“I told the governor of Georgia that I disagree strongly with his decision to open certain facilities that are in violation of the phase one guidelines for the incredible people of Georgia. But at the same time, he must do what he thinks is right, I want him to do what he thinks is right.” — President Trump
“There are more important things than living, and that’s saving this country for my children and grandchildren and saving this country for all of us.” — Texas Lt. Gov. Dan Patrick
“The evidence is circumstantial, to be sure, but it all points toward the Wuhan labs as the source of the coronavirus.”
— Senator Tom Cotton
- Recent Developments and Headlines
- Numbers and Trends
- Potential Treatments
- New Scientific Findings
- A Better Road Back?
- Caution: Blind Curves Ahead
- What do Coronavirus Models Tell Us?
- Projections and Our (Possible) Future
- Practical Tips
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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 4/22 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 = 2,635,716 (+3.1%)(+79,956)
- US Total Cases = 848,717 (+3.7%)(+29,973)
- Worldwide deaths = 184,066 (+3.7%) (+6,607)
- US deaths = 47,659 (+5.2%) (+2,341)
- Germany, UK approve human trials for coronavirus vaccine
- Dr. Fauci: Coronavirus shutdown worked
- Chinese scientist finds deadly new coronavirus mutations
- California Study Shows Virus Much More Pervasive “But Not Killing At Rate We Thought”
- President Trump: “Our Country is starting to OPEN FOR BUSINESS”
- Sec. Treasury Mnuchin: ‘Looking Forward to’ Having Most, if Not all of Economy Open by Late Summer
- VP Pence: White House believes coronavirus will be ‘largely in the past’ by summer
- Florida Gov. DeSantis: Florida Flattened the Curve, Coordinating Reopening with Southeastern States
- Gulf Widens Between States Over When to End Virus Lockdown
- Georgia Small Businesses Balk At Reopening As Defiant Dem Mayors Urge Citizens To “Please Stay Home”
- “Too Soon” – President Trump questions Georgia reopening barber shops, tattoo parlors
- Oklahoma governor announces plans to start reopening state economy
- South Dakota Gov. Kristi Noem on Beating Coronavirus Without Lockdown: ‘We’re Much Better on Offense’
- Las Vegas mayor calls for city to reopen: “We’ve had viruses for years”
- Michigan Gov. Gretchen Whitmer to extend stay-home order as state furloughs workers
- Killed By COVID-Lockdowns: 1000s Of Shut-Down US Businesses Will Be Closed Permanently
- Coronavirus Commission Chair Kay Coles James: Battle Not ‘Either’ Economy ‘Or’ Health, ‘We Must Do Both’
- Middle East coronavirus cases continue to climb everywhere except Iran
- Reports Indicate Virus Boom in North China, Beijing
- Authorities On High Alert About Northern China Virus Outbreak, Beijing District Marked “High-Risk”
- Chinese Media Admits Coronavirus Still Raging
- Coronavirus Forces Indonesia to Ban Ramadan Celebrations
- Locals Say North Korea Admitted to Coronavirus Problem
- Financial Times says UK coronavirus deaths 2x+ official number
- Outbreak reported aboard Italian cruise ship docked in Japan
- Expert Warns US Is On The Brink Of “Mass Civil Unrest”
- New York Released – Then Retracted – A New Policy Asking Paramedics To Just Let Patients Without A Pulse Die
- Air Force Preparing For ‘Cyclical’ Coronavirus, Top General Warns
- UN Admits COVID-19 Pandemic Could Spark Famines Of “Biblical Proportions”
- Tech Companies Are Rushing To Develop AI-Based Social-Distancing “Enforcement” Tools
- Navarro: Coronavirus ‘Probably’ Spawned in Lab in China
- China State TV Host: COVID-19 Came From Lab Leak… In United States
- Pompeo rips China, WHO for allegedly withholding coronavirus information
- EU eyes more autonomy, less reliance on China after coronavirus pandemic
- CDC Says Poisonings From Cleaners & Disinfectants On Sharp Rise Since Pandemic Hit US
- CDC Confirms 1st Coronavirus Fatality Occurred February 6, Weeks Earlier than Thought
- Mississippi Attorney General to Sue China over Coronavirus
- China Mocks Missouri Coronavirus Reparations Lawsuit: ‘This Will Never Happen’
- Mitch McConnell Floats Creating Bankruptcy Process for U.S. States
- De Blasio’s Wuhan Virus Snitch Line ‘Flooded’ With Obscene Pix and Reminders of His Failed Crisis Leadership
- De Blasio’s Snitch Hotline Shuts Down
- Farmer Says 61,000 Chickens Euthanized as Egg Sales Drop
- Health Secretary: UK Has ‘Reached the Peak’ of Coronavirus
- Obama: Climate Change Will Be ‘Far Harsher’ than Coronavirus
- Greta Thunberg Urges World to Tackle Coronavirus and ‘Climate Crisis’ as One
- German shoppers not rushing back as stores reopen
- Growing possibility of W-shaped economic recovery … maybe a Nike swoosh?
- San Francisco is closing streets to help with social distancing
- CNN Boss Tells Staff They Will Not Return to Offices Until at Least September
- Massive layoffs and pay cuts are likely coming to state and local governments as federal aid goes elsewhere
- Social Distancing Has Become Second Nature for Remote-Home Owners. “It’s The Biggest Luxury.”
- Russian communists defy lockdown with Red Square parade for Lenin’s 150th
- “Something’s going wrong” – UK virus response under fire
- India plans wristband patient surveillance as lockdown eases
- Couple sailing around the world had no idea about coronavirus pandemic
- Idaho mom of six faces jail for breaking stay-at-home order with yard sale
- Celebrity climate activists cheer coronavirus misery in name of environment
- Seven more big cats at Bronx Zoo test positive for coronavirus
- Sorry: Contact tracing isn’t the answer to ending lockdowns
- Coronavirus misinformation flourishes in online protest groups
- Dr. Birx is a fan of Andrew Cuomo’s coronavirus PowerPoints
- Coronavirus cases surge at NYC’s lone privately run jail
- French researchers to test nicotine patches on coronavirus patients
- Pentagon planning ‘national unity’ city flyovers amid coronavirus
- MTA honcho ‘losing patience’ with NYC on subway homeless
- Las Vegas mayor wants to reopen the city, offered to be ‘a control group’
- Majority of Florida voters want to continue social distancing, poll shows
- Kentucky nurse says coronavirus felt like her ‘bones were breaking’
- NYC home-schooling mom: ‘It’s hectic’
- WHO defends coronavirus response, says it declared emergency at ‘right time’
- Owner of NY Daily News, Chicago Tribune furloughs employees in new round of cuts
- Jellyfish spotted in Venice canals during coronavirus lockdown
- City fills skate park with sand amid coronavirus, so dirt bikers show up
- NY Gov. Cuomo: ‘It’s not our job’ to provide PPE to nursing homes
- More Americans have negative views of China than ever before: poll
- NY, NJ airports have highest number of TSA employees testing positive for coronavirus
- Bloomberg to help New York State develop coronavirus tracing program
- Tyson Foods shutting largest pork plant over coronavirus outbreak
- China ramps up coronavirus propaganda in US to heighten fears
- Lack of virus testing stokes fears in world’s refugee camps
- Recovered coronavirus patients in China test positive weeks later
- Top German paper demands $165 billion coronavirus reparations from China
- Georgia ER doctor calls plan to reopen state a ‘slap in the face’
- Spain plans to loosen coronavirus lockdown restrictions by end of May
- Anguished family stays on phone for 30 hours as dad dies of coronavirus
- De Blasio hails ‘real progress’ as coronavirus ICU admissions decrease
- De Blasio reveals plan for NYC to ‘ultimately defeat’ coronavirus
- Masks reused, bodies mount as Peru strains under coronavirus
- Romania makes millions from handing out strict coronavirus fines
- De Blasio changes mind on Macy’s July 4th fireworks: ‘Show will go on’
- Stephen Hawking’s ventilator donated to help treat coronavirus patients
- USDA to buy $3B worth of food from farmers to feed struggling families
- 2 cats become first pets in US to catch the virus
- Mayor De Blasio Says He Needs Ventilators, While Governor Cuomo Is Giving Them Away to Other States
- Will the coronavirus pandemic doom North Sea oil?
