“While we must remain vigilant, it is clear that our strategy is working, and very strongly working. These developments have put us in a strong position to finalize guidelines for states opening the country, which we will be announcing tomorrow.” — President Trump
“You must wear a mask, or cloth or an attractive bandanna.”
— NY Governor Cuomo
“If you’re willing to take a risk — and you know, everybody has their own tolerance for risks — you could figure out if you want to meet somebody on a dating app such as Tinder. And, if you want to go a little bit more intimate, well, then that’s your choice regarding a risk.” — Dr. Fauci
- Recent Developments and Headlines
- Numbers and Trends
- Potential New Treatments
- New Scientific Findings
- Clinical Trial Updates
- Observations & Unanswered Questions
- The Road Back?
- Stories from the Frontline
- Projections and Our (Possible) Future
- Practical Tips
Connect with us and receive the Coronavirus Update in your inbox every morning– send us an email at firstname.lastname@example.org.
Follow us on Facebook here
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 4/15 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%)
- US Coronavirus Death Toll Passes 30,000 After Doubling In A Week
- Vice President Pence: European Union’s Coronavirus Mortality Rate ‘Nearly 3 Times’ That of U.S.
- White House Coronavirus Task Force Plans Thursday Release of Guidelines to Reopen Country
- VP Pence: We Expect FDA Approval on Antibody Test ‘in a Matter of Days’
- NY Gov. Cuomo Giving Away Ventilators… After Weeks of Demanding More from White House
- Three-Day Average of Net Change in New York Hospitalizations Negative for First Time Since Coronavirus Pandemic Began
- NY Gov. Cuomo Orders New Yorkers to Wear Masks in Public
- NY Gov. Cuomo says NY to begin antibody testing this week
- NY will require people to wear masks on public transit
- NYC mayor says normalcy might not return until September
- Pennsylvania Governor Orders Business Employees and Customers to Wear Masks
- Gov. Jay Inslee says WA lockdown will remain in place until May 4
- LA Mayor says city likely won’t allow concerts, shows, sporting events until next year
- Pennsylvania Senate Votes To Override Democrat Governor’s Stay-At-Home Order
- Lockdown-Backlash Begins: Angry Crowd Surrounds Capitol, Demands Michigan Governor Reopen Economy
- Fox News Reports Coronavirus Originated In Wuhan Lab
- President Trump Says US ‘Thoroughly Examining’ Possibility Virus Leaked From Wuhan Biolab
- Germany to begin easing virus curbs
- Singapore reports another record jump in new cases
- Idaho extends stay at home order until April 30
- Lombardy wants to start reopening May 4
- France reports 1,483 deaths, highest single-day jump yet
- Russia reports record-breaking new case batch
- Mexico Sees 22 Percent Spike in Coronavirus Deaths in One Day
- Swedish Virus Deaths Top 1,000, Fueling Criticism Over Strategy
- France Reports 1,438 New Virus Deaths, Highest Toll to Date
- Spain reports biggest jump in new cases in nearly a week
- Iran reports lowest number of new cases in a month
- European Commission releases ‘guidance’ for EU states plotting a reopening
- Turkey Plans To Send Fresh Wave Of COVID-Infected Migrants To Europe, Report
- China Will Be Hit With Second Coronavirus Wave In November, Top Shanghai Clinical Expert Warns
- Four Michigan Sheriffs: We Will Not Enforce Governor Gretchen Whitmer’s Edicts
- Mexican Governors Decry Lacking Equipment as Coronavirus Cases Surpass 5,000
- L.A. Mayor Garcetti Says Coronavirus Could End Sports, Concerts Until 2021
- Factory shutdowns near WWII Demobilization Levels in US
- Economic Carnage Mounts as Virus Savages US Retail and Factories
- Abbott Labs Will Ship 1 Million Antibody Blood Tests This Week
- Agriculture Sec. Perdue: The Food Supply Is ‘Safe and Sound’
- Boston U. Claims Chinese Virus May Keep Campus Closed Until 2021
- Iran’s General Salami Unveils Magnetic ‘Bipolar Coronavirus Remote Detector’ – can detect infected people within 100 meters in 5 seconds without blood test
- Police State: British Cops Call For the Right to Invade Private Homes to Bust up Gatherings
- Dr. Fauci Says Sports Could Return This Summer — if Fans Excluded
- Health Expert Says 49ers Super Bowl Loss May Have Saved Lives
- ‘Momentum Building’ for February-to-May 2021 College Football Season?
- Florida Declares WWE an ‘Essential Service,’ Allows Televised Shows Without Fans
- HHS: Nearly 40 Migrant Children Test Positive for Coronavirus at Chicago Shelter
- DC extends stay-at-home order through May 15
- 1-in-7 New Yorkers May Have Already Gotten Covid-19
- Agriculture Secretary Says ‘Plenty of Food’ Despite Disruptions
- Ford Tests Buzzing Wristbands to Keep Workers at Safe Distances
- Dr. Fauci endorses Tinder hookups ‘if you’re willing to take a risk’
- Taiwan: Robot Fans Cheer at World’s First Baseball Game Since Pandemic
- Oakland County scouts ice rinks to potentially store bodies in ‘last resort’ scenario
- The pandemic is giving people vivid, unusual dreams
- German Lawyer Who Criticized Lockdown Arrested, Taken To Psych Ward
- China Launches Survey To Learn More About Asymptomatic Cases, Immunity
- Ron Paul: People “Should Be Leery About” A COVID-19 Vaccine
- Italians question merits of virus testing
- IMF cautions renewed social unrest possible amid pandemic
- Venezuela tries harsher coronavirus quarantine measures in restless Caracas barrio
- New saliva test for coronavirus rolls out in New Jersey
- Gov. Cuomo taps McKinsey to hatch ‘Trump-proof’ economic re-opening plan
- Nurses suspended for refusing to treat patients without masks
- New Jersey cops find 17 bodies stuffed inside tiny nursing home morgue
- Coronavirus lockdown rules turn co-op buildings into fortresses, dorms
- 3,000 NYC public hospital workers out sick, 924 coronavirus positive
- Trump says coronavirus pandemic has peaked, some states to reopen before May 1
- Strip clubs and lobbyists want access to coronavirus stimulus cash
- CDC estimates at least 9,200 health care workers have been infected with coronavirus
- Second city in China bans consumption of dogs and cats in wake of coronavirus
- NYPD will hit food, pharmacy workers with fines for not wearing masks
- Kenyan governor blasted over plans to include Hennessy in coronavirus care packages
- No chill: Rogue ice-cream trucks still out in NYC despite coronavirus
- Georgia suspends Ku Klux Klan mask law during coronavirus pandemic
- Fed-up cops remind people to wear pants to check mail amid coronavirus lockdown
- Dr. Fauci endorses Tinder hookups ‘if you’re willing to take a risk’
- NYPD has hundreds more coronavirus cases than it’s reporting
- Business leaders urge Trump to increase coronavirus testing before reopening US, report says
- Legal group wants essential businesses protected from coronavirus lawsuits
