion people to remain at home
- Spain loosens coronavirus restrictions as nearly 300,000 return to work
- Some European nations ease pandemic rules, but move warily
- Rising deaths in Indonesia bring fears for a limited health system
- Virus-related deaths in Britain may be 10 percent higher than the official toll.
- Ecuador’s financial capital has seen a surge of dead
- “Black People Not Allowed” – China Denies Reports It Banned African Residents From Guangzhou
- Navy’s Mercy Hospital Ship Off L.A. Now Battling Serious COVID-19 Outbreak Among Crew
- European cases (Germany, Spain) continued to slide
- Russia reports another record jump in new cases
- Oregon Gov. Kate Brown lays out her plan
- France reports largest jump in deaths in 4 days
- Italy reports smallest jump in new cases in more than a month
- China reports another 89 new infections
- Amazon warehouse worker dies of COVID-19
- NYC adds nearly 4,000 to death toll due to posthumous diagnoses
- Florida surgeon general says social distancing should continue until a vaccine is released
- CA pastors sue state to reopen churches
- Sweden deaths exceeds 1,000
- UK department of health reports 778 new deaths
- NATO warns supply chains of important medical supplies should be moved out of ‘non-member’ states
- 80% Of Americans Will Wait To Resume Normal Activities After COVID-19 Restrictions Lifted
- 21 New York City Teachers & Over 50 Total School Staff Have Died Of COVID-19
- Cruise Lines Say Bookings For 2021 Up 40% Despite Terrifying Series Of On-Board Outbreaks — Are Americans really that stupid?
- Half Of American Workers Would Rather Work From Home Forever
- “We Weren’t Prepared” For COVID-19: Macron Admits A French Disaster
- ‘You’ll See Bodies In The Streets Of Africa’ Warns Melinda Gates; Says Vaccine Is ‘Ultimate Solution’ To COVID-19
- Woman Suing Los Angeles: Mayor Garcetti Increasing Coronavirus Risk by Sheltering Homeless in Rec Centers
- Swedish Writer Claimed Boris Caught Corona On Purpose For Political Gain
- After Coronavirus Response Failures, Almost Half of Italians Want Out of EU
- French President Macron Extends Coronavirus Lockdown Until May 11
- Apple and Google Promise to Limit Access to Chinese Virus Tracing Tech
- Surge of Online Grocery Shopping Leads Amazon to Launch Waiting List
- Musicians Create Virtual Choirs and Orchestras
- Hospital Workers Concerned About Masks Delivered by New England Patriots
- First Reporter at WH Briefing Asks Question in Mask
- Costco’s high-tech meatpacking plant stays open as virus shuts migrant labor plants
- Crowd Gathers Outside Ohio Statehouse to Protest Coronavirus Lockdown
- Foot sores could be an early sign of coronavirus, experts say
- Oprah stresses seriousness of coronavirus on black community: ‘It’s taking us out’
- It was a regular poker game among eight friends, but within weeks coronavirus killed three and infected all
- Seed companies can’t keep up as more Americans turn to growing their own food
- Thousands of cars line up to get into a Los Angeles food bank as droves of desperate Americans continue to wait for hours across the country amid the coronavirus pandemic
- Study shows Americans are lonelier than ever due to coronavirus lockdown
- Swedish Virus Deaths Top 1,000, Fueling Criticism Over Strategy
- After Putin’s bravado, COVID-19 is starting to hit Russia hard
- ‘Starve or get sick’: Africa’s lockdown dilemma
- Rio’s ‘Christ the Redeemer’ Statue Outfitted with Doctor’s Coat in Tribute to Healthcare Workers
- Coronavirus shortages prompt Australia to bring manufacturing home
- Corona-besieged parents dreading prospect of a summer without camp
- Donald Trump suspends World Health Organization funding over ‘dangerous and costly’ coronavirus failings
- Virus brings out the jackals in deserted Tel Aviv park
- Ohio stops Pennsylvania residents from crossing state line to buy booze
- Lust amidst quarantine: study shows rise in horny tweets this past March
- Most NYC kids ‘probably’ already have coronavirus, doc says
- US officials raised alarms about Wuhan coronaviruses lab in 2018
- Coronavirus-besieged parents dreading prospect of a summer without camp
- McDonald’s in China apologizes for sign banning black people amid coronavirus
- Chile counts coronavirus deaths as ‘recovered’
- Staff sickouts skyrocket at NYC’s hospitals amid coronavirus outbreak
- Elbow room and silence? NYC restaurants bracing for lasting changes
- VA reports surge in coronavirus deaths, employee cases
- Beach bummed: NYC shores may not open for entire summer amid coronavirus
- Are you a ‘doomscrolling’ junkie? The new, scary coronavirus habit
- Zoo cannot be serious! Why a facility may feed animals to each other
- Netherlands 5G cell towers damaged amid COVID-19 conspiracy theories
- Scientists suggest coronavirus could spread from corpses
- Social-distancing restrictions are fine — petty authoritarianism is not
- Judge urges attorneys to get out of bed, wear clothes for Zoom hearings
- Healthy 27-year-old who had coronavirus says it ‘tricks you’ in recovery
- Doctors get married in hospital after coronavirus ruined wedding plans
- Ricky Gervais slams celebs whining about coronavirus isolation in mansions
- FBI warns fraudsters are taking advantage of coronavirus fears
- Couple mistakenly fined for posting old vacation photos during coronavirus lockdown
- Health workers are attaching photos of themselves to their gear to brighten patients’ spirits
- Coronavirus may lead to worst global recession since Great Depression
- Pregnant women without symptoms are testing positive for coronavirus
- Private island for the super rich buys thousands of coronavirus tests
- Confusing Chinese regulations are delaying face mask exports
- Russia braces for a parallel scourge: alcohol
- An African politician promises an airlift for black residents facing discrimination in China
- In Iraq, the fight against coronavirus means overcoming stigma
- Greece warns against travel ahead of Orthodox Easter
- In Japan, a hidebound office culture is hindering remote work
- Sex toy sales take off amid Colombia’s coronavirus quarantine
- Woman fined for taking turtle for a walk in Rome
- What Day Is It? You’re Not the Only One Asking
- Pot Use Reaches All-Time High In March
- Success During “Hard” Times: Sex Toy Company Sees Sales Rocket 38% Since COVID-19 Lockdown Started
- UK Cops Brag About “Hiding In The Shadows” To Catch Picnic-Goers
- Aw, Snap! Your Birthday Party Has Gone Virtual
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: 2,000,542 Total Cases (+3.7%)
- New Cases = 71,024 (-4,323) (-5.7%)
- Europe: 935,108 Total Cases (+5.6%)
- New Cases = 49,502 (+28,536) (+136.1%)
- US: 614,246 Total Cases (+4.6%)
- New Cases = 27,073 (+333) (+1.3%)
- US States:
- 40 States > 1,000 cases (+0), plus DC
- 28 States > 2,500 cases (+0)
- 20 States > 5,000 cases (+1)
- 13 States > 10,000 cases (+0): NY, NJ, MA, MI, CA, PA, IL, FL, LA, TX, GA, CT & WA
- 9 States > 20,000 cases: NY, NJ, MA, MI, CA, PA, IL, FL, LA,
- Top 5 States: (i) NY: 202,208 (+6,553); (ii) NJ: 68,824 (+4,420); (iii) MA: 28,163 (+1,296 ); (iv) MI: 27,001 (+1,366); and (v) CA: 25,777 (+1,406).
