Coronavirus Update 4-22

The first featured story (here) includes very important information that can make the difference between life and death for anyone who becomes infected with COVID-19. So please read it, and then buy a pulse oximeter asap (they have become hard to find as the demand has spiked but are currently available on Amazon).

“President Trump Right About Critics Playing ‘Blame Game’ During Coronavirus Pandemic.” NY Governor Cuomo

“Our Federal Constitutional Rights Don’t Go Away in an Emergency.” Attorney General Bill Barr

Today’s Features

Recent Developments and Headlines
Numbers and Trends
From the Frontline-Must Read Article
Potential Treatments
New Scientific Findings
Infections and Reopening
Updates — Hydroxychloroquine
COVID-19 – Comparison with other Deaths & Diseases
Technology Takes on the Coronavirus
Projections and Our (Possible) Future

Connect with us and receive the Coronavirus Update in your inbox every morning– send us an email at info.dailycovid19post@gmail.com.

Available Resource: Having put together almost 60 daily updates, our team has compiled and distributed a tremendous amount of information about the coronavirus and COVID-19 and we are happy to share what we know. So, if you have any questions regarding the virus or disease, please feel free to contact either pwduval@gmail.com or brian.sivy@gmail.com. We’d be happy to respond by email or arrange a call with you or anyone you know as soon as we can.

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 4/21 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 = 2,555,760 (+3%) (+73,183)
US Total Cases = 818,714 (+3.3%)
US New Cases = 25,985 (-7.6%) (-2,138)
NY New Cases = 4,461 (-8.6%) (-418)
Worldwide deaths = 177,459 (+4.1%) (+7,062)
US deaths = 45,318 (+6.6%) (+2,804)
WHO chief warns worst of coronavirus pandemic still ahead
New York sees total new cases decline for 6th day – smallest jump in new cases in a month
NYC Mayor de Blasio says virus hospitalizations down, ICU admissions up
Georgia, Tennessee & South Carolina unveil plans to start reopening economies by Tuesday
Colorado Gov. Jared Polis Announces Plan to Partially Reopen State
NY Gov. Cuomo: State’s coronavirus reopening may unfold region by region
Cuomo tells President Trump that NYC no longer needs USNS Comfort
JP Morgan has developed plan to get employees back in the office
CA Gov. Newsom says “now is not the time” to reopen the country
Atlanta Mayor ‘Perplexed’ by Decision to Reopen State: ‘I Don’t See that It’s Based on Anything that’s Logical’
Harvard panel of experts: US must conduct 20,000,000 coronavirus tests a day to fully reopen
Former FDA Commissioner Gottlieb says true # of US cases likely “10x higher” than official total
AG Barr says Department of Justice may sue some States with strict virus limits that violate constitutional rights
Wisconsin Republicans file lawsuit to block state’s stay-at-home order
Singapore extends lockdown until end of June, longest in the world
Iraq resists Iranian pressure to reopen their border
France suspends flights outside the Schengen area
Ireland won’t allow mass gatherings until August “at the earliest”
Italy set to ease coronavirus lockdown from May 4
A port city in Ecuador becomes an epicenter of the outbreak in Latin America
UK Parliament Reopens — With Zoom
25+ French Cities and Towns Erupt in Riots
Demonstrators fill the streets of Paris
Several Hundred Protest in Raleigh, Call on Governor to Reopen North Carolina
Italy Sees a Decline in Coronavirus Cases, Deaths
Spain caves, decides to let children under 14 leave the house unaccompanied
Black Market Demand for COVID-19-Fighting HIV Drug Surges In Russia
Fla. reports 835 new cases
California reports highest one-day rise in coronavirus cases
NJ deaths hit high
Sweden sees another jump in cases
NYPD Confiscates Drone Belonging To Freelance Photojournalist Documenting NYC’s Mass Burials
Missouri Sues China, Wuhan Lab Over COVID; Says ‘Deceit, Malfeasance, And Inaction Unleashed This Pandemic’
‘It’s Not The Same’: College Students Revolt Against Online Classes, Sue For Tuition Refunds
Rabobank: Perhaps We Can Store All The Oil In WeWork Offices
“New Normal” – Demand For Thermal Imaging Cameras Soar During Pandemic
Rich Americans Flee To Luxury ‘Doomsday Resort’ Shelters In New Zealand As Panic Grows
Social Distancing Sacrifice: Texas ER Doctor Lives In Treehouse To Keep Family Safe
Pentagon Pressures Mexico To Reopen Factories Vital To Making US Weapons
Russia Cancels Victory Day Parade, Quarantines 15,000 Troops
Drive-Through Food Bank in Hartford Draws Massive Lines During Coronavirus Pandemic
Amazon Begins Accepting Food Stamps as Stock Price Soars
American Workers Live at Factory for 28 Days to Make Coronavirus Protective Material
Study: Coronavirus Will Shut Down 47% of World’s Sporting Events in 2020
Poll shows sports fans remain wary of attending games again
UK: Scientific Evidence for Coronavirus Response Will Be Kept Secret Until Pandemic Is Over
Mafia Boss Caught Hoarding Tons of Sanitizer
UK Reliant on PPE from China and Turkey
Dad killed by coronavirus after dismissing ‘bulls***’ lockdown as a ‘political ploy’
Many New York City residents are packing up their apartments and heading for the hills or suburbs to escape the pandemic—some permanently
Gov. Jim Justice: Coronavirus May Drive Urban Exodus, Return to Rural Life
Coronavirus is largely spread by people without symptoms.
Food Rationing Is New Reality for Buyers Once Spoiled for Choice
De Blasio Says NYC Will Hold Ticker Tape Parade After Pandemic Ends
US university stops using Chinese testing kits after some found to be contaminated
Quarantine Quality Time: 4 in 5 Parents Say Coronavirus Lockdown Has Brought Family Closer Together
Conspiracy theorists burn 5G towers claiming link to virus
The Death of the Department Store: ‘Very Few Are Likely to Survive’
Pandemic and chill: Netflix adds a cool 16M subscribers
Netflix Swears It Won’t Run Out of TV Shows During the Pandemic
Virus Risks Political and Social Unrest For Some Countries With Hunger Rising
Quad bike cops flying a drone swoop on a sunbather lying on a deserted beach and fine him for breaking lockdown in Italy
Indonesia’s Aceh holds public floggings despite virus fears
Huge birds eat pet dogs after lockdown leaves streets empty of food
Connecticut cops deploy ‘pandemic drone’ to combat coronavirus
Georgia barbers should get ‘creative’ to safely cut hair, Dr. Birx says
Doctors seek execution drugs to treat coronavirus patients
Man runs ‘Boston Marathon’ by doing 1,098 laps on NYC roof
Trump pledged to help New York with coronavirus testing, Cuomo says
NYC restaurants worry customer-density rules will sour reopenings
Hear our prayers: Coronavirus cuts off France’s Mont Saint-Michel
Testing shows at least 200,000 in LA County may have been infected with coronavirus
Military continues to diagnose more than 100 new coronavirus cases a day
Air Force building Guam hospital for USS Theodore Roosevelt sailors with coronavirus
Dogs could get extreme separation anxiety after quarantine ends
Video game industry sees best March sales since 2008
Littered masks and gloves filling streets, becoming safety hazard
Social-distancing complaints surge in NYC after de Blasio’s call for tips
‘They simply let you die:’ State issues do-not-resuscitate rule for cardiac patients
Flood of prank messages caused NYC’s coronavirus ‘snitch number’ to briefly shut down
Urbana University in Ohio to close permanently due to coronavirus
Canada now requiring people to cover their faces on all flights
Skin rashes could be another surprising symptom of the coronavirus
Canada calls for probe into WHO’s coronavirus response
Staten Island cemetery races to keep up as coronavirus deaths mount
Spain cancels July’s Running of the Bulls due to coronavirus
Munich’s Oktoberfest celebrations canceled amid coronavirus pandemic
National Spelling Bee canceled for first time since 1945
Rich people doing chores for first time: ‘It’s been a complete shock’
Recreational drug shortage could hit NYC thanks to coronavirus: DEA
Some are pulling own teeth in coronavirus crisis
LA residents are putting off hospital visits over coronavirus fears
De Blasio says Macy’s July 4th fireworks show ‘hard to see right now’
Chile to issue world’s first ‘immunity passports’ to recovered coronavirus patients
Coronavirus could double number of people who go hungry
Holocaust survivor who escaped Nazi death march dies of coronavirus
Lululemon apologizes after backlash over bigwig’s ‘bat fried rice’ shirt
40% say immediate family member out of work due to coronavirus
Electronic dance festivals are off in the Netherlands. Yes, that’s a big deal
In Poland, Communist-era milk bars offer comfort in a strange time
China’s propaganda machine highlights other countries’ mistakes while suppressing its own

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.