- Workers Facing ‘Zoom Fatigue’ from Online Meetings
- Medical Surveillance State: France Calls on Apple and Google to Ditch Privacy Protections During Pandemic
- Swedish Politician Went to Stockholm and Licked Escalator to Intentionally Contract Coronavirus
- Nurse Shortage Forces London Coronavirus Hospital to Turn Away ‘Life or Death’ Patients
- There’s No Corona At the Drive In
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 = 2,635,716 (+3.1%)
- New Cases = 79,956 (+9.3%) (+6,773)
- Total Cases = 1,168,284 (+2.5%)
- New Cases = 28,233 (+4.7%) (+1,278)
- Total Cases = 422,287 (+2.9%)
- New Cases = 12,027 (-12.6%) (-1,737)
- Total Cases = 848,717 (+3.7%)
- New Cases = 29,973 (+15.4%) (+3,988)
- 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:
|Change in Total Cases (%)|
|Change in New Cases (#)||Change in New Cases (%)|
- Top 5 States = 58% of Total Cases in US (+0%)
- NY & NJ = 44% of Total Cases in US (+0%)
- 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 = 56,686 (-568)
- US series or critical cases = 14,016 (+0)
- US serious or critical cases = 2.0% of Active Cases compared with worldwide percentage of 3.3%
- Worldwide deaths = 184,066 (+3.7%) (+6,607)
- Europe deaths = 111,202 (+3.1%) (+3,296)
- US deaths = 47,659 (+5.2%) (+2,341)
- NY deaths = 20,354 (+3.4%) (+661)
- Deaths per 1M population of 5 Countries with Largest Number of Confirmed Cases:
- Italy: 415 (+7)
- Spain: 464 (+9)
- US: 144 (+7)
- France: 327 (+8)
- Germany: 63 (+2)
- US Total Confirmed Case Fatality Rate = 5.6% compared with a Worldwide Confirmed Case Fatality Rate of 7.0% [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.]
- Worldwide recoveries = 717,444 (+3.9%) (+27,218)
- US recoveries = 84,054 (+1.7%) (+1,127)
- US recoveries = 9.9% of Total US Cases
C. Potential Treatments
1. NY doctors try new treatment protocol after detecting alarming coronavirus symptom
- Signs of blood thickening and clotting were being detected in different organs by doctors from different specialties. This would turn out to be one of the alarming ways the virus ravages the body, as doctors there and elsewhere were starting to realize.
- At Mount Sinai, nephrologists noticed kidney dialysis catheters getting plugged with clots. Pulmonologists monitoring COVID-19 patients on mechanical ventilators could see portions of lungs were oddly bloodless. Neurosurgeons confronted a surge in their usual caseload of strokes due to blood clots, the age of victims skewing younger, with at least half testing positive for the virus.
- “It’s very striking how much this disease causes clots to form,” Dr. J Mocco, a Mount Sinai neurosurgeon, said in an interview, describing how some doctors think COVID-19, the illness caused by the coronavirus, is more than a lung disease. In some cases, Mocco said, a stroke was a young patient’s first symptom of COVID-19.
- As colleagues from various specialties pooled their observations, they developed a new treatment protocol. Patients now receive high doses of a blood-thinning drug even before any evidence of clotting appears.
- “Maybe, just maybe, if you prevent the clotting, you can make the disease less severe,” said Dr. David Reich, the hospital president. The new protocol will not be used on certain high-risk patients because blood thinners can lead to bleeding in the brain and other organs.
“Funny you mentioned that”
- In the three weeks beginning mid-March, Mocco saw 32 stroke patients with large blood blockages in the brain, double the usual number for that period.
- Five were unusually young, under age 49, with no obvious risk factors for strokes, “which is crazy,” he said. “Very, very atypical.” The youngest was only 31.
- At least half of the 32 patients would test positive for COVID-19, Mocco said.
- Meanwhile, Dr. Hooman Poor, a Mount Sinai lung specialist, found himself working a late shift with 14 patients on ventilators. The ventilator readings were not what he expected.
- The lungs did not seem stiff, as is common in pneumonia. Instead, it seemed blood was not circulating freely through the lungs to be aerated with each breath.
- Poor ran into a kidney doctor that night, who remarked that dialysis catheters were often getting blocked with clots.
- “And I said, ‘It’s funny that you mentioned that because I feel like all these patients have blood clots in their lungs,’” Poor recalled.
- Reich, the hospital president, told Poor about the surge in strokes seen by Mocco and said the two doctors should team up, setting off days of discussions and meetings with the hospital’s department heads.
- At 2:46 am on Easter Sunday, Poor sent Mocco his first draft of what would become the new treatment protocol.
Doctors share findings
- As their wards began to overflow with COVID-19 patients, the Mount Sinai doctors read papers describing similar findings from doctors in China’s Hubei province and other hard-hit areas and discussed them with their peers in phone calls and webinars.
- Mocco called neurosurgeons he knows elsewhere in the country. At Philadelphia’s Thomas Jefferson University Hospital, Dr. Pascal Jabbour had begun to see a similar surge in strokes among people with COVID-19. The way his patients’ blood congealed reminded him of congenital conditions such as lupus, or certain cancers.
- “I’ve never seen any other viruses causing that,” Jabbour said.
- In Boston, the Beth Israel Deaconess Medical Center began a clinical trial earlier this month to see if tPA, an anti-clotting drug, could help severely sick COVID-19 patients.
- Clotting can develop in anyone who gets very sick and spends long periods of time immobile on a ventilator, but doctors say the problem seemed to show up sooner in COVID-19 patients as a more direct consequence of the virus.
- At Mount Sinai, patients in intensive care often receive the blood-thinning agent heparin in weaker prophylactic doses. Under the new protocol, higher doses of heparin normally used to dissolve clots will be given to patients before any clots are detected.
- The treatment joins a growing toolbox at the hospital, where some patients are receiving the antibody-rich plasma of recovered COVID-19 patients or experimental antiviral drugs.
- The American Society of Hematology, which has also noted the clotting, says in its guidance to physicians that the benefits of the blood-thinning therapy for COVID-19 patients not already showing signs of clotting are “currently unknown.”
- “I certainly wouldn’t expect harps to play and angels to sing and people to just rip out their intravenous lines and waltz out of the hospital,” said Reich. “It’s likely going to be something where it just moderates the extent of the disease.”
[Note: We note that aspirin is also a blood thinner and may provide some protection against blood clots caused by COVID-19. Of course, anyone infected with COVID-19 should discuss the matter with their doctor.]
2. Swift Covid-19 vaccine within reach, say Swiss scientists
- A team of researchers at the University of Bern is hoping to be the first to produce a vaccine against Covid-19 and inoculate the entire Swiss population in October.
- “We have a realistic chance of being successful,” said Martin Bachmann, head of immunology at the Swiss university via a web conference with ACANU, the United Nations press association. “Switzerland has a history of being pragmatic and is more interested in finding a compromise to get the vaccine faster.”
- Since the beginning of the coronavirus outbreak and its designation by the World Health Organization as a Public Health Emergency of International Concern (PHEIC) at the end of January, most international health experts and authorities have said a vaccine should not be expected for about a year to 18 months – at the earliest.