- Italy’s coronavirus deaths, positive cases continue to fall
- Coronavirus will delay release of new emojis until 2022 ☹
- Antarctica scientists take steps to keep coronavirus off continent
- Coronavirus slathers lungs in sludge that slowly suffocates victims, study finds
- Georgia brewery launches ‘healthy’ Fauci beer
- MIT study: Subways a ‘major disseminator’ of coronavirus in NYC
- Congressman says US should reopen economy — even if more would die
- Navy struggling to slow outbreak on USNS Mercy as 7 sailors test positive
- NY Gov. Cuomo offers up New York as coronavirus vaccine ‘laboratory’
- Mobile cinema in Madrid entertains Spaniards stuck in coronavirus quarantine
- Space scientists using coronavirus lockdown as dry run for Mars mission
- Coronavirus snuffs out 4/20 celebration in San Francisco
- De Blasio says NYC is ‘still in the throes’ of crisis as ICU patients increase
- Protest in North Carolina demands state reopen for business
- AG Barr says places of worship can’t be ‘singled out’ amid coronavirus shutdown
- Family pretended dead relative was asleep in car to sneak out of city
- First Amazon warehouse worker dies of coronavirus
- Couple married for 60 years both die from coronavirus on same day
- NYC Mayor de Blasio: Grocery stores should require customers to wear face masks
- NYPD boss: Criminals are taking ‘advantage’ of coronavirus release
- 25 FEMA workers test positive for coronavirus
- China waited 6 days to issue warning about likely coronavirus pandemic
- FBI warns companies of employees faking positive coronavirus test results
- Some colleges consider canceling in-person classes until 2021
- Uber Eats rolls out phone ordering in NYC, Florida
- Virtual opening of ‘Pride and Prejudice’ musical draws 160,000 viewers
- Man jailed for breaking quarantine to visit girlfriend
- Nebraska mall plans to reopen despite rise in coronavirus cases
- Germany plans to gradually reopen its economy after a weeks long coronavirus shutdown
- New York City revises coronavirus death toll to add 3,700 more deaths
- Singapore, which has been praised for controlling the virus, sees a record increase in new infections
- South Koreans gladly trade privacy for a life without lockdowns or social distancing.
- British Parliament is moving its business online, for now.
- In Manila slum, life was already a struggle. The lockdown has made it worse.
- Russia’s battle with the bubonic plague prepared it for the coronavirus.
- Australia’s new cases drop, but restrictions will stay in place for at least a month
- Bogotá’s gender-based restrictions on travel are enforced with steep fines
- New research from Canada suggest that stray dogs in China transmitted coronavirus to humans after eating discarded bat meat
- RSPCA warns dogs face abuse as study claims they may have spread coronavirus to humans
- Coronavirus ‘could be spreading across the globe through farts’ claim doctors
- Coronavirus patients warned of new ‘frost bite’ and ‘red hives’ symptoms
- Landlords ‘asking for sex and nudes instead of rent’ during coronavirus crisis
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
- Total Cases = 2,083,913 (+4.2%)
- New Cases = 83,371 (+12,347) (+15.4%)
- Total Cases = 963,736 (+3.1%)
- New Cases = 28,628 (-20,874) (-42%)
- Total Cases = 153,077 (+2.1%)
- New Cases = 3,127 (+1,181) (+67.1%)
- Total Cases = 644,348 (+4.9%)
- New Cases = 30,102 (+3,029) (+11.2%)
- US States:
- 41 States > 1,000 cases (+1), plus DC
- 29 States > 2,500 cases (+0)
- 20 States > 5,000 cases (+0)
- 14 States > 10,000 cases (+1): NY, NJ, MA, MI, CA, PA, IL, FL, LA, TX, GA, CT, WA & MD
- 9 States > 20,000 cases (+0): NY, NJ, MA, MI, CA, PA, IL, FL, LA
- New York State:
- NY Total Cases = 214,618 (+6.2%)
- NY New Cases = 12,410 (+5,857) (+89.6%)
- For more information on US States and territories, see https://ncov2019.live/data
2. Serious or Critical Cases
- Worldwide serious or critical cases = 51,144 (-448)
- US series or critical cases = 13,487 (+13)
- US serious or critical cases = 2.4% 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 = 134,548 (+7,800) (+6.2%)
- Europe deaths = 88,152 (+4,518) (+5.4%)
- US deaths = 28,554 (+2,490) (+9.6%)
- NY deaths = 11,586 (+752) (+6.9%)
- NYC deaths = 7,905 (+556) (+7.6%)
- Deaths per 1M population: (i) Italy: 348 (+10); (ii) Spain: 390 (+10); (iii) US: 79 (+8); (iv) France: 241 (+12); & (v) Germany: 42 (+4)
- US Total Confirmed Case Fatality Rate = 4.4% (+0.2%) compared with a Worldwide Confirmed Case Fatality Rate of 6.5% (+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, but we do not have yet have sufficient data to confirm the actual fatality rate.]
- Worldwide recoveries = 510,666 (+24,767) (+5.1%)
- US recoveries = 48,708 (+9,888) (+25.5%)
C. Potential Treatments
1. New Israeli COVID-19 treatment seemingly successful with first two patients
- The first two patients who were treated with a new Israeli treatment for the novel COVID-19 after testing positive have shown significant improvement, with one of them even being removed from the intensive care unit (ICU) within days of treatment.
- Israeli biopharmaceutical RedHill Biopharma Ltd. administered their experimental drug, Opaganib, in Israel for the first time last week. The first two patients treated, according to the company, have demonstrated significant improvement through clinical trial within mere days of treatment.
- “We are very encouraged by the preliminary findings showing clinical improvement in the first COVID-19 patients treated with Opaganib, which further supports its safety and potential benefit to patients,” said Medical Director at RedHill, Mark L. Levitt, MD, Ph.D.
- “Our hope is that the unique mechanism of action of Opaganib, with both anti-viral and anti-inflammatory activity, will help COVID-19 patients by reducing lung inflammation, and thus preventing the disease from progressing to a stage which requires mechanical ventilation. Importantly, Opaganib is targeting a critical host factor that the coronavirus is unlikely to evade via mutation in possible future outbreaks of the pandemic.”
- The two patients initially suffered from “moderate to severe acute respiratory symptoms related to SARS-CoV-2 infection, required supplemental oxygenation and were hypoxic despite being treated with maximum flow of oxygen with cannulas.”
- After the treatment, they both needed less supplemental oxygen as well as C-reactive protein, the latter of which is an “inflammatory biomarker correlated with lung lesions which could reflect disease severity.”
- An additional condition of the coronavirus is lymphocytopenia, meaning an abnormally low level of lymphocytes in the blood, which both of the patients started off with. A few days after the treatment, however, both patients showed significant improvement in that regard.