Sources: Worldometers and ncov2019.live

1. Confirmed Total Cases and New Cases

Worldwide:
- Total Cases = 2,555,760 (+3%)
- New Cases = 73,183 (-3.7%) (-2,819)
Europe:
- Total Cases = 1,140,051 (+2.4%)
- New Cases = 26,955 (+13.1%) (+3.115)
Asia:
- Total Cases = 410,260 (+3.5%)
- New Cases = 13,764 (+3.2) (+425)
US:
- Total Cases = 818,714 (+3.3%)
- New Cases = 25,985 (-7.6%) (-2,138)
US States & Territories:
- 42 States > 1,000 cases (+0), plus DC, US Military & Puerto Rico
- 33 States > 2,500 cases (+0), plus DC & US Military
- 21 States > 5,000 cases (+0)
- 16 States > 10,000 cases (+0): NY, NJ, MA, PA, CA, MI, IL, FL, LA, TX, GA, CT, MD, WA, OH & IN
- 9 States > 20,000 cases (+0): NY, NJ, MA, PA, CA, MI, IL, FL & LA
- 5 States With Largest Number of Total Cases:

State	Total Cases	Change in Total Cases (%)	New Cases	Change in New Cases (#)	Change in New Cases (%)
NY	265,555	1.8%	4,461	(418)	(8.6%)
NJ	92,387	4.0%	3,581	76	2.2%
MA	41,199	3.9%	1,556	(10)	(0.6%)
CA	35,643	5.8%	1,957	(202)	(9.4%)
PA	35,293	4.1%	1,379	199	16.9%
Total	461,077	2.3%

Top 5 States = 58% of Total Cases in US (+1.5%)
NY & NJ = 44% of Total Cases in US (+1%)
For more information on US States and territories, see https://ncov2019.live/data & https://www.worldometers.info/coronavirus/country/us/

2. Serious or Critical Cases

Worldwide serious or critical cases = 57,257 (+491)
US series or critical cases = 14,016 (+65)
US serious or critical cases = 2.0% of Active Cases compared with worldwide percentage of 3.4%

3. Deaths

Worldwide deaths = 177,459 (+4.1%) (+7,062)
Europe deaths = 107,906 (+3.3%) (+3,415)
US deaths = 45,318 (+6.6%) (+2,804)
NY deaths = 19,693 (+4.0%) (+764)
Deaths per 1M population of 5 Countries with Largest Number of Confirmed Cases:
- Italy: 408 (+9)
- Spain: 455 (+9)
- US: 137 (+9)
- France: 319 (+9)
- Germany: 61 (+3)
US Total Confirmed Case Fatality Rate = 5.4% compared with a Worldwide Confirmed Case Fatality Rate of 6.9% [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 calculate or estimate the actual fatality rate.]

4. Recoveries

Worldwide recoveries = 690,226 (+5.8%) (+37,706)
US recoveries = 82,923 (+14.6%) (+10,534)
US recoveries = 10.1% of Total US Cases

C. From the Frontline

1. You Feel Fine, But You May Be Suffering from Hypoxia, which Can Quickly Lead to a Ventilator and Death

The following story details what was learned by Dr. Richard Levitan during 10 days of treating COVID-19 pneumonia at Bellevue Hospital. Dr. Levitan, an emergency physician in Littleton, N.H., is president of Airway Cam Technologies, a company that teaches courses in intubation and airway management.

Key Takeaways:

Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature.
But when Covid pneumonia first strikes, patients don’t feel short of breath, even as their oxygen levels fall. And by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia (as seen on chest X-rays).
Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition.
A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were using their cellphones as we put them on monitors. Although breathing fast, they had relatively minimal apparent distress, despite dangerously low oxygen levels and terrible pneumonia on chest X-rays.
By the time patients have noticeable trouble breathing and present to the hospital with dangerously low oxygen levels, many will ultimately require a ventilator. And once on ventilators, many die.
Silent hypoxia progressing rapidly to respiratory failure explains cases of Covid-19 patients dying suddenly after not feeling short of breath.
And because so many patients are not going to the hospital until their pneumonia is already well advanced, many wind up on ventilators, causing shortages of the machines.
There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.
Widespread pulse oximetry screening for Covid pneumonia — whether people check themselves on home devices or go to clinics or doctors’ offices — could provide an early warning system for the kinds of breathing problems associated with Covid pneumonia.
We must direct resources to identifying and treating the initial phase of Covid pneumonia earlier by screening for silent hypoxia. It’s time to get ahead of this virus instead of chasing it.

