“There has to be a hard look at the experts, the organizations, the international watchdogs who should have been watching for the coronavirus outbreak because we obviously missed it.”
— NY Governor Cuomo
“GOP Governors are sending vulnerable workers to die with false claims of safety.” — US Representative Alexandria Ocasio-Cortez
“To reopen the economy, we need to be testing enough people that we can quickly detect emerging hotspots and intervene early. We can’t defeat an enemy if we don’t know where it is.” — Bill Gates
“Leaders are asking us to do the impossible—cut off almost all social contact indefinitely—at often incalculable individual cost, and then belittling those who object as anti-science rubes.”
— Joseph C. Sternberg, Wall Street Journal Editorial-Page Editor
- Recent Developments and Headlines
- Numbers and Trends
- Potential Treatments
- New Scientific Findings
- How many people have been infected with coronavirus?
- Ventilators Offer Little Hope
- Corona Collateral Damage
- Play Ball!?
- The Road Back?
- Is Herd Immunity The Inevitable Endgame?
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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 4/23 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 = 2,716,806 (+3.1%) (+81,090)
- US Total Cases = 880,204 (+3.7%) (+31,487)
- Worldwide deaths = 190,582 (+3.5%) (+6,462)
- Europe deaths = 114,259 (+2.8%) (+3,057)
- US deaths = 49,845 (+4.6%) (+2,186)
- NY deaths = 20,861 (+2.5%) (+507)
- NY Gov. Cuomo: 13.9% of New Yorkers Tested Positive for Coronavirus Antibodies; 21% in NYC
- President Trump says he “strongly disagrees” with Georgia’s plan to reopen
- CA Gov. Newsom Moves Goal Posts for Ending Lockdown: 60,000 to 80,000 Daily Tests Needed
- Report: Gov. Gretchen Whitmer to Extend Michigan Lockdown Until May 15
- Nevada Gov. Sisolak: ‘We’re Certainly Not Opening Up the Strip’
- Bill Gates: It’s impossible to overstate the pain as fight against coronavirus will define our era
- California sees deadliest day since beginning of coronavirus outbreak
- Stockholm Expects ‘Herd Immunity’ in Weeks Despite Sweden Resisting Lockdown
- U.K. Social Distancing Could Last Rest of Year
- Despite Lockdown, France Rocked by Four Straight Nights of Riots
- Russia reports thousands of new cases
- Indonesia reports dozens of new deaths
- UK sees deaths slow for 2nd day
- Merkel warns “we’re still at the beginning” of the outbreak
- NY deaths continue to slow
- California reports 115 deaths
- Pompeo demands China permanently close all wet markets
- NJ on cusp of reporting 100k cases as state unveils new saliva test
- France’s stretch of slowing case growth hits 1 week mark
- Turkey cases top 100k
- Vietnam, Greece announce plans to start reopening
- Malaysia extends lockdown for 3rd time
- Data shows nearly 90% of patients placed on ventilator never recover
- Some Wuhan doctors see virus reemerge in patients 70 days after negative test
- Renowned Microbiologist Claims Wuhan Lab ‘Did Absolutely Crazy Things’ With Coronavirus
- China Denies US Request For Access To Wuhan Lab Which May Be Source Of Coronavirus Pandemic
- UK Prime Minister Boris Johnson is accused of “sleepwalking” Britain into disaster
- Nevada Brothel Causes Stir With Stimulus Request
- “Scan Your Code!”: Dystopian Post-Lockdown ‘Normal’ In Wuhan Enforced By ‘Anti-Virus Patrols’
- Texas Mayor Caught Defying Her Own Stay-At-Home Order At Local Nail Salon
- “Pandemic Drones” To Fly In Connecticut, Hunting For COVID-Carriers
- US Intel Officials Believe Chinese Diplomats May Have Spread Fake Texts To Cause Social Unrest
- Eight Meatpacking Plants Close In Weeks Across America Stoking Food Shortage Fears
- Science Teachers Adapt To Lockdown With ‘Burping Bags’ And Other At-Home Experiments
- 565 Americans Have Lost Their Job For Every Confirmed COVID-19 Death In The US
- Pork Shortages To Strike America In Two Weeks
- Migrant Areas Of Paris Hit With 4th Consecutive Night Of Riots
- Chinese Doctors’ Skin Turns “Very Dark” After Barely Surviving COVID-19
- U.S. Navy Finishes Testing 100% of Sailors on USS Theodore Roosevelt (840 positive and 4,098 negative)
- Moscow Gives Communists Special Permission to Celebrate Lenin’s Birthday
- Bill and Melinda Gates Stored Food in Basement Years Ago for a Pandemic
- Trump: Blue Angels, Thunderbirds Will Do Flyovers Across Country to Honor Medical Workers
- Italian Bishops Propose Reopening Sunday Worship on May 3
- Faulty Chinese Masks Force More than 1,000 Spanish Medics into Isolation
- 66% of Homeless in San Francisco Shelter Have Coronavirus
- Twitter Bans Coronavirus Claims That Cause ‘Harmful Activity’
- Nevada Gov. Steve Sisolak: ‘We’re Certainly Not Opening Up the Strip’
- U.K. Social Distancing Could Last Rest of Year
- Hershey Says Baking Goods Sales Soared, Gum Sales Tanked, and Future Too Chaotic to Predict
- Chinese Media Admits Coronavirus Still Raging: ‘Prevention Will Become a Protracted War’
- NY Gov. Cuomo: Want to Go Back to Work? Get a Job as an Essential Worker
- Pompeo: We May ‘Never Return’ to Funding W.H.O.
