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“We’re not opening all at once, but one careful step at a time. We’re starting our life again. We’re starting rejuvenation of our economy again in a safe and structured and a very responsible fashion.” President Trump
“It certainly was in line with what we were hoping to hear.” California Governor Newsom
- Recent Developments and Headlines
- Numbers and Trends
- Potential New Treatments
- New Scientific Findings
- Technological Advances
- Stories from the Frontline
- Updates – Symptoms and How to Protect Yourself
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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 4/16 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 = 2,190,010 (+5.1%) (+106,097)
- US Total Cases = 678,210 (+5.3%) (+33,862)
- NY Total Cases = 226,918 (+5.4%) (+11,580)
- Worldwide deaths = 147,010 (+9.2%) (+12,352)
- US deaths = 34,522 (+5,968) (+20.9%) [Note: Calculation of deaths changed to included those presumed to be caused by COVID-19]
- NY deaths = 16,106 (+4,520) (+39%) [Note: Calculation of deaths changed to included those presumed to be caused by COVID-19]
- Reports: COVID-19 patients are responding quickly to experimental drug remdesivir
- Dow futures rally 800 points after Gilead coronavirus drug reportedly shows effectiveness
- Gilead: “Anecdotal reports, while encouraging, do not provide the statistical power necessary to determine the safety and efficacy profile of remdesivir as a treatment for COVID-19.”
- Analyst bullish on Gilead says antiviral drug ‘won’t solve’ COVID-19 (see here)
- Study finds patients with no symptoms caused 44 percent of coronavirus cases
- President Trump Unveils “Opening Up American Again” Guidelines
- President Trump Says Guidelines Would Allow Some States To Reopen “Tomorrow”
- President Trump’s Guidelines May Have Some States Reopening in a Month
- Trump says reopening US can happen in some places without mass testing
- U.S. House Speaker Pelosi says Trump guidelines ‘vague and inconsistent’
- We are NOT going back to normal soon warns Dr. Fauci
- Fauci: Diseases like coronavirus ‘don’t just disappear’
- Governors caution Trump on reopening economy without enough coronavirus testing
- Maryland governor says now is ‘the worst possible time’ to lift coronavirus restrictions
- Coronavirus Update: Focus shifts to testing, as Trump tries to get anxious Americans back to work
- North Dakota releases plan to reopen state May 1
- Fla. Gov. DeSantis Creating Task Force to Reopen Florida Economy
- Protesters Gather Outside of Kentucky Governor’s Coronavirus Briefing: ‘We Want to Work’
- Rabobank: “If We Don’t Get The Reopening Just Right We Can Start The Clock To The Second Infection Wave”
- New York governor extends shutdown to May 15
- NYC Mayor de Blasio: NYC ‘far from out of woods’ as hospital patients increase
- ICUs under strain as NYC’s new coronavirus patients are sicker than ever
- NYC’s Intensive-Care Units Still “Dangerously Overcrowded” Despite ‘Flattening Curve’
- De Blasio: NYC beaches likely closed for summer due to coronavirus
- ‘Probable’ coronavirus deaths now included in CDC totals
- Midwest governors form COVID coalition
- It’s not just beaches: Coronavirus has summer in NYC looking bleak
- Michigan Judge Authorizes County to ‘Involuntarily Detain’ Suspected Coronavirus Victims
- As Washington DC faces coronavirus spike, secret military task force prepares to secure the capital
- Pennsylvania Governor Orders Business Employees and Customers to Wear Masks
- Harvard: Social Distancing Until 2022 Unless Treatment Available
- Trudeau says no plans to open border with US to “non-essential” traffic
- Germany reports jump in new cases, deaths
- Spain reports most new cases in a week
- Singapore reports another record daily jump as 2nd wave arrives
- Italy reports slight rise in new cases, pullback in deaths
- NJ reports jump in cases
- Phil Murphy opens investigation into nursing home deaths
- Sweden reports another alarming jump
- China revises its figures in Wuhan, adding 50 percent more deaths
- Chinese factories on verge of second shutdown
- China Quietly Keeping Residences Quarantined Despite ‘Reopening’ Wuhan