- Notes: (a) the number of new cases in MA decreased, and (b) the number of new cases in (i) NY increased by approx. 5%, (ii) NJ increased by approx. 55%, (iii) MI increased by approx. 37%, and (iv) CA increased by approx. 30%
- For more information on US States, see https://ncov2019.live/data
- New York State:
- NY Total Cases = 202,208 (+3.4%)
- NY New Cases = 6,553 (+312) (+5%)
- New York City:
- Total Cases = 106,763 (+2.3%)
- NYC New Cases = 2,353 (+1,151) (+95.8%)
2. Serious or Critical Cases
- Worldwide serious or critical cases = 51,592 (+438)
- US series or critical cases = 13,473 (+701)
- US serious or critical cases = 2.5% 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 = 126,858 (+7,079) (+5.9%)
- Europe: 83,634 deaths (+3,786) (+4.7%)
- US deaths = 26,064 (+2,299) (+9.7%)
- NY deaths = 10,834 (+778) (+7.7%)
- NYC deaths = 7,349 (+451) (+6.5%)
- Deaths per 1M population: (i) Italy: 348 (+10); (ii) Spain: 390 (+10); (iii) US: 79 (+8); (iv) France: 241 (+12); & (v) Germany: 42 (+4)
- Worldwide Total Confirmed Case Fatality Rate = 6.3% (+0.1%)
- US Total Confirmed Case Fatality Rate = 4.2% (+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 = 485,899 (+32,884) (+7.3%)
- US recoveries = 38,820 (+1,872) (+5.1%)
C. New Scientific Findings and Other Advancements
1. Coronavirus mutation could threaten the race to develop vaccine
- A strain of coronavirus found in India showed changes in the mechanism used to bind the virus to human cells which could render current research futile
- Researchers are targeting the same process that allowed Sars to infect people, but the mutation could upend their assumptions
- A coronavirus strain isolated in India carried a mutation that could upend vaccine development around the globe, according to researchers from Australia and Taiwan.
- The non-peer reviewed study said the change had occurred in part of the spike protein that allows the virus to bind with certain human cells.
- This structure targets cells containing ACE2, an enzyme found in the lungs which also allowed the severe acute respiratory syndrome (Sars) virus to infect people.
- Scientists know more about this receptor than any other so had been working on antibodies that target it, but an unexpected structural change could render them useless.
- The researchers – led by Wei-Lung Wang, from the National Changhua University of Education in Taiwan, and collaborators from Murdoch University in Australia – said this was the first report of a significant mutation that could threaten development of a vaccine for the virus that causes Covid-19.
- “[This] means current vaccine development against Sars-CoV-2 is at great risk of becoming futile.”
- The patient was said to be a medical student returning from Wuhan, but the strain does not appear to be closely related to any of those identified in the Chinese city and appears to be an outlier compared with variants recorded in other countries.
- The researchers found that the mutation occurred in the spike protein’s receptor-binding domain (RBD).
- A computer simulation shows that the RBD mutation, which was not found in other variants across the globe, could remove a hydrogen bond from the spike protein.
- Without this bond, the virus may be less likely to bind with ACE2, or angiotensin converting enzyme-2, which is found in the lungs and other organs.
- The virus’s presence in the country has grown rapidly in recent weeks, with cases being identified in crowded slum areas, and scientists fear the world’s second biggest country could see the next major outbreak – something that threatens a humanitarian disaster.
- A researcher with the Chinese Academy of Sciences in Beijing who is tracking the mutation of the coronavirus said he was closely monitoring the emerging strains from India.
- The findings of the new study, which was not peer-reviewed, will need further verification. For instance, there was a possibility that the mutation was caused by a technical error during the sequencing process, according to the researcher, who requested not to be named due to the sensitivity of the issue.
- Benjamin Neuman, professor and chair of biological sciences with the Texas A&M University in Texarkana, said the mutation appeared to be random, not the result of natural selection by the immune system because there were no more variants in that part of the spike than elsewhere in the genome.
- The constant mutation of the coronavirus means the vaccine will need periodic tests and updates. “The influenza virus mutates constantly, and at about the same rate as coronavirus, but we are able to successfully vaccinate against this moving target,” he said. “Finding a vaccine strategy that actually works in people is the difficult part.”
- The unusual behaviour of the coronavirus has kept scientists around the world scratching their heads. For instance, it has infected a large number of patients around the world but the genetic structure of the strain has remained relatively stable.
- “The observation of this study raised the alarm that Sars-CoV-2 mutation with varied epitope [something an antibody attaches itself to] profile could arise at any time,” they wrote in a paper released on preprint review site biorxiv.org on Saturday.
- “[This] means current vaccine development against Sars-CoV-2 is at great risk of becoming futile.”
- But others worry the thousands of strains sampled and sequenced are just the tip of the iceberg – and greater variety increases the risk that new strains will require new vaccines in the same way the flu virus does.
- Although China has five different vaccines under development “it is impossible to predict which one is more likely to succeed”, said the researcher. “They could all end in failure.”
D. Stories From the Frontline
1. Are We Treating the Wrong Disease?
- Doctors say the coronavirus is challenging core tenets of medicine, leading some to abandon long-established ventilator protocols for certain patients. But other doctors warn this could be dangerous. Watch the video on the NY Times here. [Note: In our opinion, this video is well worth watching – you cannot have an intelligent conversation with a doctor or advocate for someone in an ICU if you don’t understand what is going on and the uncertainties regarding treatment and ventilators.]
- In a separate video, Dr. Cameron Kyle-Sidell, a doctor treating COVID-19 patients in an ICU at New York City’s Maimonides Medical Center, said that:
- “I am a physician who has been working at the bedside of COVID+ patients in NYC. I believe we are treating the wrong disease and that we must change what we are doing if we want to save as many lives as possible.”
- “In February, South Korean physicians reported that critical Covid-19 patients responded well to oxygen therapy without a ventilator. Patients are getting multiple organ damage from hypoxia. It’s not the pneumonia that’s the killer, it’s the cellular oxygen deprivation. And we are hurting these patients with ventilators.”