- Bachmann, who is also professor of vaccinology at the Jenner Institute at the University of Oxford, said his accelerated timing could be partially explained by potential ease of production, where the equivalent of 200 litres of bacterial bio ferment, which is needed for the jabs, could produce 10-20 million doses.
- “The vaccine is unique because of the huge scalability. It has the ability to produce billions of doses in a short time frame,” Bachmann said.
- The vaccine under development by the Swiss team takes a different approach than other labs by using so-called virus-like particles, which are not infectious – unlike when using the virus itself – and which provide good immunity response. A prototype was developed in February, just weeks after the new coronavirus was identified in China, and proved successful in tests on laboratory mice, when the serum neutralized the virus.
- Gary Jennings, CEO of Saiba Biotechexternal link which is working with the University of Bern, said the Swiss authorities are aware of the importance of approving the vaccine’s development. “We can do this if the Swiss government and the regulators want to do it. If they want to see this vaccine made available to the public in this timeframe, then it will be done.”
- Swissmedic, the national authority responsible for approving and supervising therapeutics, confirmed that it has already been offering scientific advice to the project and is aware of how the research is progressing.
- Spokesperson Lukas Jaggi told swissinfo.ch that “in this exceptional situation, we realistically have to reckon with eight to 14 months until we have a vaccine against the new coronavirus.”
- In an e-mailed statement the communications official wrote that “Swissmedic gives high priority to time. But safety and tolerability of the vaccine come first. It is therefore important that companies and research groups contact Swissmedic at an early stage so that we can accompany and support them in their development before they submit an application for authorization.”
- Development of the vaccine to a point where it could be produced on a large scale will require raising CHF100 million ($103 million), according to Saiba Biotech, which Bachmann co-founded. While the USZ Foundationexternal link, Zurich university hospital’s charitable rganization, has expressed interest in supporting the research, Jennings said that Saiba has already been in talks with pharmaceutical giants Novartis and Lonza.
3. Are Vaccine Expectations Getting Ahead of Science
- A recovering U.S. stock market may be pricing in too much optimism over the near-term potential of a vaccine to prevent the spread of the novel coronavirus.
- An Oxford University scientist went so far as to tell The Times earlier this month that a vaccine could be ready by September, well ahead of guidance from U.S. agencies that have suggested it is likely to take a year or more.
- “Such comments make having a vaccine and having one in this timeframe seem a foregone conclusion. Such a conclusion then distorts policymakers’, investors’ and developers’ decisions and expectations,” SVB Leerink’s Geoffrey Porges said in a research note.
- High expectations have caused the stocks of companies developing vaccines to surge. Shares of the U.S. leader, Moderna Inc., have more than doubled since late February, as have smaller peers like Novavax Inc. and Inovio Pharmaceuticals Inc. Even before the coronavirus outbreak, none of these companies had successfully brought a product to the market. Pfizer Inc.-partnered BioNTech SE surged Wednesday after starting a vaccine trial in Germany.
- Porges isn’t alone in trying to tamp down the enthusiasm. It typically takes several years to develop a vaccine, so 12 to 18 months looks “very ambitious,” Severin Schwan, Roche Holding AG’s chief executive officer said Wednesday on Bloomberg TV.
- While investors may assume Moderna will be the fastest, we won’t know for at least another 12 months if the biotech’s messenger RNA vaccine is safe as well as effective, said Mark Poznansky, an associate professor of medicine at Harvard Medical School, and director of the Vaccine and Immunotherapy Center at Massachusetts General Hospital.
- The problem, as outlined by Porges, is that epidemiologists as well as economists appear to be planning for a vaccine coming down the pipeline in as little as six months, but a broadly used vaccine is likely to take two to three years in his “most optimistic” estimation.
- Porges, besides his MBA from Harvard Business School, also has a bachelor’s degree in medicine from the University of Sydney. Before moving to Wall Street, he rose through the ranks at Merck & Co. where he said he was responsible for business strategy and product planning and commercialization for the drugmaker’s vaccines.
- While some vaccines have been earmarked for faster development like Moderna’s or Johnson & Johnson’s adenovirus-based one, that speed could come at the risk of safety or efficacy liabilities down the road, Porges said.
- Even if an approved, effective vaccine is available in a year, it’s more likely it will be given to patients and health-care workers who face greater risk from the disease and “it would still take several years to confer sufficient “herd immunity” to prevent endemic spread of Covid-19,” he said.
- Vaccine researchers are aware of the shortcomings. “We don’t yet fully understand what constitutes a protective immune response to the virus or what precisely a vaccine needs to do to achieve that” Poznansky said.
- But with more than 70 vaccines in development and despite the things scientists don’t yet know about the virus, Poznansky is hopeful on the expedited timelines.
- “We’ve got a lot of vaccine shots on goal being lined up across the global scientific community, we’re hoping that by chance some of them might actually be able to invoke the immunity that we need to protect people from infection and its serious consequences,” he said.
D. New Scientific Findings and Other Advances
1. Air Conditioning Can Spread Coronavirus
- A recently released study by researchers in China, examining an outbreak of COVID-19 that occurred among some related and unrelated diners in a restaurant in Guangzhou in January, suggests that air conditioning in an enclosed space can help spread the coronavirus — but not to everyone in a room.
- The field study, the first of its kind in this pandemic, was conducted by the Guangzhou Yuexiu District Center for Disease Control and Prevention, and is set to be published by the U.S. Centers for Disease Control and Prevention in July. It describes how lunch guests on an entire floor of a five-story restaurant were all quarantined for 14 days after one restaurant patron and several family members became sick. The study has thus been able to assert with some degree of certainty that the infection in one family was able to spread to people dining at two adjacent tables in the restaurant, likely due to airflow, but not to 73 other people who were eating in the same room that day, or to any of the eight servers working that floor.
- The diagram below shows the table at one side of the dining room where Family A, as they are called in the paper, were eating on January 24. Family A had recently left Wuhan, which is 520 miles to the north of Guangzhou, and no one was showing any symptoms of illness when they sat down to lunch. Later that day, however, a 63-year-old woman in the family — identified as A1 in the diagram — came down with a fever and a cough and was taken to a hospital where she tested positive for the virus. Within several days, by January 29, two other family members became ill, and by February 2, an additional two had tested positive.
- Also in that same timeframe, two people eating at Table C contracted the virus, and by February 5, three people at Table B had as well. The diagram shows how an air conditioning unit next to Table C likely blew air — and the virus — across Table A and onto Table B, and likely bounced off the walls back to Table C.
- The upper diagram shows how airflow was emanating from a different AC unit across the other part of the dining room, where no one became ill.
- “We conclude that in this outbreak, droplet transmission was prompted by air-conditioned ventilation,” the authors write. “The key factor for infection was the direction of the airflow.”
- As the New York Times suggests, this study “illustrates some of the challenges that restaurants will face when they try to reopen.” Concerns about airflow, spacing of tables, and screening for infected patrons are likely going to be major factors in making the public comfortable to dine out again.
- The study also confirms what the CDC has acknowledged in recent weeks, namely that airborne spread of the virus is possible without coughs or sneezes, and just from talking or exhaling — though we cannot be certain that anyone in Family A did not sneeze or cough once at this meal.
- It’s also not certain whether the first patient in this study, the 63-year-old woman who was the first to show symptoms, was in fact the first person infected in her family — one or several of the other four family members could have been asymptomatic spreaders at the time of the lunch.
- And the hopeful detail to come out of this study is that tiny, aerosolized particles were not likely hanging in the air of this dining room for a lengthy period, since the servers and the 73 other restaurant patrons, all of whom were later tested, were not infected.
- But the fact that unrelated people at nearby tables were infected is a cause for concern as restaurants and other businesses where people linger for extended periods, like gyms, are going to feel like potential hazards until this pandemic fully recedes, or until a vaccine is made and widely distributed.