- One of the two patients was in the ICU and even considered for intubation, but within days of the experimental drug being administered, they were released.
- The patients received the opanagib treatment while receiving the standard care for coronavirus, which includes hydroxychloroquine (HCQ) as background therapy.
- Opanagib is a “new chemical entity,” according to RedHill, which is administered orally and performs “anticancer, anti-viral and anti-inflammatory activities.”
- “We are committed to expanding the availability of Opaganib under compassionate use to additional hospitals and countries and are hopeful that this treatment could potentially benefit COVID-19 patients with life-threatening manifestations,” Dr. Levitt said.
- The company received the green light from the Italian National Institute for Infectious Diseases last week to administer the drug in the aggressively virus-ridden country. Approximately 160 patients will be treated in “three major hospitals in northern Italy under an expanded access program.”
- Meanwhile, discussions are still ongoing in the US and other countries as to whether they may administer opanagib as part of “compassionate use program authorizations” and “potential emergency clinical development programs.”
- Israel’s Pluristem also developed a treatment for coronavirus: A placenta-based cell-therapy treatment which has proven successful on numerous patients upon which it was tested so far.
2. Coronavirus patients saved by treatment that removes blood
- Two coronavirus patients have been saved by an experimental treatment that adds oxygen back to the blood.
- Dr Ryan Padgett, 44, and Enes Dedic, 53, both became critically ill in the US.
- They required ventilators and were treated by ECMO – extracorporeal membrane oxygenation.
- Doctors remove the patients’ blood, add oxygen and remove carbon dioxide, and return it to the patients.
- Hospitals across the US are now beginning to experiment with the approach.
- ER doctor Ryan Padgett was treated at a hospital in Seattle, while Enes Dedic recovered in Phoenix.
- After being placed on a ventilator, Dr Padgett’s lungs and kidneys started failing.
- Enes Dedic was treated with a raft of coronavirus-related drugs, but none had the desired effect.
- Doctors thought he had just a day or so to live, and discovered that his immune system was attacking itself.
- Doctors then turned to ECMO as a last resort and he was placed in a medically induced coma, and given the anti-inflammatory drug Tocilizumab, along with other therapies.
- Four days later, doctors were able to take him off life support.
- 10 days later, he woke up responsive and was soon able to FaceTime his wife
[Note: This story is of particular interest in light of reports that COVID-19 is more like oxygen deprivation arising from altitude sickness instead of pneumonia. We will continue to monitor and report on stories on this potential treatment. Also see “Stories From the Frontline – What Doctors on the Front Line Wish They’d Known a Month Ago”.]
D. New Scientific Findings and Other Advancements
1. New Study Indicates Summer Won’t Stop The Coronavirus
- It’s looking increasingly likely that the novel coronavirus is stronger than its predecessor, SARS, when it comes to resisting intense heat. One recent study of additional steps that could be taken to protect lab technicians handling samples of the virus found that samples of the virus can survive when exposed to temperatures as high as 60 degrees Celsius (140 degrees Fahrenheit).
- That would seem to preclude the onset of summer as a potential ‘miracle cure’, while also suggesting that the outbreaks in Africa and South America might be worse than they appear, since the theories that high temperatures slow the virus’s spread don’t appear nearly as convincing.
- The French scientists who conducted the experiment had to heat samples of the sample, strains of the virus mixed with various animal proteins (to mimic real-world conditions in the test tube), to nearly 90 degrees Celsius (210 degrees Fahrenheit) to completely kill the virus.
- It’s just the latest curve ball that the coronavirus has thrown at researchers since the outbreak began in Wuhan.
2. New CDC Study Shows Coronavirus Can Survive For Hours On Floors, Walls, Shoes
- New research suggests that nurses, doctors and others can track the virus out of the ward and into another – perhaps a more public, or less well-protected – environment, helping to spread the disease in a new way that public health officials haven’t really considered.
- The study, entitled “Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Wuhan, China, 2020”, was conducted in two wards at Wuhan’s Huoshenshan Hospital by large team of Chinese researchers back in February and March. Though the team insisted that “respiratory droplets and close contact” remain the primary vectors for the disease, the possibility for hospital workers to transmit the virus on their shoes and clothes wasn’t really well understood, until now.
- And unfortunately, if the data are confirmed, it would suggest that wards where coronavirus patients are treated are literally crawling with the virus, placing these health-care workers at extremely high risk for infection.
- According to the research, “94% of swabs taken from the ICU floor and 100% of swabs taken from one of the general wards used to treat patients with severe symptoms tested positive for coronavirus.”
- The research found that the general wards ICU were found to have the highest levels of the virus present on the floors and walls, as well as in the air. The rate of positivity was higher for the ICU than the general wards.
- Even samples taken from the floor in the nearby hospital pharmacy showed ‘weak positive’ for the virus. Patients are not allowed in the pharmacy, meaning there’s only one way the samples could have gotten there.
- The study also suggested that “air flow” and the forces of gravity might be responsible for moving the samples to the floors and the walls. But this certainly doesn’t bode well for anybody arguing that the subway and restaurants will be able to go quickly back to normal, since an asymptomatic diner can leave the virus at their table for the next customer to pick up even if the table sits empty for hours – or even overnight.
3. These Engineers Just Solved the Biggest Problem with N95 Masks
- As the majority of the U.S. population embraces N95 respirators and cloth masks, people with pre-existing respiratory issues are at a crossroads.
- Do they don the masks to protect themselves and others from COVID-19 (coronavirus), or do they risk possibly permanently damaging their lungs due to oxygen restriction while wearing the protective covering?
- Mechanical engineers at Stanford have come up with a solution: N95 masks that protect from viruses and other microparticles, but also circulate oxygen.
- For a majority of the U.S. population, cloth masks and N95 respirators are foreign accessories. Strapping them on for the very first time amid the COVID-19 (coronavirus) pandemic can be an uncomfortable experience. In some cases, wearing the masks can even be downright dangerous. A November 2015 study, for example, suggests pregnant health care workers should think twice about wearing an N95 mask.
- But protective face coverings are quickly becoming mandatory in states like New Jersey and Maryland, where the virus is rampantly spreading. Enter Stanford mechanical engineers John Xu and Friedrich “Fritz” Prinz, who have re-engineered the N95 face mask to counteract oxygen deficiencies.
- “Through the COVID-19 crisis, many have become familiar with N95 masks, which filter out 95 percent or more of small particulate matter from the air–including the virus,” Xu said in a press statement. “But in filtering those particles, the mask also makes it harder to breathe. N95 masks are estimated to reduce oxygen intake by anywhere from 5 to 20 percent. That’s significant, even for a healthy person.”
- Not only can the masks cause dizziness and lightheadedness, Xu said, but they can also damage the lungs. For patients who already have respiratory complications, wearing a mask could be life-threatening. Then again, without a mask, heading out in public to stock up on groceries could also be a death sentence.