- Dr. Kyle-Sidell states that every hospital is treating COVID-19 as an acute respiratory disease syndrome (ARDS) that causes pneumonia. However, as far as he can see, COVID-19 is a pneumonia and should not be treated as one. Rather, it appears to be a viral infection that most resembles a high altitude disease illness in which the patients are deprived of oxygen. The problem is not respiratory failure, but oxygen failure. And, when ventilators are required (because there is no other way to provide oxygen to patients), then they must be programmed to address the right problem (too much pressure may cause more harm than good). See video below [Note: We also believe that this video is also worth watching.]
[Note: We are investigating a theory circulating on the internet because it is consistent with what some of the doctors said on the videos referenced above. Basically, the theory is that COVID-19 causes prolonged and progressive hypoxia (starving your body of oxygen) by binding to the heme groups in hemoglobin in your red blood cells. People are simply desaturating (losing o2 in their blood), and that’s what eventually leads to organ failures that kill them, not any form of ARDS or pneumonia. All the damage to the lungs you see in CT scans are from the release of oxidative iron from the hemes, this overwhelms the natural defenses against pulmonary oxidative stress and causes that nice, always-bilateral ground glass opacity in the lungs. However, we have not yet found any reliable scientific source or evidence to validate this theory.]
E. Potential Treatments
1. Vaccines, Antibodies and Drug Libraries — The Possible COVID-19 Treatments Researchers Are Excited About
- In early April, about four months after a new, highly infectious coronavirus was first identified in China, an international group of scientists reported encouraging results from a study of an experimental drug for treating the viral disease known as COVID-19.
- It was a small study, reported in the New England Journal of Medicine, but showed that remdesivir, an unapproved drug that was originally developed to fight Ebola, helped 68% of patients with severe breathing problems due to COVID-19 to improve; 60% of those who relied on a ventilator to breathe and took the drug were able to wean themselves off the machines after 18 days.
- Repurposing drugs designed to treat other diseases to now treat COVID-19 is one of the quickest ways to find a new therapy to control the current pandemic. Also in April, researchers at Vanderbilt University enrolled the first patients in a much-anticipated study of hydroxychloroquine. It’s already approved to treat malaria and certain autoimmune disorders like rheumatoid arthritis and lupus but hasn’t been studied in a clinical trial, until now, against coronavirus. Yet the medication has become a sought-after COVID-19 treatment after first Chinese doctors, and then President Trump, touted its potential in treating COVID-19. The data from China is promising but not conclusive, and infectious disease experts, including Trump’s coronavirus task force scientific advisor Dr. Anthony Fauci, aren’t convinced it’s ready for prime time yet in America’s emergency rooms and intensive care units.
- But doctors facing an increasing flood of patients say they don’t have time to wait for definitive data. In a survey of 5,000 physicians in 30 countries conducted by health care data company Sermo, 44% prescribed hydroxychloroquine for their COVID-19 patients, and 38% believed it was helping. Such off-label use in using a drug approved to treat one disease to treat another is allowed, especially during a pandemic when no other therapies are available. A similar percentage said remdesivir was “very or extremely effective” in treating COVID-19. (Although remdesivir is not approved for treating any disease, the FDA granted special authorization for doctors to use it to treat the sickest COVID-19 patients.)
- That explains the unprecedented speed with which the hydroxychloroquine study—and others like it—are popping up around the world. There are no treatments proven to disable SARS-CoV-2, the virus that causes the disease, which means all the options scientists are exploring are still very much in the trial-and-error stage. Still, they are desperate for anything that might provide even a slim chance of helping their patients survive, which is why studies are now putting dozens of different therapies and a handful of vaccines to the test. The normal road to developing new drugs is often a long one—and one that frequently meanders into dead ends and costly mistakes with no guarantees of success. But given the speed at which SARS-CoV-2 is infecting new hosts on every continent across the globe, those trials are being ushered along at a breakneck pace, telescoping the normal development and testing time by as much as half.
How COVID-19 Will Change National Security
- The newly launched Vanderbilt study, led by the National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health, will enroll more than 500 people who have been hospitalized with COVID-19 and randomly assign them to receive hydroxychloroquine or placebo. It would be the first definitive trial to test whether hydroxychloroquine should be part of standard therapy for treating COVID-19, and its lead scientist expects results in a few months.
- These are all stop-gap measures, however, since ultimately, a vaccine against COVID-19 is the only way to arm the world’s population against new waves of infection. Established pharmaceutical powers like Johnson & Johnson, Sanofi and Glaxo SmithKline are racing shoulder-to-shoulder to with startups using new technology to develop dozens of potential new vaccines, with the hope of inoculating the first people next year—none too soon before what public health officials anticipate might be another season of either the same, or potentially new, coronavirus.
Let the Immune System Do the Work—Plasma, Antibodies and More
- It’s an old-school approach that dates back to the late 19th century, but the intuitive logic behind using plasma from recovered patients—technically called “convalescent plasma”—as a treatment might still apply today. Plasma treatments have been used with some success to treat measles, mumps and influenza. The idea is to use immune cells extracted from the blood of people who have recovered from COVID-19 and infuse them into those who are infected, giving them passive immunity to the disease, which could at least minimize some of its more severe symptoms.
- It’s part of a broader range of tactics that utilize the body’s own immune response as a molecular North Star for charting the course toward new treatments. And by far, antibodies against the virus are the most abundant and efficient targets, so a number of pharmaceutical and biotechnology companies are concentrating on isolating the ones with the strongest chance of neutralizing SARS-CoV-2.
- In late March, New York Blood Center became the first U.S. facility to start collecting blood from recovered COVID-19 patients specifically to treat other people with the disease. Doctors at New York’s Mount Sinai Health System are now referring recovered (and willing) patients to the Blood Center, which collects and processes the plasma and provides the antibody-rich therapy back to hospitals to treat other COVID-19 patients. It’s not clear yet whether the practice will work to treat COVID-19, but the Food and Drug Administration (FDA) is allowing doctors to try the passive immunity treatment in the sickest patients on a case by case basis, as long as they apply for permission to use or study the plasma an investigational new drug. “If we can passively transfuse antibodies into someone who is actively sick, they might temporarily help that person fight infection more effectively, so they can get well a little bit quicker,” says Dr. Bruce Sachais, chief medical officer at New York Blood Center Enterprises.
- The biggest drawback to this approach, however, is the limited supply of antibodies. Each recovered donor has different levels of antibodies that target SARS-CoV-2, so collecting enough can be a problem, especially if the need continues to surge during an ongoing pandemic. At the Maryland-based pharmaceutical company Emergent BioSolutions, scientists are trying to overcome this challenge by turning to a unique source of plasma donors: horses. Their size makes them ideal donors, says Laura Saward, head of the company’s therapeutic business unit. Scientists already use plasma from horses to produce treatments for botulism (a bacterial infection), and have found that the volume of plasma the animals can donate means each unit can treat more than one patient (with human donors, at this point, one unit of plasma from a donor can treat one patient). Horses plasma may also have higher concentrations of antibody, so “the thought is that a smaller dose of equine plasma would be effective in people because there would be higher levels of antibody in smaller doses,” says Saward. By the end of the summer, the company expects its equine plasma to be ready for testing in people.