- “To prevent the spread of the virus in restaurants, we recommend increasing the distance between tables and improving ventilation,” the researchers write.
- But, psychologically, will that be enough?
- Harvey V. Fineberg, head of the Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats at the National Academies of Sciences, Engineering and Medicine, tells the Times that the study is “illuminating for the kind of thing we need to keep learning about as we try to configure safe work spaces.” And he suggests that germicidal ultraviolet lights may be something that restaurants, bars, and other workplaces will need to consider.
- Another consideration may be a newly developed device out of Switzerland that purportedly can detect the novel coronavirus in the air — though that could lead to panicked stampeding when it goes off.
- This study will at least set at ease those like myself who have been made nervous by the anecdotal case of the choir in Washington State where potentially a single infected person spread the virus to 44 out 60 other people in an enclosed room in March. Singing may be a better spreader than talking over a meal, this should tell us, and also as an infectious disease expert said of that case, certain people are simply super-spreaders when it comes to the capacity of their lungs to expel tiny particles — some capable of exhaling 1,000 times more fine material than the average person.
2. Chinese doctors report coronavirus can survive in the human eye
- Coronavirus may live longer in one’s eye than in other parts of the body, according to a Chinese report cited by Channel 13. The report stated that a Chinese woman was carrying the virus in her eye, while her nose was clear.
- The woman, who is 65 years old, flew to Italy from the Chinese city of Wuhan where the coronavirus first broke out.
- She reported feeling sick on January 27 and quickly began to cough and experience high fever as well as an eye infection.
- After 20 days of being in hospital, the eye infection cleared, but the virus was found in her eyes the next day.
- No virus was detected in her eyes or nose after that date, but on her 27th day in the hospital the virus was discovered again in her eyes.
- The report claimed that the virus can replicate even when it is no longer detectable, meaning the infection potential exists even when patients seem to be healthy.
3. MIT researchers find cells targeted by coronavirus in breakthrough for cure
- Researchers have pinpointed the specific cells targeted by the coronavirus — a development they hope could be helpful in the search for a cure, MIT announced Wednesday.
- The team of scientists used an existing data set on the RNA found in different types of cells to locate those with two proteins known to allow the virus to enter human cells, MIT said in a news release.
- Soon after the pandemic began, scientists learned that a viral “spike” protein binds to a certain receptor on human cells called angiotensin-converting enzyme 2, or ACE2.
- Another protein, an enzyme called TMPRSS2, aids to activate the coronavirus spike protein, allowing it to enter the cell.
- The combined binding and activation allows the virus to get into host cells, MIT explained. Now, scientists just needed to find the specific cells that express these proteins which make them more susceptible to infection.
- “As soon as we realized that the role of these proteins had been biochemically confirmed, we started looking to see where those genes were in our existing datasets,” Jose Ordovas-Montanes, a senior author of the study who runs a lab at Boston Children’s Hospital, said in the statement.
- “We were really in a good position to start to investigate which are the cells that this virus might actually target.”
- The datasets that the researchers used for the study included hundreds of cell types from the lungs, nasal passages, and intestine — all organs targeted by the virus.
- The researchers found that Type II pneumocytes in the lungs, absorptive enterocytes in the intestines, and goblet secretory cells in the nasal passages were possible targets for the virus, the release said.
- The Type II pneumocytes keep the lungs open; the absorptive enterocytes are responsible for the absorption of some nutrients; and the goblet secretory cells produce mucus.
- “This may not be the full story, but it definitely paints a much more precise picture than where the field stood before,” Ordovas-Montanes said.
- “Now we can say with some level of confidence that these receptors are expressed on these specific cells in these tissues.”
- The researchers hope their findings will be helpful to scientists working on developing treatments, or to those testing existing drugs that could be repurposed for COVID-19.
- “Our goal is to get information out to the community and to share data as soon as is humanly possible, so that we can help accelerate ongoing efforts in the scientific and medical communities,” said Alex K. Shalek, an associate chemistry professor at MIT.
- The study, published in the journal Cell, was a collaboration of researchers from MIT; the Ragon Institute of MGH, MIT and Harvard; and the Broad Institute of MIT and Harvard, along with “colleagues from around the world.”
1. CDC Director: That’s Not What I Said
- Yesterday (April 22), the media breathlessly reported that Dr. Robert Redfield, director of the CDC, said that the second wave of the virus would be more deadly than the first.
- Today, at the daily briefing of the White House Coronavirus Task Force, Dr. Redfield corrected the record:
- “I didn’t say that this was going to be worse, I said it was going to be more difficult and potentially complicated because we’ll have flu and coronavirus circulating at the same time.”
- “It doesn’t mean it’s going to be more impossible, doesn’t mean it’s going to be worse, it means it’s going to be more difficult because we’re going to have to distinguish between the two [viruses].”
F. A Better Road Back?
1. Sweden resisted a lockdown, and its capital Stockholm is expected to reach ‘herd immunity’ in weeks
- Its neighbors closed borders, schools, bars and businesses as the coronavirus pandemic swept through Europe, but Sweden went against the grain by keeping public life as unrestricted as possible.
- The strategy — aimed at allowing some exposure to the virus in order to build immunity among the general population while protecting high-risk groups like the elderly — has been controversial. Some health experts liken it to playing Russian roulette with public health.
- But now, the country’s chief epidemiologist said the strategy appears to be working and that “herd immunity” could be reached in the capital Stockholm in a matter of weeks.
- “In major parts of Sweden, around Stockholm, we have reached a plateau (in new cases) and we’re already seeing the effect of herd immunity and in a few weeks’ time we’ll see even more of the effects of that. And in the rest of the country, the situation is stable,” Dr. Anders Tegnell, chief epidemiologist at Sweden’s Public Health Agency, told CNBC on Tuesday.
- Herd immunity among a population, usually achieved through vaccination, is reached when around 60% of citizens are deemed immune. Without a vaccine for the coronavirus, however, scientists are looking at whether exposure to and recovery from Covid-19 leads to long-term immunity. Reinfections of coronavirus have been reported.
- Tegnell said sampling and modeling data indicated that 20% of Stockholm’s population is already immune to the virus, and that “in a few weeks’ time we might reach herd immunity and we believe that is why we’re seeing a slow decline in cases, in spite of sampling (testing for the coronavirus) more and more.”
- “Unfortunately the mortality rate is high due to the introduction (of the virus) in elderly care homes and we are investigating the cause of that,” he said.
- The major part of Sweden’s 15,322 confirmed cases are in Stockholm and its surrounding areas, with very small incidences of the virus in the rest of Sweden — a country of around 10 million that has a low population density outside its urban hubs.
- The number of cases in Sweden is almost double that in neighboring Denmark (it has 8,108 cases and has reported 370 deaths) and Finland (with just over 4,000 cases and 141 deaths) that imposed strict lockdown measures. Since their populations are each about 5 million — half of Sweden’s — the rates are about the same, although the comparison could be skewed by testing numbers in each country.
- But Sweden’s 1,937 deaths are far higher in number and proportionally to Denmark’s 370 and Finland’s 141.
- Sweden originally tested only people who came into a hospital but is now testing more key workers and those in care homes. Tegnell said the decision to test more groups of people was a reason for the number of confirmed cases not declining as quickly as it could have.
- Sweden is testing around 20,000 people a week and hopes to increase that to 100,000 in a few weeks’ time, Tegnell said.
- While the number of new cases appears to be declining, achieving herd immunity has proved controversial. Tacitly allowing the virus to spread (albeit having put measures in place to slow its spread) puts the elderly and people with existing health conditions at a greater risk of becoming seriously ill and, potentially, dying.
- Tegnell conceded that the situation in Sweden’s care homes, which have seen the majority of deaths from the coronavirus, is worrying.