- To solve this dilemma, Xu and Prinz are working on what they call “oxygen enrichment.”
- The two scientists regularly work on fuel cells for next-generation automobiles, so they’re familiar with trying to achieve high levels of oxygen in a concentrated flow. In combustion and electrochemical fuel conversion, for example, high levels of oxygen are required to burn things. But because ambient air is really only 21 percent oxygen, it’s necessary to isolate and concentrate the oxygen. In the case of face masks, Xu and Prinz have a goal to develop a portable device that can enrich oxygen from the surrounding air.
- That work is currently underway, and Xu and Prinz are experimenting with a few separate ideas. One is the concept of splitting water: When you run an electrical current through water, the additional electrons cause the water molecules to split back up into pure oxygen and hydrogen atoms. The hydrogen can be used as fuel and the oxygen can recirculate through the mask.
- The second approach involves moving oxygen-containing anions (negatively charged atoms) through a membrane to isolate oxygen on one side so that it can be directed back into the mask. Currently, Xu and Prinz have a prototype that’s essentially a small box worn at the waist, with a tube extending up toward the face mask.
- “We are targeting this to anyone who has to wear a mask for the long term: first responders, doctors, nurses and even patients who don’t want to infect others,” Xu said. “In the near term, we hope to get these [to] healthcare workers as soon as possible.”
E. Clinical Trial Updates
1. French study finds hydroxychloroquine doesn’t help patients
- According to a new study, hydroxychloroquine didn’t help hospitalized patients with coronavirus and was associated with heart complications, according to a new study.
- “This provides evidence that hydroxychloroquine does not apparently treat patients with Covid 19,” said Dr. Paul Offit, an infectious disease specialist at Children’s Hospital of Philadelphia. “Even worse, there were side effects caused by the drug — heart toxicities that required it be discontinued.”
- In the French study, doctors looked back at medical records for 181 patients with Covid-19 who had pneumonia and required supplemental oxygen. About half had taken hydroxychloroquine within 48 hours of being admitted to the hospital, and the other half had not.
- The study also raised important safety concerns about hydroxychloroquine.
- In the study, eight patients who took the drug developed abnormal heart rhythms and had to stop taking it.
- Abnormal heart rhythms are a known side effect of hydroxychloroquine, which has been used for decades to treat patients with diseases such as malaria, lupus and rheumatoid arthritis.
- Doctors in Sweden and Brazil have sounded warnings about chloroquine, a very similar drug, because of heart problems.
- In the new study, among the 84 patients who took hydroxychloroquine, 20.2% were admitted to the ICU or died within seven days of taking the drug. Among the 97 patients who did not take the drug, 22.1% went to the ICU or died.
- The difference was not determined to be statistically different
- Looking just at deaths, 2.8% of the patients who took hydroxychloroquine died, and 4.6% of the patients who did not take it died. That difference was also not found to be statistically significant.
- “These results do not support the use of [hydroxychloroquine] in patients hospitalized for documented SARSCoV-2-positive hypoxic pneumonia,” the study authors wrote.
- The study was published Tuesday on medRxiv.org, a pre-print server founded by Yale University, the journal BMJ and Cold Spring Harbor Laboratory. Studies published on this website have not been peer reviewed.
1. Foot sores could be an early sign of coronavirus
- Foot sores similar to chickenpox could be a new peculiar symptom of the coronavirus, according to a team of Spanish physicians.
- The Spanish General Council of Official Podiatrist Colleges warned experts that some COVID-19 patients have experienced lesions on their feet “similar to those of chickenpox or measles,” according to Newsflash.
- “They are purple lesions (very similar to those of chickenpox, measles or chilblains) which usually appear on the toes and normally heal without leaving a mark,” the group said.
- The health professionals said that the strange symptom was observed among mostly young coronavirus patients in Italy, France and Spain.
- “There has been an increasing detection of a symptom in COVID-19 sufferers, especially in children and adolescents, however, it has also been detected in some adults,” the group said.
- The council noted, however, there haven’t been enough scientific studies to back up the findings, the report said.
- “Obviously, due to the short time we still cannot speak of scientific evidence.”
- Meanwhile, the International Federation of Podologists released a report about a 13-year-old boy who complained last month of foot sores.
- It was initially assumed he was suffering from a spider bite, but he later started experiencing symptoms of the coronavirus.
- Doctors later discovered that his coronavirus-stricken sister and mother had a fever, cough and trouble breathing six days before the lesions on his feet appeared.
- The Spanish General Council of Official Podiatrist Colleges is now calling on medical professions to look out for lesions as a possible early symptom of the virus, which has spread to nearly 2 million people across the world.
- “The Podologists Council urges its colleges and its members to remain alert because this can be a sign of detection of COVID-19 to avoid infection,” the group said.
G. Observations & Unanswered Questions
1. South Korea Says Nearly 100 Recovered COVID-19 Patients Tested Positive Again
- There’s been growing concern that patients who previously tested positive for COVID-19 and eventually recovered could actually ‘relapse’ or also be ‘reinfected’ for the virus, after prior reports out of China suggested this could be possible.
- Disease experts have speculated over the nightmare possibility, but now the World Health Organization (WHO) is looking into nearly one hundred cases in South Korea which may be instances of just this feared scenario.
- “South Korean officials on Friday reported 91 patients thought cleared of the new coronavirus had tested positive again.” Jeong Eun-kyeong, director of the Korea Centers for Disease Control and Prevention, told a briefing that the virus may have been reactivated rather than the patients being re-infected.”
- The practice of health officials internationally, based on WHO guidelines, is that a patient can be discharged from the hospital and is considered free of the virus after testing negative twice. The tests must be administered at least 24 hours apart.
- “We are aware of these reports of individuals who have tested negative for COVID-19 using PCR (polymerase chain reaction) testing and then after some days testing positive again,” a WHO official said from Geneva regarding the South Korea cases.
- “We are closely liaising with our clinical experts and working hard to get more information on those individual cases. It is important to make sure that when samples are collected for testing on suspected patients, procedures are followed properly,” the statement said.
- The possibility of the virus being “reactivated” in people would be an extremely worrisome scenario, particularly as world leaders look to open economies back up again based at least in part on the hoped-for assurance that already infected people would not get it again.
2. Surprising number of pregnant women at NYC hospitals test positive for COVID-19
- A surprising number of pregnant women delivering babies at two New York City hospitals tested positive for COVID-19 without showing symptoms, according to a new study.
- The findings suggest that the true rate of COVID-19 infection in the city overall could be much higher than thought.
- In the United States, people are generally tested for COVID-19 if they have serious symptoms, and so exactly how many people have the disease is unclear.