Story: This is what I learned treating Covid-19 pneumonia

I have been practicing emergency medicine for 30 years. In 1994 I invented an imaging system for teaching intubation, the procedure of inserting breathing tubes. This led me to perform research into this procedure, and subsequently teach airway procedure courses to physicians worldwide for the last two decades.
So at the end of March, as a crush of Covid-19 patients began overwhelming hospitals in New York City, I volunteered to spend 10 days at Bellevue, helping at the hospital where I trained. Over those days, I realized that we are not detecting the deadly pneumonia the virus causes early enough and that we could be doing more to keep patients off ventilators — and alive.
On the long drive to New York from my home in New Hampshire, I called my friend Nick Caputo, an emergency physician in the Bronx, who was already in the thick of it. I wanted to know what I was facing, how to stay safe and about his insights into airway management with this disease. “Rich,” he said, “it’s like nothing I’ve ever seen before.”
He was right. Pneumonia caused by the coronavirus has had a stunning impact on the city’s hospital system. Normally an E.R. has a mix of patients with conditions ranging from the serious, such as heart attacks, strokes and traumatic injuries, to the nonlife-threatening, such as minor lacerations, intoxication, orthopedic injuries and migraine headaches.
During my recent time at Bellevue, though, almost all the E.R. patients had Covid pneumonia. Within the first hour of my first shift I inserted breathing tubes into two patients.
Even patients without respiratory complaints had Covid pneumonia. The patient stabbed in the shoulder, whom we X-rayed because we worried he had a collapsed lung, actually had Covid pneumonia. In patients on whom we did CT scans because they were injured in falls, we coincidentally found Covid pneumonia. Elderly patients who had passed out for unknown reasons and a number of diabetic patients were found to have it.
And here is what really surprised us: These patients did not report any sensation of breathing problems, even though their chest X-rays showed diffuse pneumonia and their oxygen was below normal. How could this be?
We are just beginning to recognize that Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature.
Pneumonia is an infection of the lungs in which the air sacs fill with fluid or pus. Normally, patients develop chest discomfort, pain with breathing and other breathing problems. But when Covid pneumonia first strikes, patients don’t feel short of breath, even as their oxygen levels fall. And by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia (as seen on chest X-rays). Normal oxygen saturation for most persons at sea level is 94 percent to 100 percent; Covid pneumonia patients I saw had oxygen saturations as low as 50 percent.
To my amazement, most patients I saw said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only became short of breath the day they came to the hospital. Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition.
In emergency departments we insert breathing tubes in critically ill patients for a variety of reasons. In my 30 years of practice, however, most patients requiring emergency intubation are in shock, have altered mental status or are grunting to breathe. Patients requiring intubation because of acute hypoxia are often unconscious or using every muscle they can to take a breath. They are in extreme duress. Covid pneumonia cases are very different.
A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were using their cellphones as we put them on monitors. Although breathing fast, they had relatively minimal apparent distress, despite dangerously low oxygen levels and terrible pneumonia on chest X-rays.
We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps keep the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath.
Patients compensate for the low oxygen in their blood by breathing faster and deeper — and this happens without their realizing it. This silent hypoxia, and the patient’s physiological response to it, causes even more inflammation and more air sacs to collapse, and the pneumonia worsens until their oxygen levels plummet. In effect, the patient is injuring their own lungs by breathing harder and harder. Twenty percent of Covid pneumonia patients then go on to a second and deadlier phase of lung injury. Fluid builds up and the lungs become stiff, carbon dioxide rises, and patients develop acute respiratory failure.
By the time patients have noticeable trouble breathing and present to the hospital with dangerously low oxygen levels, many will ultimately require a ventilator.
Silent hypoxia progressing rapidly to respiratory failure explains cases of Covid-19 patients dying suddenly after not feeling short of breath. (It appears that most Covid-19 patients experience relatively mild symptoms and get over the illness in a week or two without treatment.)
A major reason this pandemic is straining our health system is the alarming severity of lung injury patients have when they arrive in emergency rooms. Covid-19 overwhelmingly kills through the lungs. And because so many patients are not going to the hospital until their pneumonia is already well advanced, many wind up on ventilators, causing shortages of the machines. And once on ventilators, many die.
Avoiding the use of a ventilator is a huge win for both patient and the health care system. The resources needed for patients on ventilators are staggering. Vented patients require multiple sedatives so that they don’t buck the vent or accidentally remove their breathing tubes; they need intravenous and arterial lines, IV medicines and IV pumps. In addition to a tube in the trachea, they have tubes in their stomach and bladder. Teams of people are required to move each patient, turning them on their stomach and then their back, twice a day to improve lung function.
There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.
Pulse oximetry is no more complicated than using a thermometer. These small devices turn on with one button and are placed on a fingertip. In a few seconds, two numbers are displayed: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting oxygenation problems and elevated heart rates.
Pulse oximeters helped save the lives of two emergency physicians I know, alerting them early on to the need for treatment. When they noticed their oxygen levels declining, both went to the hospital and recovered (though one waited longer and required more treatment). Detection of hypoxia, early treatment and close monitoring apparently also worked for Boris Johnson, the British prime minister.
Widespread pulse oximetry screening for Covid pneumonia — whether people check themselves on home devices or go to clinics or doctors’ offices — could provide an early warning system for the kinds of breathing problems associated with Covid pneumonia.
People using the devices at home would want to consult with their doctors to reduce the number of people who come to the E.R. unnecessarily because they misinterpret their device. There also may be some patients who have unrecognized chronic lung problems and have borderline or slightly low oxygen saturations unrelated to Covid-19.
All patients who have tested positive for the coronavirus should have pulse oximetry monitoring for two weeks, the period during which Covid pneumonia typically develops. All persons with cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing, or even if their swab test was negative, because those tests are only about 70 percent accurate. A vast majority of Americans who have been exposed to the virus don’t know it.
There are other things we can do as well to avoid immediately resorting to intubation and a ventilator. Patient positioning maneuvers (having patients lie on their stomach and sides) opens up the lower and posterior lungs most affected in Covid pneumonia. Oxygenation and positioning helped patients breathe easier and seemed to prevent progression of the disease in many cases. In a preliminary study by Dr. Caputo, this strategy helped keep three out of four patients with advanced Covid pneumonia from needing a ventilator in the first 24 hours.
To date, Covid-19 has killed more than 40,600 people nationwide — more than 10,000 in New York State alone. Oximeters are not 100% accurate, and they are not a panacea. There will be deaths and bad outcomes that are not preventable. We don’t fully understand why certain patients get so sick, or why some go on to develop multi-organ failure. Many elderly people, already weak with chronic illness, and those with underlying lung disease do very poorly with Covid pneumonia, despite aggressive treatment.
But we can do better. Right now, many emergency rooms are either being crushed by this one disease or waiting for it to hit. We must direct resources to identifying and treating the initial phase of Covid pneumonia earlier by screening for silent hypoxia.
It’s time to get ahead of this virus instead of chasing it.

Source: Opinion | The Infection That’s Silently Killing Coronavirus Patients

D. Potential Treatments and Testing

1. Hundreds Receive Plasma From Recovered Coronavirus Patients

600 severely ill Covid-19 patients have received blood plasma from recovered patients in a study researchers hope sheds light on whether the experimental therapy improves health outcomes and yields other useful data outside the scientific rigor of a traditional clinical trial.
The patients are participating in a national expanded-access program authorized in early April by the federal Food and Drug Administration. Expanded access, also known as compassionate use, is often sought by patients with life-threatening illnesses for which there are no approved therapies, or who can’t participate in clinical trials.
The utility of data from compassionate-use studies is a source of debate within the medical and scientific community, where the gold standard for determining a new drug’s safety and efficacy has long been the controlled clinical trial. In those traditional randomized trials, one group of patients gets the experimental drug and a control group gets either the standard therapy or a placebo.
Critics say it is impossible for compassionate-use studies to show whether a drug is working, because every patient in those studies gets the compound, with no control group for comparison. Opponents also worry that patients could become reluctant to enroll in traditional clinical trials for fear they won’t get the experimental therapy.
Without a control group, though, researchers can’t be certain what is making the difference. Age, gender, weight, underlying health conditions, socioeconomic status and doctors’ own biases all can influence a patient’s outcome. And in many diseases, including Covid-19, some patients are going to get better on their own. As a result, compassionate use has been viewed as a way to give patients emergency access to experimental therapies rather than a source of reliable data.
“Will expanded access give us the same data as a perfect randomized, controlled trial? No,” said Michael Joyner of the Mayo Clinic in Rochester, Minn., and principal investigator of the expanded-access convalescent plasma project. “Will we gain insight under unusual circumstances? Yes.”
As of Sunday, the University Hospital in Madison, Wis., part of UW Health, had transfused 11 Covid patients with convalescent plasma under the expanded-access protocol, said William Hartman, an anesthesiologist and one of the investigators on the study. Eight of the patients were in life-threatening situations and now are in various stages of recovery, he said. The other three received plasma before or just after admission to the intensive-care unit and have shown improvement: One was discharged from the hospital; one was taken off a ventilator within a day and symptoms have improved. The third hasn’t worsened and hasn’t required ICU admission, he said.
“There is no lab test that proves convalescent plasma caused these results,” Dr. Hartman said. “Based on when we gave them the transfusion and the outcomes, we are encouraged.”
Between 5,000 and 10,000 people may ultimately be eligible to enroll in the convalescent plasma program, the Mayo Clinic’s Dr. Joyner said. Investigators will compare patients who get the plasma with similar patients who didn’t receive it, such as very ill patients at a hospital where the therapy wasn’t available. Researchers hope the knowledge they gather can inform future trials and aid doctors and researchers in another outbreak.
Another analysis of compassionate-use data, about the experimental drug remdesivir from Gilead Sciences Inc. published in the New England Journal of Medicine, came under criticism. Scientists pointed out that the Covid-19 patients received the drug in centers around the world where care may have differed, data on some patients was incomplete and there was no comparison group.
That study’s first author, Jonathan Grein, of Cedars-Sinai Medical Center in Los Angeles, said given how little is known about the coronavirus and how to treat it, “I think at this point any information is potentially helpful.” He said the study, funded by Gilead Sciences, noted the findings were limited and preliminary. “It is a starting point, an opportunity to aggregate our initial experiences,” he said.
There also are traditional randomized controlled studies of remdesivir under way.
The FDA has shown flexibility in accepting expanded-access data during the drug-approval process, particularly for rare conditions. The FDA also has worked closely with companies trying to extract “real world evidence” about patients’ experiences with new or experimental drugs from sources such as electronic health records.
Convalescent plasma has been tried as a potential intervention in previous public-health emergencies, including for Ebola and severe acute respiratory syndrome (SARS), according to H. Clifford Lane, clinical director at the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health. But because robust randomized clinical trials weren’t conducted, “there is still no clear data to support that it has been of benefit.”
Even with the added rigor, Dr. Lane said it would be difficult to tell whether plasma therapy or something else is responsible for any possible improvement in the Covid-19 patients. “Maybe the patients improved because as doctors got more practice treating Covid patients they did a better job, and not because the intervention had an effect,” he said. In the end, “thousands of anecdotes are still just thousands of anecdotes.”
Dr. Lane said the NIH is involved in efforts to launch randomized controlled clinical trials of manufactured intravenous immunoglobulin containing antibodies prepared from the serum of many recovered Covid patients.
Holly Fernandez Lynch, an assistant professor of medical ethics at the University of Pennsylvania, said she supports trying to glean as much information as possible from the use of experimental therapies. Nonetheless, since very little is yet known about the coronavirus itself, patient outcomes will be even more difficult to analyze compared with better-understood diseases.
“There is a sense of emergency and feeling we don’t have time to get answers,” she said. “If we keep acting like we can’t study the interventions, then we will be in the same position next time and still not know how to effectively treat people.”
Still, the compassionate-use data on plasma therapy may help shape future studies. Peter Marks, director of the FDA Center for Biologics Evaluation and Research, said, “They may get a readout on some questions sooner than we would have, had this been a conventional trial.”
Other randomized controlled trials in the works include one to test convalescent plasma given prophylactically to those at risk of Covid-19 infection, says Shmuel Shoham of Johns Hopkins University School of Medicine, the principal investigator on that trial. With Covid-19, there is room for both broad access to experimental therapies and controlled trials, he said. “There are enough questions that are worth investigating, and sadly a lot of patients.”