- “The death toll is very closely related to elderly care homes. More than half of the people that have died have lived in elderly care homes.” Tegnell said, adding that he and the Public Health Agency are “still very concerned about the elderly.”
- “It’s the group we said we needed to protect,” he said, adding that the agency was working with homes to see what improvements could be made to lower risk factors.
- Nonetheless, Tegnell said he was “fairly confident” in the strategy his agency had pursued but said it would be too early for the Swedish government to lift restrictions imposed to delay the spread of the virus. “A big part of the country has not been affected at all yet.”
- ″(But) if you look at the exit strategies that now many countries have opted for, they look very much like Sweden’s (strategy and restrictions),” he said.
- Tegnell said that soon, several studies will be published to show the extent of infection and recovery (and hopefully) immunity to the virus. Data showed the peak of infections had already been reached in Stockholm.
- Sweden’s response to the pandemic has been guided by Tegnell and the Public Health Agency. While other countries have gone into lockdown at the advice of their scientific advisors, Sweden was conspicuous in its different approach, largely trusting the public to adopt voluntary measures to delay the spread of the virus.
- Sweden’s government has advocated working from home if at all possible and to avoid nonessential travel and social contact with the elderly. Meanwhile, restaurants, bars, cafes and nightclubs have been offering seated table service only, and gatherings of more than 50 people have been banned. Yet schools for under 16-year-olds have remained open and life has generally carried on as before, just at a quieter pace.
- Tegnell said the country was conducting more widespread testing and sampling to gauge the extent of the outbreak.
- “We are right now going out and doing countrywide tests on immunity to see what big differences we have in different parts of Sweden,” Tegnell said. “It’s a little bit of a mystery why nothing has really happened in other parts of Sweden.”
- “The virus keeps on surprising us when it comes to this,” he said, noting that the most southern region of the country, which borders Denmark, had seen relatively few cases given its border location and the constant movement of people between the countries, which was allowed to continue for the most part despite the virus.
2. Sweden Ignored Coronavirus Fears, Kept Economy Open, Yet Has A Mortality Rate Similar To US [Analysis/Opinion]
- “My God, did we destroy our economy and millions of businesses for nothing?”
- So goes a now-increasingly common refrain from people wondering if coronavirus fears were vastly overblown and that the so-called “cure” of authoritarian social-distancing is now proving much more harmful than the virus itself.
- That is not to say the loss of life isn’t important, but in the case of the coronavirus it seems the actual mortality rate is far lower than initial projections, and Covid-19 continues to pose almost no risk to those in good health under the age of 60.
- And now we learn that in Sweden, which didn’t institute any nation-wide lockdown orders and kept its economy open for business, their new case and death numbers appear to have already flattened and the country’s overall mortality rate is comparable to the United States which all but closed its economy entirely in response to the virus and now faces the very real threat of a Great Depression.
- Sweden currently has a coronavirus fatality rate of 156 per million people while the US has a fatality rate of 126 deaths per million. The difference is statistically negligible. In even simpler terms, it means there’s hardly any difference between the two nations at all despite Sweden taking almost no precautions against the coronavirus and the U.S. shutting down the economy and ordering people to stay home.
- What Swedish health officials decided was, after initially reviewing the mortality rates of the virus, (and finding it wasn’t actually as deadly as early reports indicated) to allow the virus to naturally work itself through the population. Yes, some would die of it just as some die of the flu, sepsis, etc.
- Sweden shrugged off the coronavirus threat while the United States (and many other nations) freaked out, businesses collapsed and deficit spending exploded.
- And yet both have very similar overall mortality rates for the very same disease.
- And where those in Sweden continue to enjoy meals out, playing in parks, and making a living, in the United States we have neighbors reporting on neighbors for things like gathering outside, planting gardens, and/or not standing more than six feet away.
- So, did we destroy our economy and millions of businesses for nothing? Sadly, it’s sure looking that way.
3. Hundreds of people volunteer to be infected with coronavirus to accelerate the development of vaccine
- Momentum is building to speed the development of coronavirus vaccines by intentionally infecting healthy, young volunteers with the virus. A grass-roots effort has attracted nearly 1,500 potential volunteers for the controversial approach, known as a human-challenge trial.
- The effort, called 1Day Sooner, is not affiliated with groups or companies developing or funding coronavirus vaccines. But co-founder Josh Morrison hopes to show that there is broad support for human-challenge trials, which have the potential to deliver an effective coronavirus vaccine more quickly than standard trials.
- Typical vaccine trials take a long time because thousands of people receive either a vaccine or a placebo, and researchers track who becomes infected in the course of their daily lives. A challenge study could in theory be much faster: a much smaller group of volunteers would receive a candidate vaccine and then be intentionally infected with the virus, to judge the efficacy of the immunization.
- “We want to recruit as many people as possible who want to do this, and pre-qualify them as likely to be able to participate in challenge trials should they occur,” says Morrison, who is also the executive director of organ-donation advocacy group Waitlist Zero. “At the same time, we feel that the public policy decisions around challenge trials will be better informed if they highlight the voice of people interested in participating in such trials.”
- Morrison says that the people who have signed up to be part of a challenge trial tend to be young and live in urban areas, and are highly motivated to do something constructive to address the coronavirus pandemic. “Many note that they recognize the risk but believe the benefits of vaccine acceleration are so tremendous that it is worth it to them,” he says.
- Challenge studies have been conducted before for diseases including influenza and malaria. A team led by bioethicist Nir Eyal at Rutgers University in New Brunswick, New Jersey, argued that a human challenge trial could be conducted safely and ethically, in a paper in The Journal of Infectious Diseases last month.
- The approach is also gaining some political support. This week, 35 members of the US Congress, led by Bill Foster (Democrat, Illinois) and Donna Shalala (Democrat, Florida), called on Department of Health and Human Services director Alex Azar to consider human-challenge trials of coronavirus vaccines.
- Charlie Weller, head of the vaccines programme at Wellcome, a biomedical-research funder in London, says the charity has begun discussing the ethics and logistics of a human-challenge trial for a coronavirus vaccine. But she says it is unclear whether such a trial could actually speed vaccine development. Researchers first need to determine how to expose humans to the virus as safely as possible, and to consider how and even whether such studies can be done ethically. “I think there’s potential,” Weller adds, “but we’ve got so many questions to work through to understand whether it can help in the timelines we have.”
G. Caution: Blind Curves Ahead
1. Americans are poisoning themselves while trying to kill the coronavirus
- From adults creating chlorine gas in their kitchens to toddlers guzzling hand sanitizer, Americans seem to be inadvertently poisoning themselves as they try to defend against the new coronavirus, SARS-CoV-2.
- Since the beginning of March—as the COVID-19 pandemic began raging in the US—calls to poison control centers nationwide “increased sharply,” according to a new study led by researchers at the Centers for Disease Control and Prevention.
- Although researchers cannot directly link pandemic preparedness to the poison control calls, “the timing of these reported exposures corresponded to increased media coverage of the COVID-19 pandemic, reports of consumer shortages of cleaning and disinfection products, and the beginning of some local and state stay-at-home orders,” the researchers write.
- In their study—published in the CDC’s Morbidity and Mortality Weekly Report—the researchers compared calls made to 55 poison control centers in the United States between January and March of 2020, 2019, and 2018.
- In 2020, calls about exposures to cleaning and disinfecting products jumped 20 percent and 16 percent over the same three-month periods in 2019 and 2018, respectively. Those increases largely spanned March, as the pandemic picked up.
- While all age groups seemed to be affected by the pandemic-linked poisonings about equally, young children (aged 1 to 5) tend to have the most exposures overall.