- But to prevent the spread of COVID-19 in the hospital setting, doctors at Columbia University Irving Medical Center and New York-Presbyterian Allen Hospital recently implemented universal COVD-19 screening for all pregnant women admitted to their hospitals for delivery.
- Between March 22 and April 4, those hospitals screened 215 pregnant women for SARS-CoV-2 (the virus that causes COVID-19), and 33 women, or 15%, tested positive. Of these who tested positive, 29 women — or nearly 14% — showed no symptoms.
- “More than one of eight asymptomatic patients who were admitted to the labor and delivery unit were positive for SARS-CoV-2,” the authors wrote in their paper, published Monday (April 13) in The New England Journal of Medicine.
- Because the study included only pregnant women in New York City, the results may not apply to the general population.
- Pregnant women are known to be at increased risk for certain infections, such as the flu, but it’s unclear if they are at higher risk of contracting COVID-19. However, based on current information, pregnant women seem to have the same risk of COVID-19 infection as adults who aren’t pregnant, according to the Centers for Disease Control and Prevention.
- Some doctors not involved with the study said the findings suggest a high rate of infection in the general population in areas with lots of COVID-19 cases. (With more than 200,000 confirmed cases of COVID-19, New York has by far the highest number of coronavirus cases in the U.S.)
- “This study suggests that in hot spots like New York City, the level of #COVID19 exposure … could be high,” Scott Gottlieb, former Commissioner of the U.S. Food and Drug Administration, posted on Twitter on Monday (April 13). “Not the 50%-66% needed to confer herd immunity, but much more than 10%.” (Herd immunity refers to the idea that once a certain number of people have experienced a disease and developed immunity to it, that protection extends to a larger population.)
- The authors added that “the true prevalence of infection may be underreported because of false negative results of tests to detect SARS-CoV-2.”
- Overall, the findings underscore “the risk of COVID-19 among asymptomatic obstetrical patients,” the authors said. Access to data on universal screening in hospitals “provides an important opportunity to protect mothers, babies and health care teams during these challenging times,” they concluded.
H. The Road Back?
1. We may need 300,000 contact tracers to defeat COVID-19. We have 2,200.
- As Americans anxiously await news of when they can emerge from their 4-meter-wide personal-space bubbles and go back to something resembling normal life, public health experts are working furiously to determine essential steps to get us there safely. And a consensus is emerging that key among those steps is recruiting a massive number of people to perform contact tracing.
- “It is going to be critical,” Director Robert Redfield of the US Centers for Disease Control told NPR in an interview late last week. Scaled-up contact tracing, along with increased testing, is needed to “make sure that when we open up, we open up for good.”
- “We can’t afford to have multiple community outbreaks that can spiral up into sustained community transmission,” he said, “so it is going to be very aggressive, what I call ‘block and tackle,’ ‘block and tackle.'”
- Contact tracing, generally, is an effort to stop disease transmission by tracking down all the people who have had contact with someone known to be infected. Standard methods of doing this, according to the World Health Organization, involve having health workers interview people with confirmed infections to identify all of their recent contacts, who, in turn, are at risk of developing the infection or may already be sick.
- The health worker then makes a list of those contacts, gets in touch with each of them, and then follows up with them periodically to monitor testing results, potential symptoms, and quarantines (for at-risk contacts) or isolation (for infected contacts).
- Tracking the contacts of that first case—and maybe even contacts of those contacts—can keep people still incubating an infection from passing it on, halting the chain of transmission. In places where there is not widespread transmission, health workers may even be able to identify where the first case picked up their infection. In that case, the health workers can then begin contacting that person’s contacts and so on.
Pouncing on disease
- But in places where there is widespread transmission—such as the case in much of the United States currently—contact tracing is an unmanageable and even unhelpful task. That’s the point at which public health officials switch to mitigation efforts, such as the stay-at-home orders now seen in many places in the country. Public health experts are now waiting for those mitigation efforts to dampen transmission enough to be able to switch over to relying on testing and contact tracing to control transmission.
- “The concept is: once you get down to a manageable number of cases and scale up the public health system, then you will be able to pounce on any case or cluster to proactively identify cases, identify contacts, and follow up on those contacts,” Tom Frieden, a former CDC director, told STAT news recently. “When you get those things done, you can prevent the clusters from becoming outbreaks, prevent outbreaks from becoming epidemics, and prevent the epidemics from driving us into our homes again.”
- Researchers estimate that each person with COVID-19 goes on to infect two to three other people, on average [NOTE: Some estimates are as high as 5-6]. That means that one infected person could give rise to more than 59,000 cases if 10 rounds of infections are allowed to take place unimpeded.
- To keep such exponential infection from happening again in the US, we’ll need more testing and “very aggressive” contact tracing, Redfield said. Other experts heartily agreed, and many are trying to estimate just how much testing and contact tracing we’ll need.
- In a report from the think-tank American Enterprise Institute, public health experts laid out a road map to reopening the US, noting the need for increased testing. It estimated that “a national capacity of at least 750,000 tests per week would be sufficient to move to case-based interventions when paired with sufficient capacity in supportive public-health infrastructure (e.g., contact tracing).”
- Though testing is still extremely limited and backlogged in the wake of seriously delayed rollouts, we’ve actually hit that goal of a 750,000 test-per-week minimum capacity, according to the COVID Tracking Project. And efforts are underway to continue expanding test access and availability.
- We have a lot more work to do on expanding contact tracing. While some researchers and big tech companies such as Apple and Google are looking into using mobile device location data and applications to track and notify contacts, many experts are now calling for a massive recruitment of health workers to get the necessary phone interviews and follow-up done effectively.
- But, with chronically underfunded public health infrastructure and a lack of federal coordination, it won’t be easy. Many experts have estimated that we’ll need tens of thousands of contact tracers to keep the United States open. Dr. Frieden, for instance, called for an “army” of 300,000 contact tracers. A report by public health researchers at Johns Hopkins and the Association of State and Territorial Health Officials (ASTHO) estimated that we’ll need to add at least 100,000 contact tracers to the mix. To match the level of contact-tracing done in Wuhan, China, where the outbreak began, we would need more than 265,000 contact tracers.
- We currently only have 2,200 contact tracers in the country, ASTHO reports.
- This has led to some brainstorming on how to boost those numbers, including tapping into volunteer networks and medical programs to get boots on the ground.
- “We need a Marshall Plan. We need a New Deal. We need a WPA for public health,” Gregg Gonsalves, a Yale epidemiologist, told KHN.
- Meanwhile, the state of Massachusetts is working with global health nonprofit Partners in Health to recruit 1,000 people to do contact tracing.
- “Widespread testing and aggressive contact tracing have been key pillars of public health responses to infectious disease outbreaks for more than a century,” the nonprofit says on its website. “Along with effective isolation and quarantine measures, contact tracing has played an important role in highly successful control programs in Germany, the Republic of Korea, Singapore, Hong Kong, and China.”