- ‘Increasing Confidence’ Coronavirus Originated in Wuhan Lab
- Merkel announces lockdown exit plan to reopen schools, shops in Germany
- Sources believe coronavirus outbreak originated in Wuhan lab as part of China’s efforts to compete with US
- Coronavirus ends China’s near 50-year stint of economic growth
- Japan to extend state of emergency to entire country: report
- Brazil’s president fires the health minister in a clash over lockdown measures
- Singapore records another daily high, linked to crowded migrant dorms
- France coronavirus-linked deaths fall for first time in 4 days
- UK health minister says it’s too early to end lockdown as measures set to be extended
- Iraq Warns That ISIS Now Using Coronavirus Crisis To Reestablish ‘Virtual Caliphate’
- Belgium reports more than 1k new cases
- Britain crosses 100k case threshold
- UK extends lockdown by “at least” 3 weeks
- Macron says EU may collapse unless “coronabonds” happen
- European Commission President apologizes to Italy
- Russia’s streak of record new cases stretches to 5th day
- Japan expands state of emergency to cover whole country
- WSJ reports medical supplies bound for US being blocked by Beijing
- Wearing Masks Could Be The “New Normal” As States Attempt Economic Restart
- The $349 Billion Small Business Loan Program Is Now Out Of Money
- Global Food Supply Chains Beginning To Erode As Crisis Looms
- Canadian Meat Industry Warns Of “Immediate And Drastic” Impact To Supply
- Italian Beachtowns Plan “Plexiglass Cages” To Enforce Safe-Sunbathing This Summer
- College Fraternities Go Virtual During Chinese Virus Pandemic
- Report: Chinese Landlords Forcing Africans to Pay Double Rent, Citing Virus
- Moscow Anti-Coronavirus Measures Trigger Crowds
- UK Border Officer Begs for Testing of Airport Arrivals for Coronavirus
- Migrants Injured After Riot in Asylum Home Under Coronavirus Quarantine
- Rome Mayor Uses Drone to Hunt Down, Fine Jogger
- Greece to Expand Turkish Border Fence, Claims Turks Shot at Greek Police
- Destruction of the British Family: Marriage Rate Falls to Lowest in Recorded History
- Iran Parliament Hears Coronavirus Deaths Almost Double Official Count
- Mideast Debt, Unemployment to Spike in Coronavirus Recession: IMF
- Rome Mayor Uses Drone to Hunt Down, Fine Jogger
- PGA Tour Hopes to Resume in June with No Fans
- Report: NFL Considering Shortened Season, Playing Without Fans
- ‘Scattered protests push back on U.S. coronavirus stay-at-home orders
- Coronavirus’s Relentless March in Europe Clouds Reopening Plans
- Police thy neighbor: Virus fears fuel quarantine shaming
- Professional gamblers in Nevada may now be able to collect unemployment
- Supermarkets Adjust Meat Sections as Coronavirus Cuts Supply
- Australia may keep coronavirus restrictions for a year, schools may work on roster
- Vegas Dealers To Wear Masks, Casino Patrons To Get Temps Checked In Reopening Plan
- People are mass-purchasing plants during quarantine
- Airline conducts COVID-19 blood tests on passengers
- At least 37 kids at Chicago shelter for immigrant youth have coronavirus
- Brazil’s president, skeptical of coronavirus, fires health minister who pushed for social distancing
- Amazon Aims to Test All Employees for Covid-19
- Over 50 Cell Towers Vandalized in UK Due to 5G Coronavirus Conspiracy Theories
- Red Cross: Coronavirus could cause upheaval across Middle East
- Albania to impose 2-8 year jail terms on coronavirus quarantine rule-breakers
- Swiss to fine “shopping tourists” who flout coronavirus border curbs
- El Chapo’s daughter, Mexican cartels hand out coronavirus aid
- Spain village churns out coffins as death doubles demand
- Australia to retain coronavirus curbs for at least another four weeks
- China suffers worst economic drop since ’70s amid coronavirus battle
- Dogs might be able to sniff out the coronavirus
- 19 NYC doormen, supers and porters dead from coronavirus, union says
- Most NYC coronavirus testing done in whitest and wealthiest ZIP codes, Post analysis finds
- Navy’s coronavirus testing reveals ‘stealth’ spread among young, healthy sailors
- Facebook cancels large events through June 2021
- Trump unveils ‘Opening Up America’ plan, aims for May 1
- Everyone is Googling ‘will life ever go back to normal?’