- 1,000-Bed Hospital Ship USNS Comfort to Leave New York City
- Kenya: Parents Use School Coronavirus Lockdowns for Female Genital Mutilation
- Nigeria: 150 Die of ‘Strange Ailment,’ but Can’t Confirm Coronavirus
- Trump: ‘Sports Will Be the Way They Used to Be’
- How soon can businesses reopen during pandemic? A Texas suburb takes the plunge
- White House shifts from raising alarms to reopening country
- ‘Constitutionalist sheriffs’ won’t enforce coronavirus restrictions
- Grocers Hunt for Meat as Coronavirus Hobbles Beef and Pork Plants
- Virus pushes unemployment toward highest since Depression
- Trump adviser suggests reopening economy by putting ‘everybody in a space outfit’
- American billionaires have gotten $280 billion richer since the start of the COVID-19 pandemic
- U.S. civil rights agency says employers can test workers for COVID-19
- There Are More Flights Leaving Montana Than JFK as Coronavirus Slows Travel
- United mandates masks for flight attendants, unions want passengers included
- Number of Brit nudists on the rise thanks to coronavirus lockdown
- 11,000 deaths: Ravaged nursing homes plead for more testing
- One in eight relationships on rocks due to coronavirus
- Traffic light for bathroom break is new normal in coronavirus Italy
- Coronavirus Philadelphia: Schools Likely To Wear Masks Once In-Person Classes Resume, Superintendent Says
- Prejudice against frontline workers creates breeding ground for unrest
- Dozens of medical workers have been attacked in Mexico amid coronavirus fears
- On the margins of Paris, the food bank queues grow longer
- Coronavirus: Birmingham funeral staff ‘spat at’ by mourners upset with 6 person limit
- Top DHS scientists says heat, humidity slow coronavirus
- CDC triples number of coronavirus symptoms
- City health officials warn coronavirus antibody tests may not prove immunity
- Florida lawyer to wear Grim Reaper costume to stop people visiting beaches
- NY Gov. Cuomo: preliminary results of study showed that hydroxychloroquine had no effect on seriously ill coronavirus patients in New York
- New York Public Library may have to ‘quarantine’ its books as lockdown eases
- Democratic Party still hopes to hold ‘in-person’ convention in August
- Over 5,000 US meatpackers exposed to coronavirus, union says
- FDA says there is no evidence groceries can transmit coronavirus
- Rich Hamptonites are getting coronavirus tests thanks to $1,000 house calls
- Belgian port workers to wear buzzing social distancing bracelets
- Sunbathers flock to Florida’s Cocoa Beach as it reopens
- We need to start pushing the envelope to get people back to work
- Robotic dog deployed to help doctors fight coronavirus
- NYC students are suing colleges for refunds after coronavirus campus shutdowns
- Cristina Cuomo’s coronavirus ‘remedies’ include tree bark and bleach baths
- AG Barr going after landlords who seek sex for rent amid coronavirus
- Coronavirus was already spreading quickly in US by February, study says
- NYC doctor: ERs eerily quiet as non-coronavirus patients die at home
- NHL has accelerated timeline for possible return
- Volunteers in Syria building makeshift ventilators to fight coronavirus
- 2020 New York Film Festival ‘going ahead’ in September despite coronavirus
- Some good news: study finds coronavirus is not transmitted sexually
- Nearly all coronavirus patients in NY’s largest health system had underlying condition: study
- Long Island mom wakes up from coronavirus coma days after giving birth
- South Africa’s itinerant wastepickers lose livelihood in lockdown
- New York to launch probe into nursing homes over coronavirus
- Coronavirus could cause 2 million NYC residents to go hungry: de Blasio
- Walmart creating one-way aisles to stem spread of coronavirus
- NYC Major de Blasio rejects Gov. Cuomo claim that ‘it’s not our job’ to help nursing homes
- Finnish supermarket tests out hands-free door handles
- WHO: Up to half the people that died in Europe were in nursing homes
- Coronavirus is still ‘alive and well’ in NYC: de Blasio
- Coronavirus fear, anxiety can be as contagious as the illness
- Disney’s theme parks may stay closed until 2021: analyst