2. CDC, FEMA create draft plan to reopen America
- A team of government officials – led by the Federal Emergency Management Agency and the Centers for Disease Control and Prevention – has created a public health strategy to combat the coronavirus and reopen parts of the country.
- Their strategy is part of a larger White House effort to draft a national plan to get Americans out of their homes and back to work. It gives guidance to state and local governments on how they can ease mitigation efforts, moving from drastic restrictions such as stay-at-home orders in a phased way to support a safe reopening.
- A federal official who spoke on the condition of anonymity to discuss evolving plans said the overall planning document has eight parts.
- The public health response portion of “A Framework for Re-Opening America” is dated April 10. It runs 36 pages. An 11-page executive summary called “Focus on the Future – Going to Work for America” was the subject of discussions last week by FEMA and CDC officials, among others. “It’s a road map for doing it gradually,” said one participant in the planning.
- The plan lays out three-phases:
- Preparing the nation to reopen with a national communication campaign and community readiness assessment until May 1.
- Then, the effort, through May 15, would involve ramping up manufacturing of testing kits and personal protective equipment and increasing emergency funding.
- Then staged reopenings would begin, depending on local conditions. The plan does not give specific dates for reopenings but specified “not before May 1.”
- The first priority, according to the CDC response document, is to “reopen community settings where children are cared for, including K-12 schools, day cares, and locally attended summer camps, to allow the workforce to return to work. Other community settings will follow with careful monitoring for increased transmission that exceeds the public health and health care systems.”
- The document also says that during phased reopenings, it is critical to strictly follow recommendations on hand-washing and wearing face coverings in group settings.
- The plan also carries this warning: “Models indicate 30-day shelter in place followed by 180 day lifting of all mitigation results in large rebound curve – some level of mitigation will be needed until vaccines or broad community immunity is achieved for recovering communities.”
- The document says re-opening communities in this phased approach “will entail a significant risk of resurgence of the virus.”
- Any reopening must meet four conditions:
- Incidence of infection is “genuinely low.”
- A “well-functioning” monitoring system capable of “promptly detecting any increase in incidence” of infection.
- A public health system that is “reacting robustly” to all cases of covid-19 and has surge capacity to react to an increase in cases.
- A health system that has enough inpatient beds and staffing to rapidly scale up and deal with a surge in cases.
- The plan describes the conditions under which it is reasonable to lift some community mitigation measures, the phased steps to reduce those measures and indicators to monitor the impact of transmission on public health and health system capacities.
- Communities where it is necessary to maintain only “low mitigation” are places where the virus never spread significantly, and those locations can reopen soon, according to the document. Moderate mitigation is called for in former hot spots entering “controlled recovery.” Significant mitigation is recommended in current or emerging hot spots, or moderate mitigation communities showing signs of strained capacity.
- In a community following the moderate mitigation track, the report says, schools could remain open with enhanced distancing measures, such as no assemblies, no sporting events and staggered scheduling.
- The document calls for the CDC to establish a Covid-19 Response Corps to help state and local health departments with key public health functions, including contact tracing, which involves locating people who may have had contact with someone infected with the coronavirus.
- Health experts in recent days have called for federal and state officials to help expand capacity throughout the country for the labor-intensive work of tracing people who have come into contacted with infected patients, because local health departments lack the necessary staff, money and training. The plan also says that solutions for “app-based case and contact investigations will be necessary for augmenting the actions of public health workers and for greatly increasing the important role of slowing covid-19 transmission in the community.”
- Tech experts and companies such as Google and Apple are developing software that uses cellphones and apps to track people’s movements. Once someone is confirmed as infected with the coronavirus, public health workers could go back and trace people the infected person has come into contact with. But the invasive nature of cellphone tracking and apps have raised sharp concerns about civil liberties.
- The document calls for a workforce of 670 to support communities to do contact tracing as part of a surge staff, not nearly large enough based on plans from other groups.
I. Stories From the Frontline
1. Doctors think ventilators might harm some COVID-19 patients
- A global debate has emerged among doctors treating COVID-19: When should patients who need help breathing be placed on ventilators — and could intubation do some people more harm than good?
- It’s one of the biggest medical questions of the day, along with how effective the antimalarial hydroxychloroquine really is, a US doctor told AFP.
- The data is scarce and there aren’t yet formal studies on the subject since the disease itself is so new and we don’t have the benefit of hindsight.
- It’s also impossible to know for sure whether the patients placed on ventilators would have died anyway because of the severity of their conditions.
- But a growing number of doctors have said that COVID-19 patients appear to fade rapidly when they are put on ventilators and tubes are placed down their windpipes.
- In recent weeks, American hospitals have started doing what they can to delay having to use the breathing machines — which the federal government ordered 130,000 of, fearing a shortage.
- The first warning signs came from Italy, where the vast majority of patients placed on artificial breathing died.
- The statistics are also bad in the United Kingdom and in New York, where 80 percent of intubated patients die, according to the state’s governor, often after spending a week or two in intensive care in which they are placed in an artificial coma and their muscles atrophy.
- At the start of the pandemic, patients who were completely out of breath were treated under well established protocols for a severe lung condition called Acute Respiratory Distress Syndrome (ARDS).
- This condition, which prevents the lungs from taking in enough oxygen to pass on to other organs, can be triggered by infection, such as pneumonia, or by physical injury.
- It’s very dangerous, with studies placing the overall fatality rate at around 40 percent.
- The standard procedure for these patients is to intubate relatively early, and this is how COVID-19 patients have generally been treated.
- Until, that is, doctors began to realize lung complications among COVID-19 patients weren’t quite the same as “typical” ARDS patients, at least not in all cases.
- The lungs aren’t damaged in the same way — they are less “stiff.”
- Doctor Luciano Gattinoni and his colleagues in Milan described at the end of February how they had to adjust their procedures.
- “All we can do (by) ventilating these patients is ‘buying time’ with minimum additional damage,” he wrote in a research letter to the journal of the American Thoracic Society where he argued for lower air pressure settings.
- “We need to be patient.”
- Kevin Wilson, a professor of medicine at Boston University and guideline director for American Thoracic Society guideline, agreed on the need for caution.
- “Most of the health care community has gone a little nervous by these bad reports about people not doing well on ventilator, and actually is moving towards trying to delay intubation,” he told AFP.
- “We delay as long as we can, but not to a point where it becomes emergent,” he added.
- Doctors realized that some patients who had very low blood oxygen levels and would normally be intubated could in fact go without.
- Instead of going straight to ventilators, doctors are opting to use less invasive methods — like nasal cannulas that feed oxygen up the nose, conventional or more sophisticated breathing masks, or even placing the patients on their stomachs, which helps the lungs.
- “We try to wait a little longer, if possible keep people from even being on the ventilator,” said Daniel Griffin, chief of the infectious disease division of ProHEALTH Care Associates, a network of 1,000 doctors serving hospitals around New York.