- The increase in poisoning calls were due to increased exposures to bleach, non-alcohol disinfectants, and hand sanitizers—things people may use to kill SARS-CoV-2. As for exposure routes, inhalation poisonings had also increased from earlier years, according to the data.
The researchers note that:
- To reduce improper use and prevent unnecessary chemical exposures, users should always read and follow directions on the label, only use water at room temperature for dilution (unless stated otherwise on the label), avoid mixing chemical products, wear eye and skin protection, ensure adequate ventilation, and store chemicals out of the reach of children.
2. A new map shows that you can’t maintain social distancing on many New York City sidewalks
- As we stumble into the second month of quarantine in many US cities, it’s clear that by and large, we’re starting to adapt. Things that felt strange, perhaps antisocial and even reactionary — like grocery stores only allowing a limited number of people in at a time — are newly normal. It’s easier to claim personal space even in cities now that most people have accepted social distancing as the norm. That six-foot rule, however, is sometimes hard to follow, especially in population-dense places where the expectation is that people will share public space. In New York City, for example, it’s remarkably difficult: the mayor hasn’t closed many streets, and the sidewalks — plentiful though they are — feel really small.
- Earlier this month, tech news site Motherboard asked a bunch of New Yorkers to measure the sidewalks directly outside of their apartments, and it came to the bleak conclusion that “it is simply not possible to social distance on most New York City sidewalks.”
- A new map (available here: http://www.sidewalkwidths.nyc) from the developer Meli Harvey shows exactly how narrow the sidewalks in New York are, with colors overlaid onto the city’s grid. (Harvey used data from New York City’s sidewalk dataset to construct their map.) The result is a stark validation of what most New Yorkers felt to be true: there’s just not enough space for most people to stay the recommended six feet apart.
- The map is also a really good representation of how we think about space now and how we’ve adapted to the assumption that our neighbors are vectors for this disease we can’t see. We know a little bit about how the disease is transmitted from person to person, and we know why it’s important to stay away from each other. That’s why it’s more than a little infuriating that New York City’s mayor doesn’t seem to understand how to safeguard that space for his public — even as the city is undergoing the worst outbreak of COVID-19 in the country.
3. Many survivors will be left traumatized by their ICU experience
[Note: As a follow up to 4/22 Update on steps one can take to avoid going on a ventilator (read the article here), this article highlights one of the reasons that it is extremely important for those infected with COVID-19 to do everything in their power to stay off a ventilator.]
- People who survive intensive care and the process of being put on a ventilator often suffer depression, anxiety, and post-traumatic stress disorder.
- There’s a phrase to describe what we’re experiencing: collective trauma. We are all grieving—whether it’s for the deaths of loved ones, the loss of our way of life, or the knowledge that things will never quite be the same again. Most of us are experiencing some level of anxiety. The loss of control over major aspects of our lives and lack of a clear end point to the crisis are both partly to blame. For some, stress will spiral into a diagnosable mental health problem.
- But we’re not all going through the same thing. Health-care workers who treat coronavirus patients every day are likely at increased risk of such issues. Many worry about working with inadequate protective equipment. The stress they’re under now could take months or even years to process, so we won’t know the pandemic’s full impact for a long time.
- And there’s another group we need to prepare for: people who have been admitted to intensive care with covid-19 and survived. It’s very difficult to predict how many people will end up in this situation. The vast majority of those who catch coronavirus won’t need a hospital stay, according to a study of nearly 45,000 cases in China carried out by the country’s Center for Disease Control and Prevention, which found that 81% of infections are mild.
- However, as we sail past 2.5 million documented infections globally, that still means many tens of thousands of people end up in intensive care. A preprint study from one of the US’s biggest hospital systems, Kaiser, found that 42% of people hospitalized with coronavirus end up in the ICU. Data from hospitals suggests that about half of those admitted to intensive care with coronavirus make it back out again. Their chances are slimmer if they are elderly, and for all patients the prognosis worsens as time goes on, especially if they are put on a ventilator.
- For those who make it out the other side, their stay in intensive care is likely to be one of the most traumatic things they will ever experience. Being able to breathe is something we take for granted. But patients who have such difficulty breathing that they need to be intubated (which involves having a tube inserted into their mouth and down their airway) often believe they are going to die at some point during their stay in intensive care. Anecdotally, ICU doctors say patients with covid-19 tend to need a particularly large amount of sedation, which damages muscles and nerves, especially in the lungs. That damage can be permanent—which can in turn undermine the patient’s mental health.
- “Their lives will never look exactly as they were before. Being admitted to an ICU is one of those ‘before and after’ life events, like having a child, or a parent dying,” says Megan Hosey, a psychologist who treats ICU patients.
- Patients on ventilators often become delirious. They can drift in and out of consciousness, hallucinate, and become confused about what’s happening to them. It’s common for them to form delusions and misremember what’s occurred. “They can recollect that a nurse or doctor was trying to hurt them when they were doing a procedure to help them,” says Timothy Girard, associate professor of critical care medicine at the University of Pittsburgh Medical Center. It’s unsurprising, then, that so many ICU survivors go on to experience depression, anxiety, posttraumatic stress disorder, and other mental health issues.
- A 2018 UK study of nearly 5,000 ICU survivors found that over half had developed at least one of these conditions a year after they left the hospital. A 2014 meta-analysis put this figure closer to one-fifth. Either way, “the research is clear that some people who have been hospitalized will develop PTSD,” says Antonis Kousoulis, research director at the Mental Health Foundation, a UK nonprofit.
- It’s too early to know if people who’ve survived being hospitalized with coronavirus will experience similar rates of mental illness. Some will be affected more than others. And multiple studies suggest that ICU patients who have been heavily sedated, especially with high doses of benzodiazepines, are more likely to develop mental health issues, says Girard. This bodes badly given the high level of sedation required for covid-19 patients in ICUs.
- “It will be traumatic for many, but everyone responds differently. Some will develop PTSD, but some won’t,” says psychologist Elizabeth Woodward. However, the first piece of research into this specific question, conducted in China and published in Psychological Medicine, suggests we need to prepare for a tsunami of poor mental health among survivors. The researchers found that 92% of the 714 patients they surveyed had “significant posttraumatic stress symptoms.” (There is a difference between symptoms and a diagnosable condition, to be sure. It’s very common for people to experience intrusive thoughts, flashbacks, and nightmares after a traumatic incident. It’s when those symptoms recur for months on end that it tips over into clinically recognized PTSD, says Woodward.)
- While this serious secondary effect of the pandemic is undoubtedly heading our way, there is plenty we can do to mitigate its effects. Making sure those who are discharged from the ICU have ready access to medication and therapy, such as cognitive behavioral therapy, can help. Health-care workers can also keep an “ICU diary” while patients are on the ward—listing everything that happened to them and when—to help them make sense of their experience in the following months.
- Interventions require education, organization, and money—a tall order at the best of times, but especially in the middle of a pandemic, when the health-care system is struggling to cope. However, the cost of doing nothing would be far greater, says Bienvenu. “There were World War II veterans who to their dying day still woke up screaming because they never talked about what they’d experienced,” he says. “We’d like to be able to prevent that, and we can.”
H. What Do Coronavirus Models Tell Us?
1. 5 Models, 5 Very Different Projections
- In the last few weeks, we’ve all become a little more familiar with epidemiological models. These calculations, which make estimates about how many people are likely to get sick, need a hospital bed or die from coronavirus, are guiding public policy — and our expectations about what the future holds.
- But if you look at the models, they don’t really agree.
- The chart below includes 5 leading models’ predictions of U.S. coronavirus deaths through May 30, most of them standardized and compiled by a team at the University of Massachusetts Amherst.
- You’ll see differences in how high the peak of deaths is likely to get, and in how far we are from such a peak.