Source: Hundreds Receive Plasma From Recovered Coronavirus Patients in National Study

2. LabCorp’s at-home test kit is the first to be authorized by FDA

LabCorp’s at-home COVID-19 test, which is called ‘Pixel,’ has received the first Emergency Use Authorization (EUA) for such a test missed by the U.S. (FDA). The test is an at-home collection kit, which provides sample collection materials including a nasal swab to the user, who then uses the included shipping package to return the sample to a lab for testing.
Until now, the FDA has not authorized any at-home testing or sample collection kits for use, and in fact clarified its guidelines to specifically note that their use was not authorized under its guidelines when a number of startup companies debuted similar products for at-home collection and round-trip testing with labs already certified to run molecular RT-PCR tests to detect the presence of COVID-19.
The FDA notes that only LabCorp’s COVID-19 RT-PCR test has received this authorization, and that it still requires any such test to have an EUA before they can being offering services, whether or not the test is administered at home with the help of guidance from an authorized medical professional via telemedicine. Some labs facilitating at home serology tests using an exception in the FDA guidelines, but these are not viewed by the agency as tests that can confirm a case of COVID-19.
Opening up at-home testing (even via just sample collection, vs. full at-home test administration) is a big step in terms of a change in the way the agency has operated thus far. The FDA has recently updated its guidelines to note that it is working with at-home test providers to determine the best way to make those available to the public, since it “sees the public health value in expanding the availability of COVID-19 testing through safe and accurate tests that may include home collection.”
LabCorp is a U.S. medical diagnostics company with over 40 years of experience, including at-home testing via its Pixel line for colorectal cancer, diabetes, and cardiac lipid conditions. It seems like the FDA is favoring long-standing industry experience in terms of who it’s willing to open up authorizations for with at-home collection, which is likely due to the potential for increased error when you add unsupervised self-collection, packing and logistics into the mix.
Testing for COVID-19 in the U.S. currently relies on drive-through sites, as well as in-clinic and hospital testing. These tests have a high bar for access in terms of risk profile and symptom presentation, and their administration also exposes the healthcare professionals running them to risk of contracting the infection themselves. At-home testing could increase overall testing rates, while decreasing risk to frontline healthcare workers, providing a better picture of the true extent and depth of the COVID-19 pandemic.

Source: LabCorp’s at-home COVID-19 test kit is the first to be authorized by the FDA

E. New Scientific Findings and Other Advances

1. Coronavirus attacks lining of blood vessels all over the body

The coronavirus attacks the lining of blood vessels all over the body, which can ultimately lead to multiple organ failure, according to a new study published in The Lancet.
“This virus does not only attack the lungs, it attacks the vessels everywhere,” said Frank Ruschitzka, an author of the paper from University Hospital Zurich.
He said the researchers had found that the deadly virus caused more than pneumonia.
“It enters the endothelium [layer of cells], which is the defense line of the blood vessels. So it brings your own defense down and causes problems in microcirculation,” said Ruschitzka, referring to circulation in the smallest of blood vessels.
It then reduces the blood flow to different parts of the body and eventually stops blood circulation, according to Ruschitzka, chairman of the heart centre and cardiology department at the university hospital in Switzerland.
“From what we do see clinically, patients have problems in all organs – in the heart, kidney, intestine, everywhere,” he said.
That also explained why smokers and people with pre-existing conditions who had a weakened endothelial function, or unhealthy blood vessels, were more vulnerable to the novel virus, he said.
Those underlying conditions included hypertension, or high blood pressure, diabetes, obesity and established cardiovascular disease.
The study, published on Friday, found viral elements within endothelial cells, which line the inside of blood vessels, and inflammatory cells in Covid-19 patients.
While the results were based on analysis of three cases, Ruschitzka said autopsies on other Covid-19 patients had also found their blood vessel linings were “full of virus” and the function of vessels was impaired in all of their organs.
One of the cases was a 71-year-old Covid-19 patient with coronary artery disease and arterial hypertension who had developed multisystem organ failure and died, according to the study.
A postmortem analysis of his transplanted kidney showed viral structures in the endothelial cells. Researchers also found inflammatory cells in the heart, small bowel and lungs, where most small vessels appeared congested.
Another 58-year-old patient with diabetes, arterial hypertension and obesity developed mesenteric ischemia, or decreased blood flow to the small intestine that can permanently damage the organ. Lymphocytic endotheliitis, which causes inflammation of the endothelium, was also found in her lungs, heart, kidneys and liver.
Based on these findings, the researchers suggested therapies to stabilize the endothelium while tackling viral replication.
On top of a vaccination that reduces virus replication, Ruschitzka suggested strengthening vascular health may be key to treating Covid-19 patients.
“All patients who are at risk and the elderly should be treated very well for the underlying cardiovascular conditions. The better they are treated, the more likely they are to survive the Covid-19 infection,” he said.
“We know that angiotensin-converting enzyme inhibitors [heart medications used to treat high blood pressure] and anti-inflammatory drugs [make the endothelium stronger],” he said.
John Nicholls, a clinical professor in pathology at the University of Hong Kong, said more research was needed.
“While many structures may seem to resemble viral particles using the electron microscope, other laboratory techniques should be done to confirm true viral infection,” he said.

Source: Coronavirus attacks blood vessels all over the body, Swiss study finds

2. Coronavirus has mutated into more than 30 strains

Scientists in China have discovered more than 30 mutations of the new coronavirus, which they say may partly explain why it has been more deadly in certain parts of the world.
Researchers from Zhejiang University said they have “direct evidence” that the virus “has acquired mutations capable of substantially changing its pathogenicity”.
The study was written by a team including Professor Li Lanjuan, one of China’s top scientists who was reportedly the first expert to propose a lockdown in Wuhan – where COVID-19 originated.
Samples were taken from 11 patients admitted to hospitals in Hangzhou, 470 miles east of Wuhan, between 22 January and 4 February during the early phase of the outbreak.
Using “ultra-deep sequencing”, researchers identified 33 mutations of the coronavirus – known as SARS-CoV-2 – of which 19 were new.
The deadliest mutations in the patients in the study had also been found in most patients across Europe, the South China Morning Post reported.
Meanwhile, the milder strains were the predominant types found in parts of the United States, such as Washington state, the newspaper said.
One mutation found in five patients involved in the research had previously only been seen in one case in Australia, according to the study.
The researchers said the findings indicate “the true diversity of the viral strains is still largely underappreciated”.
They also warned vaccine developers need to consider the impact of these “accumulating mutations… to avoid potential pitfalls”.
In the study, the researchers assessed the viral load – meaning the amount of the virus – in human cells after one, two, four and eight hours, as well as the following day and 48 hours later.
The most aggressive strains created up to 270 times as much viral load as the least potent type, the scientists found.
Prof Li and her colleagues said their findings also indicated that a “higher viral load leads to a higher cell death ratio”.
Ten of the 11 patients involved in the study – which included eight males and three females aged between four months and 71 years old – had “moderate or worse symptoms” of COVID-19.
They have all since recovered from the virus, according to the research which has been published by medRxiv.
The findings, which have not been peer-reviewed, were approved by Zhejiang University, the study said.