- “If they look like they’re doing okay, we’ll tolerate pretty low oxygen saturations,” he added. Some recover without needing to step up the treatment.
- And if they do need to be intubated, Griffin says they use different settings on the ventilator with lower air pressure.
- Medical societies, including international experts from the Surviving Sepsis Campaign, are in the process of writing best practice guidelines. None yet have a definitive answer.
J. Projections and Our (Possible) Future
1. CDC director says US should brace for second wave of coronavirus to hit next year
- The US should brace for a second wave of coronavirus cases to hit next year, the head of the Centers for Disease Control and Prevention said Wednesday.
- Dr. Robert Redfield said COVID-19 may turn out to be seasonal like other bugs such as the flu.
- “I think we have to assume this is like other respiratory viruses, and there will be a seasonality to it,” Redfield told “Good Morning America.”
- Redfield said that the country needs to ramp up testing capacity now, and implement other control measures, such as contact tracing, to prepare for the possibility of the next large outbreak.
- “The CDC is science-based, data-driven, [so] until we see it, we don’t know for certain [there will be a resurgence],” Redfield said. “But it is critical that we plan that this virus is likely to follow a seasonality pattern similar to flu, and we’re going to have another battle with it upfront and aggressively next winter.”
- The CDC director said he refers to the strategy necessary to fight the virus as “block and tackle, block and tackle.”
- “We are working hard to augment [public health tools] now so that as we get into the next season, we’ll be able to stay in high containment mode while we complement that with some continued mitigation strategies,” Redfield said.
- More than 609,000 cases have been detected in the country, including at least 26,000 deaths, according to the latest figures from Johns Hopkins University.
2. Harvard Study: Intermittent social distancing needed for two years
- A major new study delivers sobering news: Unless hospitals boost capacity, or a treatment or vaccine is developed, a strategy of prolonged or intermittent “social distancing” may be needed for the next two years.
- The research, published Tuesday in the journal Science (read the study here), shows that there’s no way through this pandemic without more hard times. While one-time social distancing may suppress the number of critically ill patients, it concludes, infections will resurge once these measures are lifted, overwhelming hospitals.
- Researchers at Harvard’s prestigious Harvard T.H. Chan School of Public Health conceded that repeated restrictions would have profound economic, social and educational consequences.
- But this strategy – lifting and re-imposing restrictions such as school, business and event closures — will create smaller outbreaks of illness that can be better managed by hospitals, saving lives, they said.
- Over time, this approach will lead to the build up of so-called ‘herd immunity,’ when so many people are immune that an infected individual has little chance of coming into contact with someone who is vulnerable, they said.
- “Several rounds of social distancing will be required to get us to ‘herd immunity,’ in the absence of vaccination,” said Harvard epidemiologist and study co-author Dr. Marc Lipsitch at a Tuesday press conference.
- The goal of on-and-off restrictions, added co-author Stephen M. Kissler, is to flatten the curve of new cases and approach ‘herd immunity’ as slowly as possible.
- The team, comprised of some of the nation’s top disease-modeling experts, warned of an intense outbreak of COVID-19 next winter — when social distancing is relaxed and virus transmissibility is heightened, overlapping with flu season and stressing hospital capacity.
- They built multi-year models using data on seasonality from known human coronaviruses and assuming some protection, called “cross-immunity” between the COVID-19 virus and other coronaviruses.
- The Harvard team’s mathematical models of various disease trajectories point to the urgent need for innovation to bring the pandemic under long-term control.
- “New therapies and vaccines… all of those can change what happens,” said Kissler, an expert in the use of mathematical models to study the spread of infectious disease.
- For now, the best strategy allows flexibility in the timing and duration of “social distancing” restrictions, according to the Harvard team.
- When restrictions are in place, the level of illness will fall — so that when they’re lifted, “the number of cases is small enough to avoid overwhelming our intensive care capacity,” said Lipsitch.
- While strict measures quickly reduce the number of illnesses and deaths, loose measures will move us faster towards ‘herd immunity.’
- “It’s all a trade off, in terms of cases now vs. cases later,” he said.
- Ideally, we’ll inch towards the optimal level of societal immunity, without overshooting it and causing unnecessary illness and death, said Kissler.
- Based on early estimates of this virus’s infectiousness, we will likely need at least 70% of the population to be immune to have herd protection, according to Johns Hopkins School of Public Health epidemiologists Gypsyamber D’Souza and David Dowdy.
- Some studies suggest the herd immunity to this virus is larger and building faster than daily case counts would indicate, because people with mild symptoms aren’t tested. But another new study points the opposite direction: People with mild illness didn’t have many antibodies, it found, so they’re unlikely to be protected.
- It is also essential to conduct long-term serology studies, which measure antibodies in the blood of infected individuals, so we know how many people are protected, the team added.
- For now, “unless there is some enormously larger ‘herd immunity’ than we are aware of, the large majority of the population in this country and in most parts of the world remains susceptible,” said Lipsitch.
- Their models did not look at the many ways that different strategies — such as open schools but closed businesses, or small event but not large events — would affect outcomes.
- And there’s one key factor that is unknown: the rate at which viral immunity might wane, over time.
- The models also made these points:
- An outbreak can occur at any time of year, regardless of season. But if COVID-19 follows the seasonal pattern of influenza, winter/spring outbreaks could be less severe, while autumn/winter outbreaks could be more severe.
- If immunity is permanent, the virus could disappear for five or more years after causing a major outbreak.
- If immunity isn’t permanent, the virus will likely enter into regular long-term circulation, like influenza.
- Even if immunity just last for two years, “cross immunity” from related viruses could eliminate the transmission for up to three years before a resurgence in 2024, if it doesn’t fully die out.
- There could be geographic differences in seasonal variation, like flu. And regions with a smaller number of cases during the initial wave could have larger recurrent waves later.
- The team stopped short of making a formal recommendation to elected leaders and local health officials.
- “Our goal in modeling such policies is not to endorse them but to identify likely trajectories of the epidemic under alternative approaches,” they wrote.
- “We do not take a position on the advisability of these scenarios given the economic burden that sustained distancing may impose,” they wrote, “but we note the potentially catastrophic burden on the healthcare system that is predicted if distancing is poorly effective and/or not sustained for long enough.”
2. Social distancing until 2022?! Hopefully not.
[An Optimistic View]
- A new study makes a grim forecast for how much longer we might be cooped up. But there are reasons to be less pessimistic.
- A new paper by researchers from Harvard’s school of public health modeling the spread of covid-19 in the United States says that “prolonged or intermittent social distancing may be necessary into 2022.” The emphasis in many news reports about the paper is on the date, which is startling. Most of us are hoping for some relief far sooner than that. But if modeling results during this pandemic have taught us anything, it’s that we shouldn’t fixate on a number that makes for an arresting headline. Instead, we should focus on the may.