- Scientists are also looking for other ways to generate the virus-fighting antibodies produced by COVID-19 patients. At Regeneron, a biotechnology firm based in New York, researchers are turning to mice bred with human-like immune systems and infected with SARS-CoV-2. They’re searching hundreds of antibodies these animals produce for the ones that can most effectively neutralize the virus. By mid-April, the company plans to start manufacturing the most powerful candidates and prepare them (either solo or in combination) for human testing—both in those who are already infected, as well as in healthy people, to protect from getting infected in the first place, like a vaccine.
- It’s not just people and animals that can produce antibodies. Scientists now have the technology to build what are essentially molecular copying machines that can theoretically churn out large volumes of the antibodies found in recovered patients. At GigaGen, a San Francisco-based biotech startup founded by Stanford University professor Dr. Everett Meyer, scientists are identifying the right antibodies from recovered COVID-19 patients and hoping to use them as a template for synthesizing new ones, in a more consistent and efficient way so a handful of donors could potentially produce enough antibodies to treat millions of patients. “What GigaGen’s technology does is almost Xerox copy a big swath of the human repertoire of antibodies, and then takes those copies and grows it in cells [in the lab] to manufacture more antibodies outside of the human body,” says Meyer. “So we can essentially keep up with the virus.” If all goes well and the FDA gives its green light, the company intends to start testing their antibody concoctions in COVID-19 patients early next year.
- Researchers at Rockefeller University are following another clue from the human body’s virus-fighting defenses. They discovered in 2017 that human cells make a protein called LY6E that can block a virus’s ability to make copies of itself. Working with scientists at the University of Bern in Switzerland and the University of Texas Southwestern Medical Center, they found that mice genetically engineered to not produce the protein became sicker, and were more likely to die after infection with other coronaviruses, including SARS and MERS, compared to mice that were able to make the protein. “If the mice have the protein they pretty much survive,” says John Schoggins, associate professor of microbiology at the University of Texas. “If they don’t have it, they don’t survive…because their immune system can’t control the virus.”
- Because SARS-CoV-2 preferentially attacks lung tissue and causes cells in the respiratory tract to launch a hyperactive immune response, researchers are exploring ways to tame that aggressive response by dousing those cells with a familiar gas: nitric oxide, often used to relax blood vessels and open up blood flow in hospital patients on ventilators who have trouble breathing. While working on a new, portable system for delivering nitric oxide developed by Bellerophon Therapeutics to treat a breathing disorder in newborns, Dr. Roger Alvarez, an assistant professor of medicine at University of Miami, got the idea that the gas might be helpful for COVID-19 patients as well. One symptom of the viral infection is low oxygen levels in the lungs, and nitric oxide is ideally designed to grab more oxygen molecules from the air with each breath and feed it to the lungs. “With this system, patients don’t need to be in the ICU [Intensive Care Unit] at all,” he says. “The patient can be in a regular hospital bed, or even at home. So you save the cost of the ICU and from a resource standpoint, you save on needing nursing care, respiratory therapists and other ICU monitoring.”
Repurposing and Recycling Malaria, Flu, Cancer Drugs and More
- When it comes to developing a new antiviral treatment, it doesn’t always pay to start from scratch. There are dozens of drugs that have become life-saving therapies for one disease after their developers accidentally discovered that the medications had other, equally useful effects. Viagra, for example, was originally explored as a heart disease drug before its unintended effect in treating erectile dysfunction was discovered, and gabapentin was developed as an epilepsy drug, but is now also prescribed to control nerve pain.
- Within weeks of COVID-19 cases spiking to alarming levels in China, researchers at Gilead in Foster City, Cal., saw an opportunity. A drug the company had developed against Ebola, remdesivir, had shown glimmers of hope in controlling that virus in the lab—and also showed promise as a tool to treat coronaviruses like those that caused SARS and MERS. In fact, says Merdad Parsey, chief medical officer of Gilead, “We knew in the test tube that remdesivir had more activity against coronaviruses like SARS and MERS than against Ebola.” So it wasn’t entirely surprising that when the company began testing it in people during last year’s Ebola outbreak in the Democratic Republic of Congo, the results were disappointing. “The early studies against Ebola weren’t as encouraging in people as they were in animals. So we were basically on hold with the drug, waiting to see if there would be another [Ebola] outbreak to see if we could test it earlier in the infection,” says Parsey.
- Finding a new purpose for existing drugs is ideal; they are likely already proven safe and their developers have a substantial dossier of information on how the drugs work. That’s what happened with hydroxychloroquine, a malaria drug developed after the parasite that causes the illness became resistant to the chloroquine, a drug discovered during World War II and since used widely to fight the disease. As researchers studied hydroxychloroquine in the lab in recent decades , they learned it can block viruses, including coronaviruses, from infecting cells. In lab studies, when researchers infected human cells with different viruses and then bathed them in hydroxychloroquine, those cells could generally stop viruses like influenza, SARS-CoV-2, and the original SARS virus, another type of coronavirus, from infecting the cells. “The problem is that what happens in the lab often doesn’t predict what happens in a patient,” says Dr. Otto Yang, from the department of microbiology, immunology and molecular genetics at the David Geffen School of Medicine at the University of California Los Angeles. In fact, in the case of influenza, the drug wasn’t as successful in stopping infection in animals or in people. Similarly, when scientists brought hydroxychloroquine out of the lab and tested it in people, the drug failed to block infection with HIV and dengue as well.
- Other researchers are attempting to trace the same path with other repurposed drugs, including a flu treatment from Toyama Chemical, a pharmaceutical division of the Japanese conglomerate Fujifilm, called favipiravir, which Chinese researchers used to treat patients with COVID-19. More rigorous studies of both remdesivir and favipirivir against SARS-CoV-2 are ongoing; all researchers can say at this point is that they are worth studying further, and that they appear to be safe.
- Even cancer drugs are showing promise as COVID-19 treatments, not by neutralizing the virus but by healing the damage infection does to the immune system. The Swiss pharmaceutical giant Novartis, for example, has ruxolitinib (sold under the trade name Jakavi), which was approved by the FDA in 2011 to treat a number of different cancers, and is designed to tamp down an exaggerated immune response—which can be caused by both tumor cells and a virus. In the case of SARS-CoV-2, a hyperactive immune response can trigger breathing problems, called a “cytokine storm,” that require extra oxygen therapy or mechanical ventilation. In theory, ruxolitinib could suppress this virus-caused cytokine storm. Novartis is making its drug available on an emergency use basis for doctors willing to try it on their sickest patients.