Source: Coronavirus: Scientists in China find 33 mutations of virus in warning to vaccine developers

3. Sunlight destroys virus quickly, new govt. tests find, but experts say pandemic could last through summer

Preliminary results from government lab experiments show that the coronavirus does not survive long in high temperatures and high humidity, and is quickly destroyed by sunlight, providing evidence from controlled tests of what scientists believed — but had not yet proved — to be true.
A briefing on the preliminary results, marked for official use only and obtained by Yahoo News, offers hope that summertime may offer conditions less hospitable for the virus, though experts caution it will by no means eliminate, or even necessarily decrease, new cases of COVID-19, the disease caused by the coronavirus. The results, however, do add an important piece of knowledge that the White House’s science advisers have been seeking as they scramble to respond to the spreading pandemic.
The study found that the risk of “transmission from surfaces outdoors is lower during daylight” and under higher temperature and humidity conditions. “Sunlight destroys the virus quickly,” reads the briefing.
In a statement to Yahoo News, the DHS declined to answer questions about the findings and strongly cautioned against drawing any conclusions based on unpublished data.
The results are contained in a briefing by the DHS science and technology directorate, which describes experiments conducted by the National Biodefense Analysis and Countermeasures Center, a lab created after the 9/11 terrorist attacks to address biological threats.
While the DHS describes the results as preliminary, they may eventually make their way into specific recommendations. “Outdoor daytime environments are lower risk for transmission,” the briefing states.
Simulated sunlight “rapidly killed the virus in aerosols,” the briefing says, while without that treatment, “no significant loss of virus was detected in 60 minutes.”
The tests were performed on viral particles suspended in saliva. They were done indoors in environments meant to mimic various weather conditions.
While the lab results are new, scientists for many weeks have predicted, based on available data on the disease’s spread, that warmer, wetter climates would be less hospitable to the spread of the coronavirus. An early analysis by scientists observed that the virus was spreading more slowly in countries with warmer climates.
“We are not saying that at higher temperatures, the virus will suddenly go away and everything would be fine and you are going out,” Qasim Bukhari, a computational scientist at MIT and a co-author of the analysis, told Yahoo News in an interview. “No, we are not saying it. We are just seeing that there is a temperature- and humidity-related dependency, but I think many people now have started to realize this.”
The question of the effects of sunlight and heat on the coronavirus has been particularly fraught, because there has been a tendency to misinterpret the relationship between good weather and disease spread. Early on, some politicians tried to encourage people to go outside, including to beaches, arguing that sunlight would kill the virus. The problem, however, is that without widespread immunity, people can still transmit the coronavirus to others, even in warm weather.
The real question now, Bukhari said, is whether enough people have already been infected that the summer temperatures won’t prevent continued transmission.
“So let’s say 50 percent of the population is already infected, and then those temperatures arrive and then those humidity levels arrive, then what difference can those temperatures and humidity levels be? Probably none. That’s the thing.”
While the new lab results are important, the science behind how sunlight kills the virus is fairly well established, says Arthur Anderson, former director of the Office of Human Use and Ethics at the United States Army Medical Research Institute of Infectious Diseases at Fort Detrick, Md.
“[Ultraviolet] light breaks DNA into fragments. If the virus is floating around in the air and there’s bright sunlight, the UV component in sunlight will break the DNA or the RNA into pieces,” he told Yahoo News.
Infectious disease expert Dr. Anthony Fauci, who has become the leading face of the White House response, has provided cautious statements about what the summer months might mean for the coronavirus, saying recently, “It’s almost certainly going to go down a bit.” He has stopped far short, however, of saying that good weather alone would have an impact.
“Does this give a little more hope about the virus potentially decreasing?” said Dr. Kavita Patel, a Yahoo medical contributor and nonresident fellow at the Brookings Institution. “Yes. I would say even Dr. Fauci has alluded to that.”
Colds and flus don’t disappear in the summer, even if they are less common, Patel noted. “We do have cases of the flu in the summer,” she said. “That’s why all of us in medicine are being a little more guarded.”
The lab’s work was done in a controlled environment, according to the DHS briefing, and tested how long the coronavirus survives on stainless steel in a droplet of saliva from a cough or sneeze under conditions related to temperature, humidity and sunlight. The lab is now doing additional testing, such as experimenting with low-tech techniques for sterilization of protective equipment, which would include using rice cookers, clothes steamers and electric pressure cookers.

Source: Sunlight destroys virus quickly, new govt. tests find, but experts say pandemic could last through summer

4. Six feet between tables may not be enough distance to safely reopen restaurants

In January, at a restaurant in Guangzhou, China, one diner infected with the novel coronavirus but not yet feeling sick appeared to have spread the disease to nine other people. One of the restaurant’s air-conditioners apparently blew the virus particles around the dining room.
There were 73 other diners who ate that day on the same floor of the five-story restaurant, and the good news is they did not become sick. Neither did the eight employees who were working on the floor at the time.
Chinese researchers described the incident in a paper that is to be published in the July issue of the Emerging Infectious Diseases, a journal published by the Centers for Disease Control and Prevention. The field study has limitations. The researchers, for example, did not perform experiments to simulate the airborne transmission.
That outbreak illustrates some of the challenges that restaurants will face when they try to reopen. Ventilation systems can create complex patterns of air flow and keep viruses aloft, so simply spacing tables six feet apart — the minimum distance that the C.D.C. advises you keep from other people — may not be sufficient to safeguard restaurant patrons.
The social nature of dining out could increase the risk. The longer people linger in a contaminated area, the more virus particles they would likely inhale. Eating is also one activity that cannot be accomplished while wearing a mask. Virus-laden droplets can be expelled into the air through breathing and talking, not just through coughs and sneezes.
On the other hand, all of the people who became sick at the restaurant in China were either at the same table as the infected person or at one of two neighboring tables. The fact that people farther away remained healthy is a hopeful hint that the coronavirus is primarily transmitted through larger respiratory droplets, which fall out of the air more quickly than smaller droplets known as aerosols, which can float for hours.

Source: Coronavirus Death Toll Soars in Turkey; WHO Warns of Vaccine Roadblock

F. How many people have been infected with coronavirus? And Why Any Plan to Reopen Our Economy Hinges on the Answer – Part II

Introduction:

As discussed in the 4/21 update, it is important to know the approximate number of people infected with coronavirus, including those that have not been tested for the virus, because it will determine the lethality of COVID-19, which will impact public policy regarding when and how to reopen businesses. If the total number of infected people is much larger than the number of confirmed cases, then the fatality rate will be much smaller, and conversely if the total number of infected people is not much larger than the number of confirmed cases, then the fatality rate will be higher.

1. WHO warns that few have developed antibodies to Covid-19.

Only a tiny proportion of the global population – maybe as few as 2% or 3% – appear to have antibodies in the blood showing they have been infected with Covid-19, according to the World Health Organization, a finding that bodes ill for hopes that herd immunity will ease the exit from lockdown.
“Easing restrictions is not the end of the epidemic in any country,” said WHO director-general Dr Tedros Adhanom Ghebreyesus at a media briefing in Geneva on Monday. “So-called lockdowns can help to take the heat out of a country’s epidemic.”
But serological testing to find out how large a proportion of the population have had the infection and developed antibodies to it – which it is hoped will mean they have some level of immunity – suggests that the numbers are low.
“Early data suggests that a relatively small percentage of the populations may have been infected,” Tedros said. “Not more than 2%-3%.”
Dr Maria Van Kerkhove, an American infectious diseases expert who is the WHO’s technical lead on Covid-19, said they had thought the number of people infected would be higher, but she stressed it was still too early to be sure. “Initially, we see a lower proportion of people with antibodies than we were expecting,” she said. “A lower number of people are infected.”
On Friday, a study carried out in Santa Clara, California by Stanford University and released as a “pre-print” without peer review, found that 50 to 85 times more people had been infected with the virus than official figures showed.
Santa Clara county had 1,094 confirmed cases of Covid-19 at the time the study was carried out, but antibody tests suggest that between 48,000 and 81,000 people had been infected by early April, most of whom did not develop symptoms.
But even those high figures mean that within the whole population of the county, only 3% have been infected and have antibodies to the virus. A study in the Netherlands of 7,000 blood donors also found that just 3% had antibodies.
Van Kerkhove said they needed to look carefully at the way the studies were being carried out. “A number of studies we are aware of in pre-print have suggested that small proportions of the population [have antibodies],” she said. These were “in single digits, up to 14% in Germany and France”. “It is really important to understand how the studies were done.”
That would include asking how they found the people to test. Was it at random or were they blood donors, who tend to be healthy adults? They would also need to look at how well the blood tests were performed.
“We are working with a number of countries carrying out these serology studies,” she added. The WHO-supported studies would use robust methods and the tests would be validated for accuracy.
The hope will be that people who have had Covid-19 will be able to resume their lives. But Van Kerkhove last week said that even if tests showed a person had antibodies, it did not prove that they were immune.
“There are a lot of countries that are suggesting using rapid diagnostic serological tests to be able to capture what they think will be a measure of immunity,” she said. “Right now, we have no evidence that the use of a serological test can show that an individual has immunity or is protected from reinfection.”