- The paper, published on April 14 in the journal Science, brings something new and important to the table. It’s the first major study to use data from two other closely related coronaviruses, OC43 and HKU1, to predict how covid-19 will behave. These viruses cause a large share of cases of the common cold. The new paper looks at how seasonal effects influence the spread of SARS-CoV-2, the virus behind the current pandemic. And here we get to the first key variable: if, as the researchers suppose, SARS-CoV-2 behaves similarly to OC43 and HKU1, then summer will significantly slow its spread—but not enough to stop it. There is also a risk that prolonged social distancing over the summer would prime a worse outbreak in the winter of 2020-21, because there would still be lots of people who hadn’t yet had the virus.
- The next critical variable in the researchers’ model is the duration of immunity. Marc Lipsitch, a respected epidemiologist and one of the study’s lead authors, said in a press conference that “reasonable guesses are that on the short end there might be partial protection for a year or close to it, and on the long end, it might be several years of good protection. But it’s really speculative at this point.”
- In the model, immunity that lasts about a year would result in annual outbreaks of covid-19 (assuming no social distancing or any other interventions), while longer immunity results in increasingly less frequent outbreaks. These outbreaks would also be less severe if it turns out that a person who has had one of the other coronaviruses also gains some level of immunity to SARS-CoV-2.
- The researchers’ model, by their own description, makes many simplifying assumptions. It does not consider how aggressive contact tracing might suppress the virus’s spread, for example. And it models all people identically: everyone is either susceptible, exposed, infectious, or recovered. There is no way, within their framework, to account for how people of different ages tend to react to the virus differently, for instance.
- They also assume an R0 in the absence of social distancing—the average number of susceptible people a victim infects—of between 2 and 2.5. Some studies have suggested R0 is higher than that, and this would actually be good news—it would mean that the virus has already spread far more widely, and is far less deadly, than is generally believed to be the case. As Lipsitch said, “If there is more herd immunity in the population than we believe, each case we know about may be generating more immunity through mild cases than we have been thinking. That is certainly possible.” And they assume, for the purposes of the model, that no progress will be made in treating the disease, or creating a vaccine.
- Under these assumptions—and assuming in addition that social distancing reduces the virus’s transmissibility by 60% and that summertime reduces it by 40%—the model forecasts that in order to maintain the number of cases requiring critical care below what hospitals can currently handle, the US would need to maintain current social distancing conditions through the middle of May, reinstate them for the month of August and again in late October through the end of the year, and then from February to April 2021, in June 2021, and for comparable periods in 2022 and beyond.
- Doubling the number of critical care beds—but keeping the other assumptions the same—would make for a much better picture. After three more one-or-two-month intervals through the middle of 2021, and then a month-long period at the end of 2021, the US would reach herd immunity by July 2022.
- Still, with so many unknowns, the combinations of parameters can quickly multiply. The researchers considered dozens of different scenarios in their paper. In all of them, “several rounds of social distancing will be required to get us to herd immunity in the absence of a vaccine,” Lipsitch said.
- The uncertainty is about how many rounds would be needed, and there is no reason to believe with confidence that it has to take until the summer of 2022. It should be possible to much more than double the number of critical care beds, for instance. Effective contact tracing would allow us to identify more accurately who is most likely to have been exposed to the disease instead of having to lock entire districts down. And if widespread tests can be conducted in the next month or so, we’ll have much better data on how far the virus has spread, and how far it could still go. Even if the US is not at the forefront of testing, better data from, say, Germany or Finland would still allow modelers to forecast with much greater confidence.
- But as Zeynep Tufekci noted in the Atlantic, such models aren’t supposed to predict the future. Rather, they’re supposed to describe “a range of possibilities”—and “those possibilities are highly sensitive to our actions.” We might be in for years of isolation if we don’t take certain actions. We could choose to take them instead
3. This is where all 50 states stand on reopening their economies
- More than 90% of the US population is currently under a stay-at-home or shelter-in-place order as the coronavirus pandemic continues to upend life as we know it. But worries for the economy — and people’s mental health — are raising the question: When will things go back to normal?
- Western States Pact: California, Oregon and Washington agreed to study and coordinate the reopening. No timetable has been set.
- Northeastern States: Connecticut, New Jersey, New York, Pennsylvania, Delaware, Rhode Island and Massachusetts announced plans to coordinate the reopening of the economy
- Other states who are studying or who have made specific statements regarding a target date to reopen include:
- Alaska may open sometime during the week of April 19
- Colorado is considering opening on April 26
- Florida is considering reopening schools on May 1
- Idaho may reopen businesses by the end of April
- Oklahoma may reopen by April 30
- Tennessee says it plans to reopen in May
- Here is when each state’s stay-at-home order is set to expire:
K. Practical Tips & Useful Information
1. Face shields are even better than masks. Here’s how to make your own.
- Prominent Japanese designer Tokujin Yoshioka created the Olympic Flame for the 2020 Tokyo Games. Made of recycled aluminum waste, it was fashioned into the shape of a cherry blossom—Japan’s most beloved flower. But now that the games have been postponed until next summer, Yoshioka has turned his attention elsewhere: a face shield to guard against coronavirus transmission.
- Yoshioka’s “easy-to-make face shield” uses a hard, clear PVC sheet to protect the eyes, nose, and mouth—COVID-19’s favorite entry points into the respiratory system.
- The free template provides detailed measurements for both the size of openings for glasses and the thickness of the plastic boundary (clear PVC sheets can usually be found at home improvement stores).
- With three easy steps—print out the paper template, place it on top of the plastic sheet to cut out the shape, and attach it to the frame of glasses—citizens and healthcare workers alike can create their own personal protective equipment as products remain scarce.
- There’s even a handy instructional video on Yoshioka’s website, which shows how the natural curve of glasses frames bends the plastic to the shape of the face without any folding or additional tools. See the video here: Easy-to-make FACE SHIELD on Vimeo
- Due to the highly contagious nature of the coronavirus, which most experts claim can travel via droplets up to six feet, doctors aren’t just urging medical professionals to wear face coverings at all times but the general population as well.
- Anytime someone leaves the home, the best way to prevent infection is to have the most vulnerable entry points protected. Masks have been heavily promoted as the equipment of choice, but now hospital epidemiologists in Iowa suggest that face shields like Yoshioka’s are an even better solution because they cover a greater surface area and help keep wearers from touching their face.
- Download the pattern here.
- “Importantly, face shields are durable, can be cleaned after use, reused repeatedly, and for many people are more comfortable than face masks.
- Because these shields are reusable and are diversified across the supply chains of multiple industries, the current supply is less limited than for face masks,” write Dr. Michael Edmond and Dr. Daniel Diekema, infectious disease specialists in Iowa City.
- In 2010, Yoshioka was named one of Fast Company’s Most Creative People. Over the last decade, he’s contributed his design skills to everything from a transparent cellphone to a “church” made of 500 crystal prisms.