- Coronavirus could erode global fight against other diseases
- Carnival execs let ships sail amid coronavirus threat
- US Open pushing to have tournament with fans
- Cuomo bashes Trump’s ‘bizarre’ claim of NYC padding coronavirus death toll
- British government extends coronavirus lockdown by at least 3 weeks
- Seed sellers say demand growing out of control
- NASA staff are sending rover commands to Mars from home
- Sweden grapples with high death toll after controversially refusing to lock down
- Australia to detect coronavirus spread by testing raw sewage
- Coronavirus small-business relief program runs out of money after 2 weeks
- Sobering news: Booze may heighten risk of coronavirus, WHO says
- Amazon wants customers to buy less stuff
- Hundreds aboard French Naval flagship Charles de Gaulle get coronavirus
- Judge caught shirtless during Zoom court session
- Gambling sites are taking bets on the number of coronavirus cases
- To recovery and beyond! Man beats coronavirus with ‘Buzz Lightyear’ helmet
- Nurses suspended for refusing to treat patients without masks
- World Health Organization Spends Twice as Much on Travel as on Medical Supplies
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 = 2,190,010 (+5.1%)
- New Cases = 106,097 (+27.26%) (+22,726)
- Total Cases = 1,007,797 (+3.1%)
- New Cases = 44,061 (+53.9%) (+15,433)
- Total Cases = 156,548 (+2.7%)
- New Cases = 3,471 (+11%) (+344)
- Total Cases = 678,210 (+5.3%)
- New Cases = 33,862 (+12.5%) (+3,760)
- US States:
- 41 States > 1,000 cases (+0), plus DC & Puerto Rico
- 29 States > 2,500 cases (+0), plus US Military
- 21 States > 5,000 cases (+1)
- 14 States > 10,000 cases (+0): 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
- Top 5 States:
|Change in Total Cases (%)|
|Change in New Cases (#)||Change in New Cases (%)|
- For more information on US States and territories, see https://ncov2019.live/data
2. Serious or Critical Cases
- Worldwide serious or critical cases = 56,601 (+5,457)
- US series or critical cases = 13,369 (-118)
- US serious or critical cases = 2.3% 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 = 147,010 (+9.2%) (+12,352)
- Europe deaths = 92,048 (+4.4%) (+3,896)
- US deaths = 34,522 (+20.9%) (+5,968) [Note: Calculation of deaths changed to included those presumed to be caused by COVID-19]
- NY deaths = 16,106 (+39%) (+4,520) [Note: Calculation of deaths changed to included those presumed to be caused by COVID-19]
- Deaths per 1M population: (i) Italy: 367 (+19); (ii) Spain: 413 (+23); (iii) US: 105 (+26); (iv) France: 275 (+34); & (v) Germany: 49 (+7)
- US Total Confirmed Case Fatality Rate = 5.1% (+0.7%) compared with a Worldwide Confirmed Case Fatality Rate of 6.7% (+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 = 553,650 (+8.4%) (+42,984)
- US recoveries = 57,844 (+18.8%) (+9,136)
C. Potential Treatments
1. Early peek at data on Gilead coronavirus drug suggests patients are responding to treatment
- Chicago hospital treating severe Covid-19 patients with Gilead Sciences’ antiviral medicine remdesivir in a closely watched clinical trial is seeing rapid recoveries in fever and respiratory symptoms, with nearly all patients discharged in less than a week, STAT has learned.
- Remdesivir was one of the first medicines identified as having the potential to impact SARS-CoV-2, the novel coronavirus that causes Covid-19, in lab tests. The entire world has been waiting for results from Gilead’s clinical trials, and positive results would likely lead to fast approvals by the FDA and other regulatory agencies. If safe and effective, it could become the first approved treatment against the disease.
- The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir.
- “The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital.
- The outcomes offer only a snapshot of remdesivir’s effectiveness. The same trials are being run concurrently at other institutions, and it’s impossible to determine the full study results with any certainty. Still, no other clinical data from the Gilead studies have been released to date, and excitement is high. Last month, President Trump touted the potential for remdesivir — as he has for many still-unproven treatments — and said it “seems to have a very good result.”
- In a statement Thursday, Gilead said: “What we can say at this stage is that we look forward to data from ongoing studies becoming available.”
- Gilead had said to expect results for its trial involving severe cases in April. Mullane said during her presentation that data for the first 400 patients in the study would be “locked” by Gilead Thursday, meaning that results could come any day.
- Mullane, while encouraged by the University of Chicago data, made clear her own hesitancy about drawing too many conclusions.
- “It’s always hard,” she said, because the severe trial doesn’t include a placebo group for comparison. “But certainly when we start [the] drug, we see fever curves falling,” she said. “Fever is now not a requirement for people to go on trial, we do see when patients do come in with high fevers, they do [reduce] quite quickly. We have seen people come off ventilators a day after starting therapy. So, in that realm, overall our patients have done very well.”
- She added: “Most of our patients are severe and most of them are leaving at six days, so that tells us duration of therapy doesn’t have to be 10 days. We have very few that went out to 10 days, maybe three,” she said.
- Asked about the data, Eric Topol, director of the Scripps Research Translational Institute, described them as “encouraging.”
- “The severely hit patients are at such high-risk of fatality. So if it’s true that many of the 113 patients were in this category and were discharged, it’s another positive signal that the drug has efficacy,” he said, adding that it will be important to see more data from randomized controlled studies.
- Gilead’s severe Covid-19 study includes 2,400 participants from 152 different clinical trial sites all over the world. Its moderate Covid-19 study includes 1,600 patients in 169 different centers, also all over the world.
- The trial is investigating five- and 10-day treatment courses of remdesivir. The primary goal is a statistical comparison of patient improvement between the two treatment arms. Improvement is measured using a seven-point numerical scale that encompasses death (at worst) and discharge from hospital (best outcome), with various degrees of supplemental oxygen and intubation in between.
- The lack of a control arm in the study could make interpreting the results more challenging.
2. Israeli firm hopeful as it starts treating COVID-19 patients with placenta cells
- Israeli scientists who claim a single placenta can treat 20,000 coronavirus sufferers are hopeful after beginning the treatment, as some of its first patients have shown improvement while their company’s shares have skyrocketed.
- Pluristem Therapeutics uses placentas to grow smart cells, and programs them to secrete therapeutic proteins in the bodies of sick people. It has just treated its first American COVID-19 patient after treating seven Israelis.