- Most of the models shown above predict that the country is currently past or near the peak number of deaths for this wave of the epidemic, assuming current restrictions aren’t relaxed. But they estimate a range of total deaths — 60,000 to 100,000 — through May 23.
- These models use different techniques to project the future. But most of them share an important basic assumption: They are built around the notion that the current regimen of stay-at-home orders and social distancing will continue. And almost all of them cut off their predictions after two months or less, even though epidemiologists believe that the coronavirus pandemic will be with us for far longer.
- However good the modelers’ mathematical strategies may be, many of the descriptive facts about the virus are still unclear. Researchers aren’t sure about the rate at which people who become infected die, or about the rate of transmission to other people. They don’t know for sure how many people have already been infected and have some immunity to the disease — or how long that immunity will last. Even the count of coronavirus deaths itself is uncertain.
- In addition to the usual challenges, the models have recently been asked to contend with a large revision in the number of deaths believed to be caused by coronavirus in New York.
- Several epidemiologists said it was hard to expect the models to offer precise forecasts at this point because they rely on such uncertain inputs. “It’s like trying to repair a car while it’s still running,” said Andrew Noymer, an associate professor of public health at the University of California, Irvine.
- The model most frequently cited by the White House is from researchers at the Institute for Health Metrics and Evaluation at the University of Washington. It makes its estimates by comparing the recent trajectory of the coronavirus in the United States with those of countries further along in their epidemics. That method allows them to estimate a trajectory without having to know too many facts about the disease itself. This model has tended to be less pessimistic than the others about the next few months; the White House has cited its estimate of around 60,000 deaths over the next few months. Epidemiologists have been loudly and publicly critical of its design.
- The other models, including those from Northeastern University and Columbia University, which are built on epidemiological theory, use estimates about how contagious the virus is, how long it takes for people to recover, and what share of infected people with different risk factors will develop a serious illness or die. In theory, such methods are more precise, because they are built around the ways that diseases actually spread and kill people in different circumstances. But because these models all rest on a shaky foundation of knowledge about the virus, several of them have also conflicted with recent death counts, and their projections vary.
- “We want them to provide more information than they can,” said Jeffrey Shaman, a co-author of the Columbia model, who said the models were still valuable in showing a range of what could happen. “We have uncertainty on top of uncertainty on top of uncertainty.”
- But they remain the best guide as policymakers and hospital executives try to plan for how many hospital beds or ventilators — or how much morgue capacity — they need. That doesn’t mean the models have been as useful as policymakers would like: New York relied on models that told it to create far more bed and ventilator capacity than it has turned out to need.
- Researchers at the Los Alamos National Lab have released a model with state-level predictions that assume social distancing interventions will continue. Their predictions for New York State include a broad range of possibilities, including cumulative totals of less than 25,000 deaths and more than 60,000 deaths by the end of May. Four of the other modelers are publishing estimates for individual states as well as the nation as a whole.
- Nicholas Reich, a biostatistician who runs a seasonal flu forecasting lab at the University of Massachusetts Amherst, said it was important to collect outputs from all the models, because of the uncertainty around all the projections.
- “If you’re just looking at one model, you’re not seeing the full diversity of what could happen,” said Mr. Reich, who leads the team that aggregated the data.
- A review of all these models shows how much they are adapting to new information. The projections change, as new death counts and public health research bring them closer to understanding how the disease, and the people it affects, are behaving. Most of the projections have reduced their expected number of cases and deaths in the coming weeks.
- Although some politicians like to treat the models as precise, all of them include large bands of uncertainty around their principal projections. In some cases, the real numbers have ended up outside these ranges more often than they should, a sign that the modelers have underestimated how little they know.
- Samuel Clark, a demographer at Ohio State University, says he has been closely watching the model from Imperial College London for a sense of how the epidemic might respond to different scenarios, but he does not currently expect any of the models to function like crystal balls.
- “They’re basing their model on very few data, and because of that you have very large uncertainty,” Mr. Clark said.
- Errors may come from methodological flaws in the models. And they may come from errors in assumptions about the disease, like its fatality rate. But they may also come because no mathematical model can be sure what actions governments and individuals will take in the face of a prolonged epidemic.
- Currently, most states have imposed some form of stay-at-home order, and several cities have required people to wear masks when they work and shop. Those kinds of measures are designed to slow the spread of the virus, to achieve a reduction in cases and deaths that all of these models expect.
- But the White House has already begun preparations for states to loosen such restrictions once the cases get low enough. Once behavior changes, the spread of the disease is likely to change too, meaning all the models will need to recalibrate. The teams from Imperial College London and Northeastern University release projections only about a week into the future, because their researchers worry that policy and norms could change quickly.
- The Columbia University model tries to anticipate those different possible futures. In our charts above, we showed the output of the middle scenario of the range. But the model has three outputs, based on different estimates of how much governments and people will work to reduce social contact when they see an increase in confirmed cases.
- Dimitris Bertsimas, a co-author of a model from the Massachusetts Institute of Technology, said his team had declined to make very long-term predictions, given the policy uncertainty.
- “We are reasonably certain until approximately June 15 there will be significant measures” to contain the spread of the virus, said Mr. Bertsimas, an associate dean of business analytics at M.I.T.’s Sloan School of Management. “After that, God knows.”
- [NOTE: We continue to monitor the IHME Murray Model other models for new and meaningful insights into our potential future. However, as previously noted, while projections have provided insights into trends, we believe that when it comes to specific estimates the projections have been materially inaccurate. For that reason, we are not going to report on updates on the IHME Model or other models in the future unless we believe the updated projections provide meaningful information or insights. But, if interested, you can find the latest updates to the IHME Model here.]
I. Projections and Our (Possible) Future
1. 4 Trends For A Post-COVID-19 World
- Society has rapidly adopted new behaviors that are re-shaping the future.
- We’re on the verge of a new era for virtual care in the healthcare system.
- Digital transformation is accelerating, due to so many people working from home.
- The quarantine has forced even the most resistant consumer into the online world.
- The network for online communications has been fortified.
- You’re probably wondering if I’m about to tell you we’re entering a post-COVID-19 apocalyptic world, with tribes of nomad warriors travelling from town to town in search of food and water.
- No. I am not telling you that.
- I believe we will eventually get control over the COVID-19 one way or another. We’ve done it before and we’ll do it again. Whether it’s a 6-month journey or a 24-month “Whac-A-Mole” is irrelevant to this article. (Although it is highly relevant to investors at the moment.)
- There are plenty of articles debating whether this is a bear market rally or Great Depression 2.0. There are few discussing the longer-term implications of what we’re currently experiencing.
- Society has been forced to rapidly adopt new behaviors. The longer these behaviors are performed, the more habitual and commonplace they become. Trends that once existed in the background have been forced to the forefront of our daily lives. Technologies and behaviors that once might have taken years to reach saturation have been embraced by hundreds of millions in a matter of weeks. For many, these behaviors will stick.
- While there’s a mythical stat floating around the internet that it takes 21 days to form a new habit, there is some validity to this claim. Indeed, research by Phillippa Lally, Cornelia H. M. van jaarsveld, Henry W. W. Potts and Jane Wardle published in the European Journey of Social Psychology indicates it can take anywhere from 18-254 days to form a habit:
- The time it took participants to reach 95% of their asymptote of automaticity ranged from 18 to 254 days; indicating considerable variation in how long it takes people to reach their limit of automaticity and highlighting that it can take a very long time. Missing one opportunity to perform the behavior did not materially affect the habit formation process. With repetition of a behavior in a consistent context, automaticity increases following an asymptotic curve which can be modelled at the individual level.
- Although we might not be in quarantine for 254 days, enough of us will repeat new behaviors enough times to permanently change life for a material segment of society. Moreover, the apparent benefits to those new behaviors will accelerate and reinforce adoption over the long run. And that has implications for long-term investors.