- Eli Lilly is also testing one of its anti-inflammatory drugs, baricitinib, in severe COVID-19 patients. Like ruxolitinib, baricitinib interferes with the revved up signalling among immume cells that can trigger the inflammatory cytokine storm. According to president of Lilly Bio-Medicines Patrik Jonsson, there are even early hints from case studies of doctors treating COVID-19 patients that the drug may target the virus too, which could mean that it helps to lower the viral load in infected patients. The company is working with NIAID to confirm whether this is the case in a more rigorous study of severe COVID-19 patients, and expects to see results by summer.
Finding the Needle in the Haystack—Where New Coronavirus Therapies Are Born
- It wasn’t immediately obvious that baricitinib could potentially treat COVID-19; it took an artificial intelligence effort by UK-based BenevolentAI to scour existing medical literature and descriptions of drug structures to identify baricitinib as a possible therapy.
- Such machine learning-based techniques are making the search for new therapies far more efficient than ever before. Chloroquine, hydroxychloroquine’s parent, came out of a massive war-time drug discovery effort in the 1940s, when governments and pharmaceutical companies combed through existing drug libraries for promising new ways to treat malaria. With computing power that is orders of magnitude greater now, it’s now possible to single out not just existing drugs with antiviral potential, but entirely new ones that may have gone unnoticed.
From the Obvious to the Not So Obvious
- But today, we are in the midst of a pandemic, and scientists are eager to leave no potentially promising technology untried. Banking on the growing body of science looking at how newborn babies are able to avoid life-threatening infections in their first days in the world, researchers at New Jersey-based Celularity are investigating how placental cells, rich with immune cells that protect the baby in utero, might also become a source of immune defense therapy against COVID-19. It’s part of a broader strategy of cell-based treatments that scientists are beginning to explore for treating cancer as well as infectious disease.
Vaccines: The Ultimate Protector
- As effective and critical as these therapies might be, they are a safety net for the best weapon against an infectious disease: a vaccine.
- The main reason that a new virus like SARS-CoV-2 has such free license to infect hundreds of thousands of people around the world is because it’s an entirely new enemy for the human immune system — making the planet’s population an open target for infection. But a vaccine that can prime the body to build an army of antibodies and immune cells trained to recognize and destroy the coronavirus would act as an impenetrable molecular fortress blocking invasion and preventing disease.
- Unfortunately, vaccines take time to develop—years, if not decades. Scientists at Johnson & Johnson are currently working on a vaccine using fragments of the SARS-CoV-2 spike protein, an easy protein target that sprinkles the surface of the virus like a crown (hence the name “coronavirus,” from the Latin for “crown”). The company loads the viral gene for the spike protein into a disabled common-cold virus vector that delivers the genetic material to human cells. The immune system then recognizes the viral fragments as foreign and deploys defensive cells to destroy it. In the process, the immune system learns to recognize the genetic material of the virus, so when the body is confronted by the actual virus, it’s ready to attack.
- That timeline is already accelerated quite a bit compared to vaccine research in non-pandemic contexts. But new technology that doesn’t require a live transport system could shrink the time to human tests even further. Working with the National Institute of Allergy and Infectious Diseases, Moderna Therapeutics, a biotech based in Cambridge, Mass., developed its mRNA vaccine in a record 42 days after the genetic sequence of the new coronavirus was released in mid January. Its system turns the human body into a living lab to churn out the viral proteins that activate the immune system.
- If those results aren’t as promising as health experts hope, there are other innovative options in the works. At the University of Pittsburgh, scientists who had been developing a vaccine against the original SARS virus have switched to making a shot against the new one. Their technology involves hundreds of microneedles in a band-aid like patch that deliver parts of the coronavirus protein directly into the skin. From there, the foreign viral proteins are swept into the blood and into the lymph system, where immune cells recognize them as invaders and develop antibodies against them. After seeing animals inoculated with their vaccine develop strong antibodies against SARS-CoV-2, the team is ready to submit an application to the FDA to begin testing in people.
- What’s different about these new coronavirus efforts is the fact that they aren’t all designed to control SARS-CoV-2 alone. Recognizing that this coronavirus is the third in recent decades to cause pandemic disease, scientists are focusing on building therapies, including vaccines, that can quickly be adapted to target different coronaviruses that might emerge in coming years. “We hope these new technologies become the kinds of things we build in our tool kits that as humans will allow us to respond in a much more accelerated way to the next pandemic,” says Moderna’s Hoge. “Because we expect continuing threats from viruses in the future.”
2. World Health Organization Says 70 Vaccines in the Works, With Three Leading Candidates
- There are 70 coronavirus vaccines in development globally, with three candidates already being tested in human trials, according to the WHO, as drugmakers race to find a cure for the deadly pathogen.
- The furthest along in the clinical process is an experimental vaccine developed by Hong Kong-listed CanSino Biologics Inc. and the Beijing Institute of Biotechnology, which is in phase 2. The other two being tested in humans are treatments developed separately by U.S. drugmakers Moderna Inc. and Inovio Pharmaceuticals Inc., according to a WHO document.
- Progress is occurring at unprecedented speed in developing vaccines as the infectious pathogen looks unlikely to be stamped out through containment measures alone. The drug industry is hoping to compress the time it takes to get a vaccine to market — usually about 10 to 15 years — to within the next year.
- Drugmakers big and small have jumped in to try to develop a vaccine, which would be the most effective way to contain the virus. Pharmaceutical giants like Pfizer Inc. and Sanofi have vaccine candidates in the preclinical stages, according to the WHO document.
- CanSino said last month it received Chinese regulatory approval to start human trials of its vaccine. Cambridge, Massachusetts-based Moderna — which has never put out a product — received regulatory approval to move quickly to human trials in March, skipping the years of animal trials that are the norm in developing vaccines. Inovio began its human trials last week.
Also See: Everything Must Go Right for Big Pharma’s Bet on a Fast Vaccine @ world Everything Must Go Right to Find a Fast Coronavirus Vaccine Apr 7, 2020
3. Potential new treatment for COVID-19 uncovered by AI enters trials
- BenevolentAI, a startup which has raised $292 million to apply AI to create drugs faster, today says it has uncovered an already approved drug as a potential treatment for COVID-19, after it applied its AI platform and team to the problem. The revelation, which has now appeared in peer-reviewed scientific journals and has entered clinical trials with a major pharmaceutical company, could offer a glimmer of hope to a world locked down by the pandemic.
- In February, BenevolentAI set up a specialist scientific team and launched an investigation using its drug discovery platform.
- Baroness Joanna Shields, CEO of BenevolentAI, explained: “In response to the COVID-19 global health emergency, we turned our AI drug discovery and development platform toward understanding the body’s response to this novel infectious disease.”
- Key to their approach was that “rather than focusing solely on drugs that could affect the virus directly, we explored ways to inhibit the cellular processes that the virus uses to infect human cells,” she said.
- The idea was to identify approved drugs that could potentially stop the progression of COVID-19, inhibit the “cytokine storm” and reduce the inflammatory damage associated with this disease.
- Cytokines are small proteins released by many different cells in the body, including those of the immune system, where they coordinate the body’s response against infection and trigger inflammation.