- There is no follow-up data on the American patient, but the company reported that as of a follow-up on April 7, all seven Israelis had survived and three were on target to soon move off ventilators, while one had shown deterioration in respiratory parameters.
- Two of the four Israelis with multiple organ failure showed clinical recovery as well as respiratory improvement. All patients were one week after treatment at time of follow-up, apart from one, who received treatment after the others and whose health update wasn’t reported.
- The treatment of select patients doesn’t constitute a clinical trial and there is no control group, but company CEO and president Yaky Yanay said Thursday that a trial will come soon and, once conducted, he hopes that “approval can be very fast.” Upon receiving the green light from regulators, he said, massive quantities of treatment can be prepared. “We can manufacture cells to treat thousands very quickly,” he said.
- But public health expert Manfred Green said he is “very very cautious” about such innovations. Green, founding director of the Israel Center for Disease Control and director of the University of Haifa’s international masters program in public health, said: “I don’t have any feeling this is going to work. This is a viral disease, not something from outer space, and for viral diseases we’ve always struggled to find treatment.”
- Yanay said that his innovation will save lives, both by improving the health of critical patients, and by freeing up space in intensive care units for others.
- “I think this will have a huge impact because currently the battle is in the ICUs,” he said. “We need to take people off ventilation machines and get them out of ICUs.”
- The treatment is waiting on regulatory approval, but Pluristem is receiving approvals on a patient-by-patient basis in Israel and the US, hoping to gather enough information for full approval. In Israel it has worked so far at three hospitals under a compassionate use program, and at Holy Name Medical Center in New Jersey it was allowed to administer cells under the Coronavirus Treatment Acceleration Program, an emergency mechanism for possible therapies.
3. Coronavirus: vaccine with ‘incomplete’ immunity could offer a solution to pandemic, experts say.
- As the race for a vaccine accelerates, the National Institutes of Health has begun a first trial for one developed by Moderna to have phase one results in weeks
- As the United States, far and away the global leader in coronavirus cases and deaths, seeks treatments to halt the pandemic and resume regular economic activities, medical experts say that a quicker solution may be vaccines that are less than total.
- “There is evidence that immunity doesn’t necessarily have to be sterilizing or even comprehensive,” said Dr Mark Denison, director of paediatric infectious diseases at Vanderbilt University Medical Centre in Nashville, Tennessee.
- Denison, who is working on antiviral treatments for Covid-19, said that “immunity that is incomplete … is likely to lead to infections that are milder, even if you can’t get absolute protection”.
- “That’s a better primary goal that may be more achievable” in the current situation, Denison said during an online discussion about vaccines on Tuesday. The outbreak has so far infected more than 610,000 and claimed more than 27,000 lives in the US.
- “However, if we say a Covid-19 vaccine were licensed with 50 per cent effectiveness at this time, that will be a very appealing kind of efficacy,” said Edwards, who served on a Center for Disease Control and Prevention immunization committee that advises the Food and Drug Administration (FDA) on drug approval.
D. New Scientific Findings and Other Advancements
1. A Tiny Hospital in Texas Might Help Solve the Mask Shortage
- On the southeast side of San Antonio, Texas, a small hospital that faces a shopping mall on what used to be an air force base is suddenly fielding a flurry of calls about a possible solution to the N95 mask shortage.
- There, at the Texas Center for Infectious Disease (TCID), staff receive a special mask on the first day of their orientation — it’s theirs to keep and maintain throughout the year. The mask, known as an elastomeric respirator, is made of durable plastic and has a face piece that goes over the mouth and nose attached to two cartridge filters that attach on the left and right sides.
- The durable masks given to hospital workers at TCID are called North 7700 respirators and they’re much more effective than N95 masks.
- Unlike N95 masks, which filter 95% of particles larger than 0.3 microns in diameter, the P100 cartridges used in the North 7700 masks at the Texas hospitals filter out 99.97% of particles. In fact, there is a strict policy against wearing N95s at the hospital unless you are a visitor.
- “The elastomeric material and design fit much better against your face,” and they are cleanable and washable, says Lisa Brosseau, a respiratory protection and infectious diseases scientist at the University of Illinois, Chicago. “Especially in pandemic situations, why not give everyone an elastomeric respirator, fit-test them, and they’ll have it forever?”
- Elastomeric respirators are made by a few manufacturers, including Honeywell. They are intended for people who need protection against hazardous vapors, gases, and particulate matter, and are more likely to be used in factories than in hospitals. “I use mine on the farm when moving grain,” says one Amazon reviewer.
- The demand for information about TCID’s elastomeric respirator approach is so great that the hospital has assembled a series of primers that it emails to people and hospitals that reach out about them. Salena DeAnda, a respiratory therapist at TCID, sends out the message. Her emails always include words of encouragement: “I hope this information helps you and your team!” she writes. “Thank you and please stay safe during this trying time for our country.”
2. Subways a ‘major disseminator’ of coronavirus in NYC
- A new study argues that city subways and buses were a “major disseminator” of the coronavirus in the Big Apple.