- Speeding tickets soar on empty California highways amid coronavirus lockdown
- New York allowed coronavirus patients to be sent back to nursing homes
- Pakistani doctors warn that the country is loosening its lockdown too soon
- Isolating at home has become dangerous for many Italians
- Indonesian religious leaders urge Muslims to mark Ramadan by staying home
- Japan promised every household two masks. Now many are being recalled
- Hong Kong creeps back to a semblance of normalcy
- Australia and New Zealand, whose leaders are political opposites, are quietly beating the virus
- The Philippine capital’s lockdown will continue until at least mid-May
- Ecuador’s increased deaths during the outbreak are 15 times the official coronavirus toll
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 = 2,716,806 (+3.1%)
- New Cases = 81,090 (+1.4%) (+1,134)
- Total Cases = 1,193,276 (+2.1%)
- New Cases = 24,992 (-11.5%) (-3,241)
- Total Cases = 435,276 (+3.1%)
- New Cases = 12,989 (+8.0%) (+962)
- Total Cases = 880,204 (+3.7%)
- New Cases = 31,487 (+5.1%) (+1,514)
- 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 = 55.8% of Total Cases in US (-2.2%)
- NY & NJ = 45% of Total Cases in US (+1.0%)
- 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 = 58,696 (+2,010)
- US series or critical cases = 14,997 (+981)
- US serious or critical cases = 2.0% of Active Cases compared with worldwide percentage of 3.3%
- Worldwide deaths = 190,582 (+3.5%) (+6,462)
- Europe deaths = 114,259 (+2.8%) (+3,057)
- US deaths = 49,845 (+4.6%) (+2,186)
- NY deaths = 20,861 (+2.5%) (+507)
- Deaths per 1M population of 5 Countries with Largest Number of Confirmed Cases:
- Spain: 474 (+10)
- Italy: 423 (+8)
- France: 335 (+8)
- US: 151 (+7)
- Germany: 67 (+4)
- US Total Confirmed Case Fatality Rate = 5.7% 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 = 745,413 (+3.9%) (+27,969)
- US recoveries = 85,922 (+2.2%) (+1,872)
- US recoveries = 9.8% of Total US Cases
C. Potential Treatments
1. First Vaccine To Protect An Animal From Infection
- For the first time, one of the many COVID-19 vaccines in development has protected an animal, rhesus macaques, from infection by the new coronavirus, scientists report. The vaccine, an old-fashioned formulation consisting of a chemically inactivated version of the virus, produced no obvious side effects in the monkeys, and human trials began on 16 April.
- Researchers from Sinovac Biotech, a privately held Beijing-based company, gave two different doses of their COVID-19 vaccine to a total of eight rhesus macaque monkeys. Three weeks later, the group introduced SARS-CoV-2, the virus that causes COVID-19, into the monkeys’ lungs through tubes down their tracheas, and none developed a full-blown infection.
- The monkeys given the highest dose of vaccine had the best response: Seven days after the animals received the virus, researchers could not detect it in the pharynx or lungs of any of them. Some of the lower dosed animals had a “viral blip” but also appeared to have controlled the infection, the Sinovac team reports in a paper published on 19 April on the preprint server bioRxiv. In contrast, four control animals developed high levels of viral RNA in several body parts and severe pneumonia. The results “give us a lot of confidence” that the vaccine will work in humans, says Meng Weining, Sinovac’s senior director for overseas regulatory affairs.
- “I like it,” says Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai who has co-authored a status report about the many different COVID-19 vaccines in development. “This is old school but it might work. What I like most is that many vaccine producers, also in lower–middle-income countries, could make such a vaccine.”
- But Douglas Reed of the University of Pittsburgh, who is developing and testing COVID-19 vaccines in monkey studies, says the number of animals was too small to yield statistically significant results. His team also has a manuscript in preparation that raises concerns about the way the Sinovac team grew the stock of novel coronavirus used to challenge the animals: It may have caused changes that make it less reflective of the ones that infect humans.