- The body’s response to infection goes into overdrive when SARS-CoV-2 — the virus behind the COVID-19 pandemic — enters the lungs, triggering an immune response and attracting immune cells to the region to attack the virus. This results in localized inflammation. Some people experience worse symptoms than others at this point. But in some people, excessive or uncontrolled levels of cytokines are released, which then activate more immune cells, resulting in “hyperinflammation,” which can seriously harm or even kill the person.
- BenevolentAI’s team fed into their platform everything they knew about COVID-19 and the drugs that could inhibit the cellular processes that the virus uses.
- In an interview with TechCrunch, Peter Richardson, BenevolentAI’s VP of Pharmacology, explained how the discovery came about.
- “Using the BenevolentAI Knowledge Graph there were two processes. One was finding the connections, and the regulators,” he said.
- “It’s incredibly, incredibly difficult to hold in your head what’s relevant, all the time, without having the Knowledge Graph to show you the basic points. It’s really good at showing the basic interactions that are so important in understanding a biological process. Cellular tracking is an amazingly complicated thing to process.”
- But, he said, the BenevolentAI platform handled the information with aplomb: “This took an hour for the platform to process.”
- The next process was for the human team to find possible drugs to inhibit regulators. These were then fed into the Knowledge Graph. Richardson said this “took roughly half an hour to process.”
- The result was that they identified baricitinib as a potential drug with both anti-viral and anti-cytokine properties, with 90 minutes of computing time, inside three days of additional human work.
- Benevolent’s research findings were published in The Lancet in early February and again twice in the Lancet Infectious Diseases journal. These proposed baricitinib as a potential treatment with both anti-viral and anti-inflammatory properties for COVID-19 patients admitted to hospital prior to the development of critical lung damage.
- By March, investigator-led studies began recruiting and treating infected patients with baricitinib. Today, Eli Lilly and the US National Institute for Allergies and Infectious Diseases (NIAID) have announced that the drug will now begin its first large randomized trial in COVID-19 patients.
- Baricitinib, sold as a prescription drug called Olumiant, is an already approved drug developed by Eli Lilly and Incyte for the treatment of rheumatoid arthritis.
- The randomized trial announced by Eli Lilly with NIAID will investigate the efficacy and safety of baricitinib as a potential treatment for patients with serious COVID-19 infections.
- The study will begin in the U.S. in late April, with planned expansion to additional sites in Europe and Asia, with the results being expected within the next two months. This new trial joins a Canadian government randomized trial already underway assessing baricitinib as a potential treatment.
4. GlaxoSmithKline and Sanofi Announce Joint Coronavirus Vaccine Program.
- The vaccine heavy-hitters are finally taking the field.
- Four months into a devastating global pandemic, two of the world’s largest vaccine makers, GlaxoSmithKline (ticker: GSK) and Sanofi (SNY), announced a collaboration Tuesday to develop a Covid-19 vaccine that they say could be ready by the end of next year. The companies said they would have the capability to manufacture hundreds of millions of doses annually.
- “Normally development of a vaccine would take at least a decade,” Glaxo CEO Emma Walmsley said on a press conference call on Tuesday morning. “But we’re planning to start trials in the next few months and, if we’re successful, subject to regulatory considerations, we aim to complete the development required to make the vaccine available in the second half of 2021.”
- The collaboration combines a previously announced Sanofi effort to develop a Covid-19 vaccine candidate using the company’s recombinant DNA platform with Glaxo’s vaccine adjuvant technology, which Sanofi had previously offered to share with others working on Covid-19 vaccines. Adjuvants are added to vaccines to make them more potent and can reduce the required dose of a vaccine.
- The Sanofi effort, initially a collaboration with the Biomedical Advanced Research and Development Authority, a U.S. federal government office that funds vaccine development, has succeeded in identifying a Covid-19 antigen. DNA encoding the antigen will be combined with Glaxo’s adjuvant to create the vaccine. The companies said in a statement they hope to begin clinical trials in the second half of this year.
- As the spread of the virus picked up speed early this year, the world’s largest vaccine makers were notably absent from the roster of companies beginning work on Covid-19 vaccines. While Johnson & Johnson (JNJ), which doesn’t have a significant vaccine business, announced a Covid-19 vaccine program in January alongside a handful of smaller biotech firms, big vaccine makers like Glaxo and Sanofi appeared to lag behind.
- In the months since, the two companies have announced a raft of efforts. Just last week, Glaxo unveiled a multipart Covid-19 collaboration with the hot biotech firm Vir Biotechnology (VIR), while Sanofi is working with the mRNA specialist firm Translate Bio (TBIO).
- The new collaboration between Sanofi and Glaxo, however, may be the most significant Covid-19 vaccine project yet announced across the industry. The deal not only takes advantage of the expertise of two of the world’s largest vaccine makers, but also of their manufacturing prowess, a key emerging issue given that a Covid-19 vaccine would likely need to be given to hundreds of millions, if not billions, of people.
- Walmsley said that she believes that the world will require more than one vaccine for Covid-19.
- “We are absolutely committed to access as a company,” Walmsley said on the Tuesday press call. “It’s one of the reasons why today, in terms of the portfolio of partnerships we are making, we are absolutely committed to include in our approach a certain volume of donations for the very poorest countries in the world.”
- “As the world faces this unprecedented global health crisis, it is clear that no one company can go it alone.” Sanofi CEO Paul Hudson said in a statement. “That is why Sanofi is continuing to complement its expertise and resources with our peers, such as GSK, with the goal to create and supply sufficient quantities of vaccines that will help stop this virus.”
F. Observations & Unanswered Questions
1. Coronavirus deaths lower in countries using tuberculosis vaccine, study finds.
- Coronavirus death rates are nearly six times lower in countries that use a nearly century-old tuberculosis vaccine, a new study found.
- The study, conducted by researchers at the Johns Hopkins Bloomberg School of Public Health, found that the COVID-19 mortality rate among countries that use the Bacillus Calmette-Guérin (BCG) vaccination was 5.8 times lower than in those that do not.
- “Demonstration that exposure to BCG vaccination can ameliorate severe COVID-19 disease and lower mortality could rationalize a therapeutic or preventive strategy that can have immediately deployable global impact.”
- The vaccine, first administered to a human in 1921 and primarily used to protect against tuberculosis, is undergoing clinical trials to test its ability to ward off COVID-19.
- After accounting for the economic status of the countries and their elderly populations — both of which contribute to death rates — “the intriguing observation of a significant association between BCG use and lower COVID-19-attributable mortality remained discernable,” the researchers said.
- The researchers said the findings “warrant deeper epidemiological scrutiny and prospective evaluation in individually randomized trials.”
- “I think BCG vaccine is a bit of the equivalent of a Hail Mary pass,” Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine, told WBZ-TV this week. “It’s such an outside-the-box concept that one would like to be optimistic, but we’ll have to wait and see.”