Source: WHO warns that few have developed antibodies to Covid-19

G. Updates

1. NIH recommends against use of anti-malria drug hydroxychloroquine in combination with antibiotic azithromycin

A panel of medical experts convened by the U.S. National Institutes of Health recommended against the use of a drug combination touted by President Donald Trump for Covid-19 patients.
The NIH panel, made up of 50 doctors, pharmacy experts and government researchers and officials, specifically recommended against the use of the anti-malaria drug hydroxychloroquine in combination with the antibiotic azithromycin.
The malaria pill can cause heart issues, and the NIH panel warned of the potential for harm from the combination.

Source: US Virus Guidelines Reject Trump-Backed Drug Combination

2. Veteran Administration study found no benefit from malaria drug (hydroxychloroquine)

Hydroxychloroquine showed no benefit in a study by the U.S. veterans hospitals.
The nationwide study was not a rigorous experiment. But with 368 patients, it’s the largest look in the US so far of hydroxychloroquine with or without the antibiotic azithromycin for COVID-19.
The study was posted on an online site for researchers and has not been reviewed by other scientists. Grants from the National Institutes of Health and the University of Virginia paid for the work.
Researchers analyzed medical records of 368 male veterans hospitalized with confirmed coronavirus infection at Veterans Health Administration medical centers who died or were discharged by April 11.
About 28% who were given hydroxychloroquine plus usual care died, versus 11% of those getting routine care alone. About 22% of those getting the drug plus azithromycin died too, but the difference between that group and usual care was not considered large enough to rule out other factors that could have affected survival.
Hydroxychloroquine made no difference in the need for a breathing machine, either.
On Tuesday, NIH issued new treatment guidelines from a panel of experts, saying there was not enough evidence to recommend for or against chloroquine or hydroxychloroquine for COVID-19. But it also advised against using hydroxychloroquine with azithromycin because of the potential side effects.
At the University of Wisconsin, Madison, “I think we’re all rather underwhelmed” at what’s been seen among the few patients there who’ve tried it, said Dr. Nasia Safdar, medical director of infection control and prevention.
The NIH and others have more rigorous tests underway.

Source: More deaths, no benefit from malaria drug in VA virus study

H. Comparing COVID-19 to Other Diseases and Causes of Death

1. Not Like the Flu, Not Like Car Crashes, Not Like… .

The chart shows deaths per capita to allow for comparison of data from different years. Deaths are shown from:
Covid-19, starting from February 17. (Covid Tracking Project)
The 2017-18 flu season: This was the deadliest recent flu season. The chart shows one line for deaths attributed directly to flu, and another for deaths attributed to either flu or pneumonia. The smaller line is an undercount of flu-caused deaths, the larger is an overcount, with the real number lying somewhere in between. (More on this below.) The data begin on October 1, 2017, which the CDC considered the first week of that flu season. (CDC)
Heart disease and cancer: The first and second leading causes of death in the United States. The chart shows total 2017 deaths averaged per week. (CDC)
Car crashes: Weekly deaths beginning from January 1, 2018. (National Highway Traffic Safety Administration)
1957-58 Asian flu pandemic: Weekly influenza and pneumonia deaths beginning from August 24, 1957. These data come from a contemporary CDC program that surveilled 108 American cities with a total population of about 50 million people. We have used that figure, rather than the total U.S. population at the time, to calculate deaths per million. (CDC)

Source: Not Like the Flu, Not Like Car Crashes, Not Like

I. Technology Takes on the Coronavirus

1. Facebook is tracking coronavirus symptoms by county to identify hotspots

Facebook on Monday released its first map that tracks coronavirus symptoms county by county and plans to update it daily throughout the outbreak.
You can view the map here: Facebook COVID-19 Symptom Map
Facebook partnered with Carnegie Mellon University researchers to create an opt-in survey designed to help identify Covid-19 hotspots before the cases are confirmed. The map breaks down the percentage of people per county who have self-reported coronavirus symptoms, such as loss of smell, cough and fever.
It shows, for example, that 1.45% of people in New York County have reported coronavirus symptoms. But, as you can see in the map below, a huge portion of the map does not have enough participants to show data.
More than 1 million people responded to the survey within the first two weeks, according to Facebook. CEO Mark Zuckerberg said the company will roll out the survey globally this week, which will help it provide a more complete picture.
Facebook has been criticized for its handling of health issues and privacy. Zuckerberg said Monday that Facebook can only see aggregated data. The Carnegie Mellon researchers can see individual survey responses, however.
Zuckerberg stressed that social media platforms have an advantage when it comes to helping health researchers, since they can access large groups of people.
“Facebook is uniquely suited to run these surveys because we serve a global community of billions of people and can do statistically accurate sampling,” Zuckerberg said in a Facebook post. The company said more than 2 billion people use its platform.
In a Washington Post op-ed published Monday, Zuckerberg added that Facebook can help health officials around the world access precise data to make public health decisions in the coming months.
“This is work that social networks are well-situated to do. By distributing surveys to large numbers of people whose identities we know, we can quickly generate enough signal to correct for biases and ensure sampling is done properly,” he said.

Source: Facebook coronavirus symptom tracking map released

J. Projections and Our (Possible) Future

1. Second coronavirus wave could be deadlier

The head of the US Centers for Disease Control and Prevention warned Tuesday that a second wave of the coronavirus pandemic expected this winter could be deadlier than the current pandemic.
“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” CDC Director Robert Redfield told The Washington Post, saying that it would likely coincide with peak flu season.
“And when I’ve said this to others, they kind of put their head back, they don’t understand what I mean.”
Two simultaneous outbreaks of respiratory infections would dramatically strain the health care system, he said.
The first wave of COVID-19, the disease caused by the coronavirus, has already killed more than 42,000 Americans.
Redfield said federal and state officials need to use the coming months to prepare for a worst-case scenario.
As the stay-at-home orders are lifted, officials need to stress the importance of social distancing and hand washing, he said.

Source: Second coronavirus wave could be deadlier, CDC chief warns

2. The Hammer & the Dance: immunity passports, stop-start lockdowns, strategic self-infection, and a new normal

Below is the transcript of a podcast hosted by Michael Barbaro; produced by Alexandra Leigh Young and Clare Toeniskoetter; with help from Daniel Guillemette; and edited by M.J. Davis Lin and Theo Balcomb. [You can listen to the podcast here.]