- The paper, by MIT economics professor and physician Jeffrey Harris, points to a parallel between high ridership “and the rapid, exponential surge in infections” in the first two weeks of March — when the subways were still packed with up to 5 million riders per day — as well as between turnstile entries and virus hotspots.
- “New York City’s multi-tentacled subway system was a major disseminator — if not the principal transmission vehicle — of coronavirus infection during the initial takeoff of the massive epidemic,” argues Harris, who works as a physician in Massachusetts.
- While the study concedes that the data “cannot by itself answer question of causation,” Harris says the conditions of a typical subway car or bus match up with the current understanding of how the virus spreads.
- “We know that close contact in subways is fully consistent with the spread of coronavirus, either by inhalable droplets or residual fomites left on railings, pivoted grab handles, and those smooth, metallic, vertical poles that everyone shares,” he writes.
- But some experts and transit officials question the study’s findings.
- Hofstra University professor of public health Anthony Santella told The Post he was “not surprised” that there was a correlation, but questioned Harris’ conclusion.
- “We’re talking about early March before the restrictive public health control measures went in place,” Santella said.
- “It’s certainly not solely related to the subway system. It’s because of our own behaviors and when these other measures went into place.”
- MTA chairman Pat Foye echoed that point in comments to reporters Wednesday afternoon, calling the study “flawed.” He noted that Gov. Andrew Cuomo closed all non-essential businesses on March 20.
- “Social density … was a result of many factors — business, restaurants, bars, Madison Square Garden, sports arenas, concerts, and the things that make New York happen,” Foye said.
E. Technological Advances
1. FDA debuts new online portal to encourage donation of plasma from recovered COVID-19 patients.
- One of the avenues currently being pursued in terms of developing an effective treatment for COVID-19 is through the use of convalescent plasma. Basically, that means using the liquid component of blood from people who have had, and already recovered fully from, COVID-19 to produce treatments that hopefully translate to others the antibodies they developed over the course of fighting off the virus. The FDA has created a dedicated new website (found here) seeking recovered COVID-19 donations, and explaining its potential uses.
- The new FDA website around COVID-19 plasma donation defines what it is, and why it’s under investigation as a possible treatment. It also outlines what conditions need to be met in order for an individual to be qualified to donate (no symptoms for at least 28 days prior to donation, or at least 14 days when combined with a confirmed negative lab test for active COVID-19 viral presence), and it directs you to donate via an American Red Cross or local blood center nearby.
- Why is so much COVID-19 patient plasma needed, if it’s not yet even proven to be effective in treatment of the virus? Mainly because there are a lot of efforts underway to determine whether it actually can help with efforts to combat the virus, including clinical trials for a number of different treatments, as well as single-patient treatment authorizations through what are known as emergency investigational new drug (eIND) one-off usage approvals from the FDA.
1. A Proposal to Quickly Ramp Up Testing
Note: The following proposal is made by Mr. Lipton and Ms. Sortwell, the chair and associate chair of translational neuroscience at Michigan State University’s College of Human Medicine.
- Our research team used Food and Drug Administration guidelines and a scientific report from Wuhan, China, to develop a Covid-19 test in early March. It took one week. Our test doesn’t use the reagents other labs are desperately seeking, and it can identify levels of virus so low that a typical test could miss them entirely. Yet our lab sits idle.
- Across the U.S., tens of thousands of similar academic research labs have the expertise and equipment to help the country test for Covid-19. If even one-tenth of these labs joined the effort, we could test an additional 500,000 to one million samples a day.
- Academic research labs conduct studies; they don’t test patients. In fact, they’re legally precluded from offering a result that would inform a diagnosis. This makes sense—even with our advanced testing capabilities, highly trained scientists and cutting-edge methods, the regulations governing scientific research differ from those governing clinical diagnostics. Yet the mission of medicine is at the core of what we do, too. Our labs exist to improve the lives and alleviate the suffering of our fellow citizens. Let us help.
- The Centers for Medicare & Medicaid Services manages the Clinical Laboratory Improvement Amendments certification system. The FDA approves high-complexity testing and regulates who can run a test and which tests can be run.
- Although regulations have been relaxed to allow academic research laboratories already working under the umbrella of CLIA-certified labs to be “deputized” for coronavirus testing, in the 85 days since the first infected American citizen was identified, less than 1% of the population has been tested.
- If the CMS and FDA would collaborate to allow states temporarily to deputize any academic research lab providing evidence of a working, FDA-compliant Covid-19 test, several thousand idle labs across the country could validate any number of approved Covid-19 tests. Screenings could be validated in less than a week.
- Under normal circumstances, the rules that govern medical labs make sense. But when patient welfare is compromised by the lack of widespread testing, we need to adapt.
- State and federal leaders should join us in urging the CMS and FDA to offer swift temporary CLIA accreditations for academic research labs that demonstrate their fitness to assist testing efforts. By clearing this path, these regulatory bodies will help all citizens have a better chance in the fight against Covid-19.
G. Stories From the Frontline
1. Most NYC kids ‘probably’ already have coronavirus
- Most New York children “probably” already have coronavirus and are serving as vectors to spread the disease, according to one New York pediatrician.