G. Trends & Responses
1. Teladoc’s Remote Doctor Visits Surge in Coronavirus Crisis.
- Teladoc Health Inc. said its remote medical appointments have more than doubled in number since early March, a sign the coronavirus pandemic is remaking how doctors take care of patients.
- Teladoc said it is conducting more than 20,000 remote medical appointments a day, more than twice the average daily volume of visits during the first week in March. The Purchase, N.Y., company hosted 1.8 million visits in the first quarter, up from 1.06 million visits a year earlier.
- The performance suggests just how much telemedicine has surged as a result of the pandemic, after anecdotal reports indicating an uptick. How enduring the pickup will prove to be is unknown, though industry officials suspect at least a fraction of patients will stick with remote medical appointments after becoming accustomed to the technology.
- “Virtual care has moved to center stage and I would say it’s taken an irreversible leap forward,” said Teladoc Chief Executive Jason Gorevic.
- Telemedicine visits are essentially doctor’s appointments conducted over the phone or via a video meeting. Patients with health emergencies are typically matched with available doctors, while those seeking appointments for treating allergies, skin conditions and other routine ailments pre-book appointments. For the patients, a visit often costs the co-pay they would pay upon seeing a doctor in person, though some insurers have waived that cost during the pandemic.
- A standard visit through Teladoc typically costs a patient about $49 out of pocket, the company says.
- Teladoc and other telehealth providers once struggled to grab the attention of patients and change the old habit of going to a doctor’s office. Now thousands more patients are embracing talking with a doctor over the phone or via video chat, as many states require residents to shelter in place and practice social distancing.
- Remote care has also become an important tool for keeping noncritical patients away from hospitals strained by a surge in patients diagnosed with Covid-19, the disease caused by the new coronavirus.
- “All of the regular health care that has nothing to do with Covid was forced to transition onto telehealth,” said Roy Schoenberg, president and chief executive of American Well Corp., which supplies software for many insurers’ and hospitals’ telemedicine programs. The company now helps facilitate 30,000 to 40,000 telehealth videos a day, a tenfold increase.
- Meanwhile, telehealth providers are working to recruit new physicians to handle the rising numbers of remote consultations.
- Regulatory changes have helped make possible the increased use of telemedicine that is driven by the pandemic, industry officials say.
- The Department of Health and Human Services said last month that it would waive potential penalties under the federal patient-privacy law—known as the Health Insurance Portability and Accountability Act—as long as teleconferencing tools are used in good faith.
- The Trump administration last month expanded access to telemedicine for Medicare recipients, seniors and the disabled, and allowed doctors to practice across state borders. The changes eliminated barriers that once limited which patients physicians could treat.
H. Projections and Our (Possible) Future
1. Updated IHME (Murray) Model (4/13/20): 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. Since switching to a three-day production schedule, IHME team members have been processing new data and testing updated methods since April 10. All estimation updates and results presented here reflect data captured for April 10, 11, and 12, with production models run on April 12.
- The next set of results for countries for which IHME is already producing estimates will be published on Wednesday, April 15.
- 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.
Predicting COVID-19 deaths: expanding hospitalization-to-death ratio inputs
- To see a more detailed explanation of the changes, see the IHME udpate page here: http://www.healthdata.org/covid/updates.
- Similar to our April 5 estimation update, we have been able to incorporate additional data sources on hospital admissions and corresponding outcomes for COVID-19 patients. Such data are vital inputs for our estimates of hospitalization-to-death ratios, which then inform the model parameters used for predicting hospital bed need. In other words, thanks to several state governments and hospital groups, we now have a larger quantity of hospitalization data that also are likely to be more representative of current hospital resource needs of COVID-19 patients.
- Our estimates released today use the 23 state-specific ratios noted below, and for states without state-specific ratios, the pooled ratio of 6.6 (95% confidence interval of 6.2 to 7.1) is applied. The previous pooled ratio estimate was 7.0 (95% CI 4.0 to 12.7); as result, predicted peak hospital resource use may be lower than previously estimated for some locations.
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 13 [NOTE: moved back from April 10], reaching 2,150 deaths per day 1,983 deaths [NOTE: an increase from 1,983 per day] (estimate range of 464 to 7,084) . These projections suggest that the US may be nearing its peak for COVID-19 deaths; however, this national average does not reflect the considerable variation in timing of epidemic peaks across states.
- 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 experienced its peak – at 800 COVID-19 deaths reported on April 10 – as well as New Jersey and Illinois (272 and 82 reported deaths on April 8, respectively).
- Based on the latest available data, a number of states also may be nearing or reaching their epidemic peaks for daily COVID-19 deaths over the next week or so:
|State||Predicted peak date of daily COVID-19 deaths||Predicted daily COVID-19 deaths at peak: average projection (estimate range)|
|Ohio||April 13||27 (4 to 117)|
|Maine||April 13||3 (0 to 11)|
|North Carolina||April 13||22 (2 to 110)|
|Tennessee||April 13||20 (1 to 68)|
|Pennsylvania||April 18||88 (13 to 366)|
|West Virginia||April 20||4 (0 to 20)|
Predictions for cumulative deaths.
- For the US, projected cumulative COVID-19 deaths could reach 68,841 61,545 (estimate range of 30,188 to 175,965) across states during the epidemic’s first wave. Today’s release is up slightly from the national-level predictions published on April 10, where the cumulative death toll was projected to be 61,545 (estimate range of 26,487 to 155,315).
- The increase in cumulative deaths is at least partially driven by higher cumulative estimates for Massachusetts and New York, reflecting the latest COVID-19 death data that are publicly available.
- 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:
|*Change estimates do not include uncertainty; they are only based on the average value. If prediction values’ uncertainty intervals (the numbers reported in parentheses) overlap a lot across different releases, changes in these estimates are not considered substantively different.|
Hospital resource use predictions.
- For the US, the predicted peak date for hospital resource use could be around April 14, with COVID-19 patients potentially requiring
- 59,592 total hospital beds (estimate range of 13,060 to 191,692)
- 15,696 ICU beds (estimate range of 5,162 to 45,374)
- 14,089 invasive ventilators (estimate range of 4,046 to 42,253).
- The average projected total hospital bed need is now lower than the April 10 release (a mean prediction of 86,379, with an estimated range of 24,290 to 232,948); as mentioned above, this change is related to the updated hospitalization-to-death ratios estimated across states.
- Based on the current data and model, several states may be experiencing their peak hospital use or have recently experienced this peak (April 7-9); these include New York, New Jersey, Michigan, Illinois, and Louisiana.
- Conversely, below are some states with projections pointing to high total hospital bed need, as well as other key hospital resources, that may peak between now and the end of April:
- A total of 18 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 in the table represents the number of days since (“-”) or the number of days until (“+”) peak hospitalization usage.
2. This is the end of the office as we know it
- The pandemic already pushed millions to work from home. Many of them will likely go back to a very different office.