- Below are 4 major changes that will impact investors going forward:
1. Rise of Telehealth and Digital Therapeutics
- If it can be avoided, nobody is going to a doctor’s office or the hospital. People want to avoid virus hot-zones and the medical community needs to reserve capacity for chronically ill, including COVID-19 patients.
- Of course, the delivery of health services goes beyond doctors’ appointments. A vast range of services – therapy, diagnostic follow-ups, personal training, counselling, and so on – can be delivered digitally.
- While this channel for delivering healthcare services has existed for years, widespread adoption was limited because people were unsure how it worked. But with government encouragement (e.g. President Trump talked about telehealth during a press briefing), this has become a new way of life. While not everyone has had to make a doctor’s appointment during the quarantine, enough people have adopted the technology to lead change for friends and family in the future.
- There will always be some who prefer the human touch. After all, there were many who rejected the notion of making a deposit at an ATM. Yet, the delivery of banking and payment services has still dramatically transformed because the business case (corporate and personal) was strong enough to justify the transition.
2. Remote Working and Teleconferencing
- “Digital transformation is accelerating, due to so many people working from home. New work-life balances are also being struck.” – Mary Meeker
- Corporations have just conducted a massive experiment – a massive experiment that has proven successful.
- The old stodgy biases against working from home – people will slack off, collaboration declines, workers are unable to connect – have been proven false. People can work from home. And large traditional companies that were previously hesitant are now building this into their standard practices. Partly for business continuity purposes, after getting caught unprepared when the quarantines were ordered, but also because they’ve quickly recognized the benefits.
- I doubt I have to tell you about how employees benefit by working from home. The immediate benefits are obvious – no commute, save money on transportation and food, more flexible working hours. However, there are less obvious benefits like the ability to live farther from work, helping employees who work in cities with expensive real estate (e.g. San Francisco, Vancouver, Toronto, New York).
- There are also substantial benefits for employers. Companies headquartered in high-rent/high-salary areas like Manhattan can now comfortably hire employees in lower-cost areas of the country, increasing the pool of available candidates and reducing salaries expense. Also, by allowing more employees to work remotely, companies can reduce their physical footprint, saving considerable amounts on commercial real estate leases for office space (and the additional infrastructure to support each desk).
- Bond Capital conducted an informal survey of companies, asking what they’ve learned from 1.5 months of remote work. Here are some of the findings:
- At the margin, productivity is the same or higher
- Video calls, when not overused, are efficient/productive and they tend to start/end on time (or early)
- Messenger and video-based information sharing/editing is very effective
- People outside of headquarters feel more included
- It’s easier to bring outsiders in for quick video discussions
- Time flexibility/commute time elimination/family meal sharing are big wins for workers
3. Acceleration of Offline-to-Online Consumption
- With stores, restaurants and entertainment venues closed, the quarantine has forced even the most resistant consumer into the digital world.
- Grocery shoppers are increasingly buying online, many using the app Instacart. To survive, restaurants have acquiesced to delivery services like Uber Eats (UBER) and DoorDash.
- People have also jumped on-board the Netflix (NFLX) and Disney+ (DIS) trains. While new subscribers and users might not become lifelong converts, a segment will keep using these delivery and entertainment services. (Note: I’m not suggesting Disney overall is a huge beneficiary of this trend, since its theme park and ESPN revenues will get hit hard by the lockdown.)
- However, the big winner from the acceleration of offline-to-online consumption is Amazon (AMZN), which is trading near all-time highs. To Amazon’s advantage, as individual brick-and-mortar retailers are forced to shut it has essentially become a retail monopoly (for the time being). Eventually brick-and-mortar will return, but with a huge proportion closing down permanently, Amazon has a long runway to profit from retail dislocation.
- Perhaps the most interesting – and needed – transition will be to the delivery of education. The trend was already in motion, but it will become increasingly clear that education can be delivered online in some respects.
- Millions of kids are using Google Classrooms (GOOG) (NASDAQ:GOOGL), but I expect the trend to follow through to post-secondary education as well. Traditional universities will fight to retain their huge tuition fees, but the concept of online college education is becoming increasingly accepted. While a full-scale transition isn’t likely, in the future there will be an increase in hybrid and tiered approaches to delivering education.
4. Adoption of Lifetime Communication Habits
- Millions of kids around the world haven’t seen their friends over a month. For the first time, many of these same kids have started using video-chat services like Google Hangouts, Apple’s (AAPL) Facetime and Zoom as a substitute.
- Previously, these companies would have spent millions in marketing dollars to achieve the same effect. Now they suddenly have been granted the opportunity to create lifetime value from each new account.
- Once the world opens up again, kids will become kids again. But the network for online communications has been fortified. And to the companies that use that asset wisely, this could be worth billions in lifetime customer value.
J. Practical Tips and Other Useful Information
1. Why wearing gloves to the grocery store isn’t fighting coronavirus
- The gloves are coming off in the fight against dangerous myths surrounding the coronavirus.
- Despite no recommendations from the Centers for Disease Control and Prevention to do so, shoppers continue to wear gloves in public places, such as grocery stores. The meaningless gesture has left doctors and health experts shaking their heads — not only are the gloves ineffective, they may be worsening the spread of COVID-19.
- The virus primarily spreads through our mouth, not our hands, so there’s no evidence that gloves do anything to protect people from picking up the illness. The risk is when people touch their faces, which they do with and without gloves, says Marilyn Roberts, a microbiologist and professor in the University of Washington’s Department of Environmental & Occupational Health Sciences.
- “The biggest issue is that people are picking up COVID-19 from other people,” Roberts tells The Post. “They’re not picking it up from surfaces.”
Why they’re making matters worse
- Even if you’re careful not to touch your face or your phone while wearing the gloves, improper disposal of the wares could make your gloves a corona-culprit. In 2003, for example, Canadian researchers were exposed to SARS after removing their personal protective equipment incorrectly. Cases like these are the main reason why gloves often do more harm than good, Roberts says.
- “Wearing gloves if you’re just going to the grocery store isn’t going to be that protective,” Roberts says. “The bigger issue is the inappropriate disposal.”
- And the average shopper likely isn’t well-versed in proper glove removal, says Dr. Niket Sonpal, assistant clinical professor at Touro College of Medicine in New York.
- “In medical school we spend whole lessons on how to don gloves and remove them,” Sonpal tells The Post.
- Nurses and doctors are trained on how to take gloves off properly: by pinching the glove at the wrist, turning it inside out while pulling it off your hand, and removing the next one so that your hand never touches the outer side of the glove. Although health-care workers need gloves to treat patients safely, and protect themselves, there’s no need to use them for a shop.
- And lately, many glove-wearers have also been littering with their tossed out gloves, which Roberts says could potentially further the spread if another person comes into contact with the trash.
2. Avoid touching pretty much anything with this clever hand tool
- If the current pandemic has taught us anything, it’s that we all have a bad habit of touching random surfaces and then our faces all the time. The problem is you can’t just stop withdrawing money from an ATM, opening the door to the grocery store or signing your signature on a credit card keypad. But, what you can do is put a barrier between you and potentially germ-ridden areas.
- The CLEANKEY does just that. This gadget puts distance between your hands and door handles, keypads, elevator buttons, touchscreens and other surfaces you’ll inevitably come into contact with during social distancing—so much so that you’ll limit your interaction with everyday points-of-contact by up to 99%. Think of the gadget as a second set of hands. With it, you can grip door handles, push buttons, pull levers and sign on touchscreens, all without direct contact. And because it is crafted out of copper, the design is inherently antimicrobial and helps slow down the spread of bacteria or stop them completely in their tracks. Once you’re back in the comfort of your own home, all you have to do is give it a quick clean with a disinfectant wipe, and it’s ready to be taken back out into public again.