- Dr. Dyan Hes at New York City’s Gramercy Pediatrics advised parents to assume their children have the virus if they contract even mild symptoms consistent with the disease.
- “I think that probably 80 percent of the children have coronavirus. We are not testing children. I’m in New York City. I can’t get my patients tested,” Hes said during an interview at CBS News.
- “And we have to assume, if they are sick, they have coronavirus. Most of them, probably 80 to 90 percent of them, are asymptomatic.”
- But the number of infected children is unknown because so many children don’t display any symptoms, she said — and that could alter COVID-19’s mortality rate.
- “So, these numbers are so skewed. I think that the mortality rate is way, way less than 0.5 percent for children who have it because it is so prevalent,” Hes said.
- “You have to remember thousands of kids die from flu a year. This is much, much less virulent in children.”
- The bigger risk lies in those infected children passing the virus to much more vulnerable populations, like the elderly or those with pre-existing health conditions.
- “The problem with children is that they are so asymptomatic that they are spreading it. And our biggest mistake was that we didn’t close the public schools when we should have,” said Hes.
- “So the children were the vectors to the teachers, who might be elderly or immunocompromised.”
- Hes said parents should only take their children to a doctor for scheduled vaccine visits or if they’re exhibiting shortness of breath.
- “[Y]ou just have to keep that child at home for 14 days. Socially distance,” she added. “When they go back out, if they’re above age 2, they should be wearing masks.”
- Children make up a small fraction of confirmed US coronavirus cases — 2,572 of the 149,082 cases reported as of April 2 for which the patient’s age was known, or about 1.7 percent.
- But Hes says the true number of pediatric cases is not known because of the limited testing available and the relatively minor threat to kids.
- “We have zero tests for children. We have zero swabs,” she said.
- “I’ve had patients whose parents have COVID, child has a 102.5 fever. At the beginning when we were doing this, we were sending them to the ER. They got turned away. They were not tested because we do not have enough tests and the kids are doing well.”
1. Coronavirus Symptoms and How to Protect Yourself: What We Know.
- Scientists and public-health officials are learning more about the new coronavirus behind a continuing pandemic. We are updating our questions and answers regularly to keep up with their findings. Here is what they know so far, and how you can minimize your risk.
What are the symptoms of Covid-19?
- The virus infects the lower respiratory tract. Patients initially develop a fever, cough and aches, and can progress to shortness of breath and complications from pneumonia, according to case reports. Of nearly 56,000 patients in China, 87.9% had a fever, 67.7% had a dry cough, 38.1% experienced fatigue, and 18.6% had shortness of breath. Other, less common symptoms included sore throat, headache, aches, chills, vomiting, diarrhea and nasal congestion. [Note: Loss of smell is also being reported as a symptom of the virus. Also, there have been reports that some bad headaches and neck aches may be viral meningitis.]
- Some people become only mildly ill, or are infected but don’t get sick. Others are mildly ill for a few days, then rapidly develop more severe symptoms of pneumonia.
- The U.S. Centers for Disease Control and Prevention says that people with severe symptoms should seek medical treatment immediately. Those severe symptoms include:
- Difficulty in breathing or shortness of breath
- Persistent pain or pressure in the chest
- Bluish lips or face
- Coronavirus patients initially develop a fever, cough and aches, and can progress to shortness of breath and complications from pneumonia, according to case reports.
What should I do if I develop symptoms?
- If you think you have been exposed and develop symptoms, call your doctor. Ask if you can be tested. He or she will likely test you first for other respiratory infections such as the flu.
- Isolate yourself from others and limit contact with pets as well. Cover your mouth and nose with a tissue when you cough and sneeze. Follow the same precautions you would to prevent infection, washing hands regularly. Wear a face mask, if you have one, when around others at home.
How worried should I be?
- Most people who are infected might become only mildly ill, data suggest. But “mild” can be anything from a fever, cough and aches to pneumonia. So for most people it is probably not just a few sniffles. And mild or not, you’ll have to be isolated or quarantined.
- By not getting infected, you would also protect those around you, including older family members or anyone you know with heart disease or diabetes, conditions that increase risk of severe illness.
- Of 44,672 reported cases in China, 81% had mild symptoms, 13.8% were severely ill, and 4.7% were critically ill, according to the Chinese CDC. All of those who died were in critical condition.
- Public-health officials are trying to determine how many people have been infected, including those who didn’t get sick at all. They are concerned and want to contain the virus because its effects aren’t fully known. In addition, new viruses can mutate, possibly becoming more virulent as they work their way through a population.
I’m social distancing and I feel fine. Am I in the clear?
- The new coronavirus is spreading in many cities, and as long as it is spreading at this rate, there is a risk of getting it. You may not show symptoms right away. People become ill between two and 14 days after infection, or in an average of about 5 days, according to most estimates.
Is taking a common, over-the-counter cold medication helpful?
- Experts say this is helpful for controlling symptoms, which is the mainstay of treating the new coronavirus. But it isn’t a cure and won’t prevent you from infecting others.