- If and when you return to your office after the novel coronavirus pandemic, you’ll probably notice some differences.
- Upon entering your building, the doors may open automatically so you don’t have to touch the handles. Before you board your elevator, you might tell the elevator where you’d like to go, rather than pressing the many buttons within the elevator. When you reach your floor, you could walk into a room full of dividers and well-spaced desks instead of the crowded open floor plan you’re used to. In common areas like meeting rooms and kitchens, expect to see fewer chairs and posted documentation of the last time they were cleaned.
- These are just the changes you can see. Less noticeable in the post-coronavirus office would be more frequent cleaning policies, antimicrobial properties woven into fabrics and materials, amped-up ventilation systems, or even the addition of UV lights for more deeply disinfecting the office at night.
- Of course, this is all assuming you go back to your old office at all. As the coronavirus takes a steep toll on the economy and the workforce, many won’t have jobs to go back to. Some who are still employed will now permanently work from home, and some employers will choose to downsize their leases or look for flexible office space rather than long-term leases. Coworking spaces will probably never be what they once were as they forgo hot desks and communal spaces for more sanitary — and less profitable — private areas.
- Many of these adjustments in office design are actually just accelerations of real estate trends that existed well before the pandemic. But just as policies around telehealth and liquor have quickly shifted, the Covid-19 crisis will force swift and permanent changes in both commercial real estate and work culture itself. The office as we know it will never be the same.
- Working from home will be the new normal for many
- According to a new MIT report, 34 percent of Americans who previously commuted to work report that they were working from home by the first week of April due to the coronavirus. That’s the same percentage of people who can work from home, according to a recent University of Chicago publication.
- These new numbers represent a seismic shift in work culture. Prior to the pandemic, the number of people regularly working from home remained in the single digits, with only about 4 percent of the US workforce working from home at least half the time. However, the trend of working from home had been gaining momentum incrementally for years, as technology and company cultures increasingly accommodated it. So it’s also likely that many Americans who are now working from home for the first time will continue to do so after the pandemic.
- “Once they’ve done it, they’re going to want to continue,” said Kate Lister, president of consulting firm Global Workplace Analytics, which is currently running a survey about work-from-home participation. She predicts that 30 percent of people will work from home multiple days per week within a couple of years. Lister added that there has been pent-up demand by employees for greater work-life flexibility, and that the coronavirus has made their employers see the light, especially as they themselves have had to work from home.
- “It had been proven prior to this, but a lot of company management and leaders showed great skepticism,” Steve King, partner at small-business consulting firm Emergent Research, told Recode. “That skepticism will go away because companies recognize that remote work does work.”
- Furthermore, the necessity of working from home brought on by the pandemic has also caused many employers and employees to spend money on new technology, like video conferencing subscriptions as well as new equipment. According to data from expense management provider Emburse, the most frequent employee expenses in the first half of March included computer monitors, desks, office supplies, mice, and keyboards — a departure from the norm. These purchases presumably happened at companies where working from home was a new development.
- More formalization and company policies around remote work are necessary for the shift to be successful. A recent PWC study showed that about half of businesses expect a dip in productivity during the pandemic due to a lack of remote work capabilities. Companies where people have worked from home for a while and have built up guidelines — about, say, what time of night is appropriate to expect a response on Slack, how employees can securely access company files, and whether employees are allowed to expense an at-home monitor or standing desk — will probably have an easier time working from home.
- “The dog is going to walk through the meeting, your child is going to walk through. Period. We’ve just relaxed our standards to that. Maybe it will bring us closer.”
- “I do think this is going to reshape the workplace,” Janet Pogue-McLaurin, principal and workplace leader at design and architecture firm Gensler, told Recode. “Social distance thinking may be part of our DNA moving forward.”
- That means people will want more space. Following the last recession, companies had been trying to do more with less space. That meant packing more and more people into open office spaces, a practice known as “densification.”
- “Densification will take a hiatus,” Pogue-McLaurin said. “We’ll shift to, ‘How do we dedensify to create the physical distancing that we now need to have?’”
- That could mean more private spaces or personal offices for individuals, and more distance between desks. Rather than desk setups that face each other or are right next to each other, we might now be positioned to our colleague’s backs with more space between us. A conference room that normally fit 10 people might now only hold chairs for five. Expect greater spacing and fewer seating options in communal areas like kitchens as well.
- In the immediate future, “we’ll see physical, hard things that create separation,” Cavataio said. “Over time, we will start to design differently to create space, versus how tight can we get it. Can we get our generous six feet of physical distance and still create a company environment people want to be in, knowing you have safety inherently based in the design?”
- Commercial real estate services firm Cushman & Wakefield is testing a new design concept called “Six Feet Office” in which it visually displays unique foot traffic routing in the office to keep people the recommended six feet apart.
- “There’s going to be a special effort to consider and think about every possible place within the built environment that a human being has touched and the possibility of that being a source of contamination,” Don Gilpin, president and chief operating officer at IFMA, said.
- That effort could include everything from higher-quality air filtration systems to more-powerful cleaners. Every surface — including door handles, light switches, countertops, copy machine buttons, AV equipment, coffee makers, and many more — will have to be dealt with. According to Cavataio, regular offices will likely take cues from health care design. This shift could include the addition of things like copper fixtures, fabric that retains fewer germs and can more easily be cleaned, more space in kitchens and bathrooms, as well as more attention paid to how far liquids can splash. Some companies could even use UV lighting to disinfect offices at night or meeting rooms in between uses, a practice that’s increasingly common in hospitals.
- Inevitably, the most consequential way to prevent the spread of germs in an office might just be to limit the number of people allowed inside at once. Rather than having everyone work in the office from nine to five, companies might want to bring in certain teams at specific times to lessen congestion. The initial process of bringing employees back to work, at least, will probably be staggered.
- “What we are anticipating is a gradual ramp-up of business as usual,” Gilpin said. “We are not expecting a flood gate of theaters and corporate spaces opening up to employees and the public. We see this as a gradual process.”
- “The impact on office [space] should not be as deep or broad as what was felt after the financial crisis,” Whelan said.
- Experts say there will certainly be an acceleration of existing trends in office real estate, including a move away from traditional 10-year leases for shorter ones or for flexible or coworking space (more on that later). Still, the nature of existing office leases will likely temper upheaval in the office market.
- “Those who signed 10-year leases a few years ago are legally obligated to meet the terms of those leases,” Savage, the NYU professor, said. “But this could affect expansion plans.”
- Whatever happens to demand for more or less square footage, the coronavirus will likely affect the type of space people are looking for. Spaces with more private areas that might limit the spread of germs stand to become more popular, for example. And while meeting rooms will still be important, companies will likely reconsider the types of meeting rooms they want (and, by extension, question whether a meeting is necessary in person in the first place). Those new types of meeting rooms will be geared toward group projects and collaboration.