- Another concern is that monkeys do not develop the most severe symptoms that SARS-CoV-2 causes in humans. The Sinovac researchers acknowledge in the paper that “It’s still too early to define the best animal model for studying SARS-CoV-2,” but noted that unvaccinated rhesus macaques given the virus “mimic COVID-19-like symptoms.”
- The study also addressed worries that partial protection could be dangerous. Earlier animal experiments with vaccines against the related coronaviruses that cause severe acute respiratory syndrome and Middle East respiratory syndrome had found that low antibody levels could lead to aberrant immune responses when an animal was given the pathogens, enhancing the infection and causing pathology in their lungs. But the Sinovac team did not find any evidence of lung damage in vaccinated animals who produced relatively low levels of antibodies, which “lessens the concern about vaccine enhancement,” Reed says. “More work needs to be done though.”
- SARS-CoV-2 seems to accumulate mutations slowly; even so, variants might pose a challenge for a vaccine. In test tube experiments, the Sinovac researchers mixed antibodies taken from monkeys, rats, and mice given their vaccine with strains of the virus isolated from COVID-19 patients in China, Italy, Switzerland, Spain, and the United Kingdom. The antibodies potently “neutralized” all the strains, which are “widely scattered on the phylogenic tree,” the researchers noted.
- “This provides strong evidence that the virus is not mutating in a way that would make it resistant to a #COVID19 vaccine,” tweeted immunologist Mark Slifka of Oregon Health & Science University. “Good to know.”
- Sinovac is an experienced vaccinemaker—it has marketed inactivated viral vaccines for hand, foot, and mouth disease; hepatitis A and B; and H5N1 influenza or bird flu. But Meng says it could produce, at most, about 100 million doses of the vaccine and might need to partner with other makers if the company’s COVID-19 vaccine proves safe and effective in human trials.
- The company recently started phase I clinical trials in Jiangsu province, north of Shanghai, which aim to gauge safety and immune responses in 144 volunteers. An equal number of participants will receive the high and low doses or a placebo. Although placebos are not typically used in phase I studies—which do not assess efficacy—Meng says this can help better evaluate whether the vaccine causes any dangerous side effects. The company hopes to start phase II studies by mid-May that have the same design but enroll more than 1000 people, with results due by the end of June.
- If all goes well, Meng says, Sinovac will seek to launch traditional phase III efficacy trials that compare the vaccine with a placebo in thousands of people. The company has also discussed joining international vaccine trials being organized by the World Health Organization (WHO). Given the low level of transmission now occurring in China, the company is considering still more efficacy trials in other countries being hit harder by the virus. “We can’t put all our eggs in one basket,” Meng says.
- To quickly obtain more efficacy data after the phase I and II trials and potentially help people, Meng says Sinovac may ask regulatory agencies in China and other countries for emergency authorization to give the vaccine to those at high risk of becoming infected, such as customs agents and police officers who do not typically wear the protective gear used by health care workers. The Democratic Republic of the Congo in 2018 began to widely use an experimental Ebola vaccine under that status and the evidence suggests it powerfully helped curb that epidemic. (That Ebola vaccine first received regulatory approval in November 2019.)
- According to WHO, six other vaccines had entered human trials as of 23 April, and 77 others were in development. The vast majority of these vaccines use the modern tools of genetic engineering—only four rely on the old-fashioned inactivation technology—but Meng says what ultimately matters is whether a vaccine is safe and effective, not how it’s made. “We are not comparing ourselves to anyone,” Meng says. “In this pandemic situation, the most important thing is to make a vaccine, no matter what kind of vaccine it is, that’s safe and effective as soon as possible.”
2. Can nicotine patches reduce risk of infection?
- Evidence is beginning to show the proportion of smokers infected with coronavirus is much lower than the rates in the general population.
- A French study found that only 4.4% of 350 coronavirus patients hospitalized were regular smokers and 5.3% of 130 homebound patients smoked. This pales in comparison with at least 25% of the French population that smokes
- Researchers theorized nicotine could prevent the virus from infecting cells or that nicotine was preventing the immune system from overreacting to the virus
- Doctors at a major hospital in Paris – who also found low rates of smoking among the infected – are now planning to give nicotine patches to COVID-19 patients.
- They will also give them to frontline workers to see if the stimulant has any effect on preventing the spread of the virus, according to reports.
- It comes after world-famous artist David Hockney last week said he believes smoking could protect people against the deadly coronavirus.
- MailOnline looked at the science and found he may have been onto something, with one researcher saying there was ‘bizarrely strong’ evidence it could be true.