I’ve heard I shouldn’t take ibuprofen. Is that true?
- There have been reports that use of painkillers from a class known as nonsteroidal anti-inflammatory drugs, containing ingredients like ibuprofen, might worsen Covid-19 infections. Ibuprofen is known to reduce inflammation in the body that may be needed to fight an infection. But the World Health Organization says it doesn’t recommend against the use of ibuprofen. The public health agency said it isn’t aware of evidence on the topic or negative effects in patients from ibuprofen, beyond the usual side effects. It says it is consulting with physicians who are treating patients.
Is there a test?
- Yes, there are diagnostic tests that you can get through a doctor or hospital, which are the only way to confirm for certain whether a patient has the new coronavirus or another infection. Hundreds of thousands of people have been tested in China and South Korea. In the U.S., testing was limited by problems with a CDC-developed test and narrow testing criteria. Now, more tests are being distributed and the CDC says doctors may decide whether a patient should be tested.
- Diagnostic tests are the only way to confirm for certain whether a patient has the new coronavirus or another infection.
- Blood tests are being developed and licensed to test people for antibodies to the virus, to determine how many have been infected. Some may not have gotten sick. That test could also show whether people who did get sick are immune from reinfection.
What if I have to self-isolate?
- If you are told to self-isolate, you will need to stay at home and avoid contact with others for 14 days. Try not to stay in the same room with others at the same time, the U.K.’s National Health Service recommends. Stay in a well-ventilated room with a window that can be opened. Don’t share towels, utensils or dishes with others, and wash them thoroughly after use. Clean bathrooms and surfaces regularly. Wash your hands before and after contact with pets.
- Don’t go out to public places; ask family members or friends to get groceries, medicines and other supplies for you. Ask delivery people to leave items outside.
Are there drugs to treat coronaviruses?
- There aren’t any drugs or vaccines approved specifically for the new virus. But more than three dozen are in development or being studied. The first human testing of Moderna Inc.’s experimental vaccine against the virus has begun at the Kaiser Permanente Washington Health Research Institute in Seattle. While this first part is starting early, the estimate still is that testing of the vaccine will take a year to 18 months to complete. A few other vaccine makers are developing products targeting the virus.
- Two clinical trials in China and one in the U.S. are evaluating remdesivir, an antiviral drug from Gilead Sciences Inc. that was also tested for Ebola. A malaria drug, hydroxychloroquine, has gained attention as a possible treatment, but there is insufficient scientific evidence that it works, experts say.
How do I keep from getting Covid-19?
- Schools, workplaces and other public gathering places have been closed in many places, and officials are recommending—and in some cases, requiring—that people remain in their homes and away from exposure to other people while the coronavirus continues to spread.
Who is most at risk?
- Adults of all ages have been infected, but the risk of severe disease and death is highest for older people and those with underlying health conditions such as heart disease, chronic lung disease, cancer and diabetes. Most of the 1,023 people whose deaths were included in a study by the Chinese Center for Disease Control and Prevention were age 60 or older, and/or had other illnesses. Many patients who have died were admitted to hospitals when their illness was advanced. One large study in China found a mortality rate of 14.8% in people ages 80 and older, and 8% in people ages 70 to 79, compared with a 2.3% mortality rate overall in the population studied. [Note: studies have indicated that obesity and being 65 or more years old are the two greatest risk factors, and other studies have indicated that the most at risk have multiple underlying health conditions.]
Are my children at risk?
- Few children have been reported with the infection, but that could change. Of the children who were infected in China, only a small proportion were severely ill, according to the WHO. While the disease is mild for teens and younger adults, some have had severe illnesses and died. Of 121 U.S. patients admitted to an intensive care unit, 12% were adults between the ages of 20 and 44, according to a study by the U.S. CDC.
How at risk is someone in the U.S.?
- Covid-19 has spread rapidly, with cases identified in all 50 states and large outbreaks in some areas. Federal, state and local officials are taking unprecedented steps to try to minimize transmission, such as banning large gatherings and imposing restrictions on movement. Everyone in the U.S. is being advised to adhere to these measures for their own safety and to protect others, particularly those at highest risk.
- The number of confirmed cases is substantially lower than the number of actual infections, public-health officials say, because of a shortage of tests and because many people who get infected might not be sick enough to realize it.
- Public-health officials hope to “flatten the curve” of infections with the social-distancing measures, slowing the spread of the virus so that fewer people are infected. That’s important to keep more people healthy and prevent hospitals from becoming too overwhelmed to care for all of the sick.
How is the virus spread among humans?
- It transmits through “respiratory droplets” when an infected person speaks, coughs or sneezes, according to the WHO. The droplets spread through the air and can land on another person’s mouth or nose, or possibly be inhaled into their lungs, infecting them. The droplets can also settle on nearby surfaces like a desk, counter or doorknob, where they can survive for a period. A person can become infected by touching a contaminated surface, then touching their mouth, nose or eyes.