Monday, April 20th, 2020
Michael Barbaro: Today: As President Trump urges states to begin reopening their economies, a debate begins over when and how to end the lockdowns. Science reporter Donald G. McNeil Jr. on what that might look like.
So Donald, we have come to you at just about every turn in this pandemic to understand what’s next, and the portraits of the future that you have painted for us each time we talk have been strikingly accurate. You told us all the way back in February to prepare for lockdowns. Those happened. You told us to prepare for high death rates. You said that people we know would die, and that, sadly, has happened. You warned us of shortages of medical supplies. That too has happened. Just about everything you said would happen has more or less happened. So I want to turn to the next installment of this rolling conversation we’ve been having with you.
Michael Barbaro: And start with a question that I think is on everyone’s mind right now, which is when and how we start to reopen our society and what that would look like.
Donald G. Mcneil Jr.: I’m talking to experts. I’m looking at the other pandemics I’ve covered. I’m talking to medical historians and making predictions based on data. And so I think a lot of people think that by May or June or August, we’re going to return to something like normalcy. But all the experts I talk to say, no, that’s a fantasy.
Michael Barbaro: Why is it a fantasy?
Donald G. Mcneil Jr.: Well, because if we all tried to come out at once, everything would look cool for about three weeks. And a week or two after that the emergency rooms would start to fill again, and people would start to die again. Flattening the curve is a notion that people love, but when we say we’re flattening the curve, no, we’re plateauing at a very high level of the curve. That means a steady rate of deaths. So what we want is to see the lockdown last until we get back down to close to what the normal baseline rate of deaths is. And it’s going to be piece by piece. We might be able to let a certain number of people ride the subway each day. People still staying apart from each other. We’re not going to be able to let people sit next to each other in football stadiums. Maybe the team will play on the field, and there will be some cameramen in the stands, but it’s not going to be the way it was before.
Michael Barbaro: OK. So if there’s not going to be any kind of single moment where the curtain goes up and life resumes, what does a lifting of these lockdowns start to look like?
Donald G. Mcneil Jr.: Well, the best description I heard of it was in an article. It was on March 19, by Tomas Pueyo, a writer in San Francisco. And it was called “The Hammer and the Dance.” And the hammer is the lockdown. There was no question of social distancing light. It was more like, bam, everybody has to go into their houses. But then, once you get the deaths down to a minimum, then you begin the dance. And the dance is dancing a little bit out, and opening up some of the restrictions and seeing, you know, how far can you let people go. And then you see what that does to death rates. And once the death rates go up, you have to go back and leave the dance floor and go into lockdown again. And it repeats again and again. And it’s dance in, dance out, dance in, dance out. And basically that’s what the epidemiological models show we have to do.
Michael Barbaro: So in this scenario, tiptoeing back to normal happens, and if there is a resurgence in infections, then the hammer comes back down.
Donald G. Mcneil Jr.: Exactly.
Michael Barbaro: So let’s talk about what the opening starts to look like. Describe the dance.
Donald G. Mcneil Jr.: OK. So the dance is you have this whole list of things you can ask people to do. One of them being wear masks. Another one is sit six feet apart from your dining companions at a restaurant. So a restaurant that had 100 customers before now has about 10 customers in it. You have to cut down travel between cities, because people from a hot zone, like New York recently, could go to a cool zone and start infections. International travelers will have to be quarantined for 14 days so that we’re sure they’re not infected when they come in. So we will have to find restrictions on people’s movements that keeps them from getting too close and letting the virus spread again. Because when the virus spreads, deaths follow.
Michael Barbaro: OK. Let’s get a little more specific here. What does the dance mean for, let’s say, schools?
Donald G. Mcneil Jr.: Well, schools is a big mystery, because we don’t know much about the virus in children. Very, very few children get hospitalized and die. It happens, but it’s very uncommon. But the question is, how much do the kids get the virus and transmit the virus? Because if you open schools, the children may be fine, but the teachers won’t necessarily be, and the children’s parents and grandparents won’t be. So mayors and governors are going to have to decide, maybe we’re going to open school for two weeks and see what happens? Or maybe we’re going to let half the kids go to school this week but have them sitting six feet apart, and then next week the other half of the kids get to come to school.
Michael Barbaro: And Donald, what about the typical workplace. From the way you’re describing schools, it sounds like, at the very least, people at an office or a factory would need to be six feet apart. What else?
Donald G. Mcneil Jr.: Well, it depends on what you mean by the average workplace. Are you a construction crew? Are you an office, like The New York Times? Are you a factory? Are you a food processing plant? Everyone is different. And for those of us who work most of the day on computers, there’s not a whole lot of reason to go back to the workplace. It may be more of a source of danger than any advantage you get from being there. Whereas if you work in a chicken processing plant, you’ve got to be near the chickens. So somehow they’re going to have to stretch out those chicken disassembly lines, so that people can do it safely without infecting each other. And they’ll have to wear masks, and maybe there’ll be plexiglass between the workers. There’s lots of measures you can take, and they’re going to be different for every single workplace.
Michael Barbaro: I want to talk for just a moment about geography, because I wonder if the scenarios you’re describing would apply as rigorously in one part of, for example, the United States as another, based on issues like density or the cycle of this virus. There are many places in the United States that have been largely untouched by this virus. Or there are places like Washington state, where it seems the virus has turned a corner. So would this hammer and dance scenario apply in the same way to every corner of the country? Or could it be applied more lightly or more severely, based on density, based on number of infections?
Donald G. Mcneil Jr.: Yes and no. It’s a fantasy to believe that there are any parts of the country that are untouched by this virus. It is much more intense in some places, like New York and New Orleans and Detroit, but it’s everywhere. If you look at any map of cases, it’s certainly in every state. It’s in multiple counties in every state. So it’s going to have to be different techniques developed, not just for every state in every county, but for every work situation, so that you are not transmitting virus to each other.
Michael Barbaro: Donald, is the point of the hammer and the dance to avoid having the rest of the country get infected, or does it simply slow an inevitable version of mass infection but not prevent it?
Donald G. Mcneil Jr.: It slows it down. A certain amount of infection is inevitable, because emergency workers are going to have to be at their jobs. Medical workers are going to get infected. There’s going to be a certain level of infection at all times, but you want to damp it down to the minimum. But all the models say that maybe 3 percent of America is infected by now. The other epidemiologists think maybe it’s 10 percent. That 10 percent is a pretty high guess. So that still leaves 300 million Americans uninfected. So we’re a country that’s somewhere north of 90 percent susceptible. And each time we do the dance out and dance in, we chop a few more people off that susceptible list. A few of them are dead. A bunch of them become immune. But it only proceeds in fits and starts. Maybe we go three million at a time, three million at a time, three million at a time. It’s not a fast process.
Michael Barbaro: And how long do the experts you talked to say that this dance will need to occur? At some point, do we stop dancing and we just get to go back to normal?
Donald G. Mcneil Jr.: The dance will end when we have a vaccine that we can all take, or if we have a prophylactic pill that will protect us all, like PrEP protects you from HIV. Or when so many of us would become infected — 70-plus percent have become infected, and the virus dies out or slows down just because it can’t find any new victims to infect.
Donald G. Mcneil Jr.: But making a vaccine within 18 months is extremely optimistic. The record we’ve ever had for producing a vaccine is four years. That was a mumps vaccine produced back in the ‘50s. We’ve got new techniques that speed it up, but some things can’t be sped up. And then after we design the vaccine, we have to think about producing the vaccine. If we need 300 million doses of vaccine, or if we need two shots — if we need 600 million doses of vaccine — that’s a gigantic undertaking. I talked to some vaccine production experts, and they said, the average vaccine plant in America makes 5 to 10 million doses. So we’ve got to find some way to make 300 to 600 million doses of vaccine, and we have to start planning now, even before the vaccine exists.
Michael Barbaro: Donald, you just said that the record for making a vaccine is four years. Are you saying that there is a version of this where this dance, in the hammer and dance metaphor, goes on not for one year but something like four years?
Donald G. Mcneil Jr.: That’s a kind of worst case scenario, as far as timing is concerned. Everything may get lowered in this. We may test vaccines in a way that we would think of as ethically unthinkable in normal times. We may go with somewhat lower safety standards for vaccines, because we’re facing a situation where life is dangerous. But yeah, the fastest human vaccine ever made was mumps. Four years, from start to finish.