- Respiratory droplets are heavy and don’t travel far in the air, so transmission is believed to occur mostly through close contact, meaning within 6 feet of an infected person. [Note: recent studies have indicated that the virus can be aerosolized through small droplets that remain in the air for hours. Also, at least one study has indicated that 6 feet may not be enough distance.]
- Scientists are also investigating whether the new coronavirus might spread through urine or feces. Tests have found it in the digestive tract of some patients.
How long can the virus survive on surfaces?
- It can last up to 72 hours on plastic and stainless steel, up to 24 hours on cardboard and four hours on copper, according to a study in the New England Journal of Medicine by U.S. government and academic scientists. But it degrades quickly, said Vincent Munster, a virologist with the National Institute of Allergy and Infectious Diseases who led the research. [Note: Some studies have indicated that the virus can survive on surfaces for longer periods of time.]
- The study also showed that the virus can survive in small droplets, known as aerosols, for about three hours, though it disintegrates over time. These droplets are small enough to remain suspended in the air for half an hour to an hour, depending on air flow, Dr. Munster said.
- Wipe down countertops, doorknobs and other commonly touched surfaces frequently. Regular household disinfectant wipes and cleaners kill the virus.
Can face masks protect you?
- Health experts and mask makers say only a properly used reusable N95 respirator mask certified by an independent agency can guard fully against the virus. Surgical masks and even cloth masks can provide some protection, though. The U.S. CDC recommends that people wear cloth masks or face coverings—even a bandanna or scarf will do—in public places like grocery stores where social distancing may be difficult.
- Surgical masks and even cloth masks can provide some protection against the virus.
- Cloth masks or coverings don’t fully protect wearers from becoming infected because they aren’t completely sealed on the face, according to experts. But they can help prevent people who are infected from spreading the virus by catching droplets emitted while exhaling, coughing or sneezing. They shouldn’t be used on children under 2 years old or anyone who has trouble breathing, the CDC says. The CDC asks people to use nonmedical masks because supplies of masks are short and should be saved for health-care workers and caregivers.
What else can I do to protect myself?
- The most important thing you can do is wash your hands frequently, for at least 20 seconds each time. Wash them regularly when you are at the office, when you come home, before you eat and other times that you are touching surfaces. You can also use a hand sanitizer that contains at least 60% alcohol. Don’t touch your eyes, nose or mouth—viruses can enter your body that way. Wipe down objects and surfaces frequently with household cleaner, which will kill the virus. Maintain a distance from people who are sick. Stay about 6 feet or more away from others.
- Stock up on some supplies when recommended to stay home, infectious-disease experts say. Items to consider include shelf-stable foods like cans of beans, packages of rice and pasta, and beverages; pain relievers and other common medications; extra prescription medications; and hygiene and cleaning products.
Is it safe to travel internationally?
- The State Department advises U.S. citizens to avoid all travel abroad due to the global impact of Covid-19, and has urged Americans currently abroad to return home immediately. Citizens living abroad are also advised to avoid all international travel. Those who are in countries where outbreaks are occurring should stay home as much as possible, limit contact with others and follow guidelines from the CDC to prevent infection, U.S. authorities say.
Can I donate blood?
- The CDC, American Red Cross and U.S. Surgeon General are encouraging people to donate blood, if they are able and healthy. “Social distancing does not have to mean social disengagement,” said Surgeon General Jerome Adams.
- To minimize risks of exposure to the new coronavirus, the CDC has recommended that blood centers keep donor chairs 6 feet apart and encouraged people to make appointments ahead of time to minimize crowding.
How easily does the virus spread?
- Disease-modeling experts have estimated that on average, each infected person has transmitted the virus to about 2.6 others, though the range is between 1.5 and 3.5 and one recent report put that number as high as 5.7 for the epidemic in China. Those rates are higher than for some influenza viruses; some are lower than for SARS; and they are far lower than for measles, in which one infected person can transmit the virus to 12 to 18 other people.
- Public-health experts caution that these estimates are preliminary, change over time and can be lowered by measures to prevent the virus from spreading.
- Experts are debating how easily the virus is transmitted. The WHO-led mission of experts who visited China reported that clusters of transmission occurred largely in families, suggesting close contact. Other outbreaks suggest more widespread patterns.
What is the incubation period?
- People become ill between two and 14 days after infection, according to most estimates. One report described a person who became ill 27 days after infection. However, a study by researchers at Johns Hopkins University found that the median incubation period is 5.1 days, and 97.5% of those who develop symptoms will do so within 11.5 days.
Can you get infected after you have already had the disease?
- That isn’t yet known. Sometimes a person is immune to a disease after an infection, but not always. Blood tests that reveal how many antibodies people who have recovered have will shed some light on the prospects for immunity.
Can you catch the virus from someone even before they have symptoms?
- Several studies have now shown that people who have no symptoms, early symptoms or mild symptoms can transmit the virus to others. Scientists say this type of transmission might be common, and a possible explanation for why the virus spreads so quickly. They are studying it further. The CDC advises people to maintain a safe distance—6 feet or more—from others if Covid-19 is spreading in their communities.