Michael Barbaro: So I just want to be clear. Is there a world, according to the experts you’re talking to, who say the world of tiptoeing out and coming back and realizing that there’s a resurgence, and then tiptoeing back out again, that that could last years?
Donald G. Mcneil Jr.: Yes.
Michael Barbaro: And during that, the virus lasts? It doesn’t die off in the hot summers?
Donald G. Mcneil Jr.: There is zero evidence that this virus dies off in hot weather. The virus is circulating now in India, in Brazil, in Australia.
Michael Barbaro: Very, very hot environments.
Donald G. Mcneil Jr.: Exactly. There’s no evidence that it’s going to die out in the summer.
Michael Barbaro: Donald, I’m willing to speak for many listeners when I say that the idea of living in masks, with everyone sitting six feet apart, and the expectation that a viral resurgence might mean that even that becomes too risky and so everyone goes back under lockdown — that that could go on for years is really pretty depressing and kind of hard to wrap one’s head around.
Donald G. Mcneil Jr.: I know. But if we don’t go into a dance, means there’s going to be more infections and more deaths.
Michael Barbaro: Don, during this period, it feels like not everyone is going to be on equal footing, in the sense that some of us will have been infected and will possess some kind of immunity to Covid-19, right? And many of us, of course, will not have been infected and will not possess that immunity. So how does that factor into this, give and take, this dance you’re describing?
Donald G. Mcneil Jr.: Well, we’re already seeing this happen. There are a very small number of people now who are immune. And they’re very much in demand. They’re in demand for their blood, because you can harvest antibodies from their blood. They’re in demand for doing medical jobs that are dangerous, like intubating patients, because they can do it without fear of infection. They’ll be in demand for all sorts of other jobs, because they can travel anywhere. They can do face-to-face interactions with customers without any fear. And they’re going to be a special class in society. There’ll be different standards, different ways of living for two different classes in society. So say you’re an immune and I’m not. I basically have to stay inside here in hiding, and I’m depressed as hell about it. I have a granddaughter who’s going to be born in June, and I sit here in my apartment thinking, I may not see her until she’s two years old. And that’s horrible to contemplate, but it may be a fact. Meanwhile, you, as an immune, could go visit my granddaughter or go out and take my job, or —
Michael Barbaro: No one can take your job, Donald, just to be clear.
Donald G. Mcneil Jr.: Not a heck of a lot of people want my job. There’ll be different standards, different ways of living for two different classes in society for a while. It’s quite science fiction-y. It’s kind of dystopian.
Michael Barbaro: Right. That kind of a societal schism, right, between the immune and the still susceptible, it would seem to require a few pieces of firm knowledge. One is that there’s a widespread ability to tell who is immune versus who is not, and the other piece of knowledge is that we know for sure that being infected confers immunity. So how do you resolve either of those?
Donald G. Mcneil Jr.: We don’t know those things yet. We don’t know them for dead sure, but as Tony Fauci says, usually when you recover from disease, you’re immune for a while. But we don’t know how long the immunity lasts, because this disease has only been around since November at the earliest.
Michael Barbaro: Mm-hmm. Are there plans? Do you envision a universe in which people literally wear some sort of sign that they are immune and that that can be rigorously proven?
Donald G. Mcneil Jr.: Yes. That is already beginning to take place. Germany is talking about issuing certificates, but you don’t want something you can pass from person to person. So China takes people’s cell phones and has a QR code that you read as you come into the subway, you come into a restaurant, you come into any place where somebody can check your phone. And that readout tells the person looking at your phone that you’re immune. So yeah, people are already thinking about this.
Michael Barbaro: In the scenario that you’re laying out, immunity and the ability to show immunity would seem to be incredibly desirable and might create some very complicated incentives.
Donald G. Mcneil Jr.: Yes. People are going to be tempted to become immunes and to do it the chickenpox party way.
Michael Barbaro: What do you mean?
Donald G. Mcneil Jr.: To deliberately infect themselves, hoping for the best, but that they emerge at the end of it as an immune. That temptation is going to be enormous.
Michael Barbaro: You’re describing deliberate and perhaps large scale acts of self-infection.
Donald G. Mcneil Jr.: Yes. I am. There is a lot of historical precedent for that stuff. In the years before smallpox vaccine, people used to take pus from the blisters of smallpox victims, or dried up scabs from smallpox victims, and put the pus into — stab a little hole in their child’s arm and put some of the pus in there, or blow the scabs into your nose. And that would give you a usually mild case of smallpox. And I talked to an immunologist who said, look, the child had about a 1 percent chance of dying, and the parents recognized that. And that was better, because if you had a smallpox epidemic come through, usually, about a third of the susceptibles died. So if you had six kids, you might think hard about giving them all a little bit of smallpox in their arm.
Michael Barbaro: Don, what you’re describing is a very calculated risk that some people may take to self-infect, and I wonder just how dangerous it may be if people miscalculate.
Donald G. Mcneil Jr.: With the virus acting the way it is acting now, it’s very dangerous. We know that there are people who are more at risk, but we also know that it’s unpredictable — that young, athletic, healthy people, totally unpredictably, end up on a ventilator, and a few of them die.
Michael Barbaro: Right.
Donald G. Mcneil Jr.: So it’s people making life or death decisions for freedom.
Michael Barbaro: And a paycheck.
Donald G. Mcneil Jr.: And a paycheck, yes.
Michael Barbaro: Everything that you’re talking about here seems to assume the absence of a successful treatment and a world where we’re pretty much waiting for a vaccine. Could that change? When we’ve asked you this question in the past, you have said that there wasn’t a viable treatment. Do you have any sense that that may be changing and that a treatment might come before a vaccine?
Donald G. Mcneil Jr.: I don’t have any sense that it’s changing in an important way. There is something that doctors place some hope in, and that is taking the blood from people who’ve recovered from the disease, and removing the red blood cells and the white blood cells and everything else and leaving just the antibodies. Those antibodies glob onto the virus and neutralize it, and so you can inject them into somebody who’s sick. But it’s a technology that is not fast-moving, so it’s not in the immediate future. But scientists are hopeful that it’s in the mid-term future.
Michael Barbaro: So in other words, for the time being, we are left pretty much with the hammer and the dance as our most practical solution.
Donald G. Mcneil Jr.: Exactly.
Michael Barbaro: So Donald, with everything that you just said in mind, I want to return to that first time we ever spoke. Because when we had that conversation, you were well ahead of anybody else in preparing us for what the pandemic would mean on a personal level. You told us about your stockpile of food, your month worth of medicine, and you told us that we should be prepared not to see our friends and our family for a while. And all of that proved prescient. But there’s one area where I recall you, perhaps, underestimated something. You said be prepared for a couple of months of something that might look like a lockdown. And now, it’s feeling like it’s going to last a lot longer. So with that in mind, what preparations are you making now that the rest of us may end up making for ourselves in the coming days, weeks, months, to prepare for that new reality?
Donald G. Mcneil Jr.: I’m busy. I’m working harder than I’ve ever worked hard before, and that’s given me a sense of purpose. That gives me some psychological stability that a lot of other people don’t have the luck to have. I’m thinking about what am I going to do to entertain myself? I’m thinking of buying a fishing rod and becoming one of those old guys on the piers who’s fishing for bluefish. I like trout fishing, but it seems unlikely I’m going to get away to do that for a while. So it’s just, you have to mentally prepare yourself for these things. And now be it said, I have visions for the future that are rosy, and that keeps me going too.
Michael Barbaro: You do?
Donald G. Mcneil Jr.: Yeah. If you look at the periods after World War I and after World War II, not only did the economy come back after both those periods. Remember, after the one-two punch of World War I plus the Spanish influenza, we had the roaring ‘20s. After World War II, we had a period in which, in Europe, the war widows and pensions fund became the European welfare state. War profiteers suddenly faced higher taxes and a lot of scrutiny. People had pretty much had it with the rich by that time, and they wanted more. They wanted the G.I. Bill. They wanted federally-sponsored mortgages for housing. They wanted better health care. And to some extent, they got it. I was born in 1954, and my parents were of the generation that had made it through the Great Depression and through the Second World War. And they had a different attitude on life. They had a sense of, hey, we did this incredible thing. We did it all together. We got through it. I hope that sort of era comes again, that people will take more pleasure in small things in life. And that we will do more to make sure that we take care of each other, and that that’ll go through all levels of society. And like I said, I try not to predict the future, but maybe something like that will emerge from this.
Michael Barbaro: Well, of all the visions that you have given us, I like that one the best.
Donald G. Mcneil Jr.: Me too.
Michael Barbaro: Donald, thank you very much.

Source: The Next Year (or Two) of the Pandemic