- One study in China, where the pandemic began, showed only 6.5% of COVID-19 patients were smokers, compared to 26.6% of the population.
- Another study by the CDC found just 1.3% of hospitalized patients were smokers – compared to 14% of the population of America.
- And research by hospitals in Paris found that smokers were under-represented in both inpatients and outpatients, suggesting that any protective effect could affect anyone, not just those hospitalized by their illness.
- French scientist Professor Jean-François Delfraissy, who is leading a scientific council advising the country’s government on COVID-19, said: ‘We have something very special with tobacco.
- ‘We have found that the vast majority of serious cases are not smokers, as if (…) tobacco protects against this virus, via nicotine,’ French news site Sud Ouest reported.
- The study by Dr. Farsalinos adds by way of explanation: ‘It has been observed that decreased ACE-2 availability contributes to lung injury and acute respiratory distress syndrome development.
- ‘Therefore, higher ACE-2 expression, while seemingly paradoxical, may protect against acute lung injury caused by COVID-19.’
- This is a disputed area of science – there are studies which show smoking can both increase and decrease the levels of ACE-2 available on someone’s lung cells.
- An increase in ACE-2 before infection could allow more of the viruses to get into the body in the first place, making someone more vulnerable to the disease.
- A paper published by scientists at University College London offers the opposite view to Dr. Farsalinos.
D. New Scientific Findings and Other Advances
1. Research by DHS shows that coronavirus dies much faster when exposes to sunlight
- Bill Bryan, the head of the science and technology directorate at the Department of Homeland Security, said that solar light along with high temperatures and humidity have a “powerful effect” of creating environments less favorable for the virus to survive.
- A chart released during the White House coronavirus task force by the DHS showed that the novel coronavirus dies within two minutes in hot summer humidity while on surfaces and a minute and a half while in the air.
- “Coronavirus dies at a much more rapid pace when exposed to sunlight and humidity,” Bryan said during the White House briefing. “The virus dies the quickest in direct sunlight. Isopropyl alcohol will kill the virus in 30 seconds.”
- Bryan, however, warned that the results from a DHS study were still in the nascent stages and cautioned Americans to continue practicing social distancing and other hygiene measures outlined by the federal government.
E. How many people have been infected with coronavirus? And Why Any Plan to Reopen Our Economy Hinges on the Answer. Part III
- 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.
- Estimates of the fatality rate of COVID-19 by public health officials and epidemiologists have ranged from less than 1% to 3.4% (by comparison, the fatality rate of the flu is generally estimated at 0.1%). If we can determine that the fatality rate is less than 1%, we can be more aggressive in reopening our businesses. On the other hand, if fatality rate is higher, then it would be prudent to be more cautious.
1. Antibody study suggests that nearly 3,000,000 New Yorkers have had coronavirus
- New York Gov. Andrew Cuomo revealed Thursday that preliminary results from a coronavirus antibody study show the statewide infection rate is 13.9 percent, which would mean around 2.7 million residents could have carried the disease. [Note: 2.7 million is more than 10 times the number of confirmed cases in New York.]
- The 3,000 samples were collected from 40 sites in 19 counties, according to Cuomo, and suggested the infection rate is as high as 21.2 percent in places like New York City. [Note: 21.2% is substantially higher than the percentages of infected persons estimated in other studies that have conducted in California and Europe.]
- “These are people who were infected and who developed the antibodies to fight the infection,” Cuomo said. “They had the virus, they developed the antibodies and they are now ‘recovered’.”
- The governor says the testing was conducted at sites set up outside places like grocery and box stores.
- “These are people who were out and about shopping,” Cuomo said. “They were not people who were in their home, they are not people who are isolated, they are not people who are quarantined — who you could argue probably had a lower rate of infection because they wouldn’t come out of the house.”
- Percent positive by region:
- Long Island: 16.7%
- NYC: 21.2%
- Westchester/Rockland: 11.7%
- Rest of state: 3.6%
- (Weighted results)
- Percent positive by demographic:
- Female: 12%
- Male: 15.9%
- Asian: 11.7%
- Black: 22.1%
- Latino/Hispanic: 22.5%
- Multi/None/Other: 22.8%
- White: 9.1%
- (Weighted results)
- Nearly 70% of the overall testing was done in the regions of Westchester, New York City and Long Island.
F. Ventilators Offer Little Hope
1. 88% of coronavirus patients on ventilators didn’t make it
- Of the 88% of coronavirus patients on a ventilator who died, 57% had hypertension, 41% were obese and 34% had diabetes
- People with underlying health conditions, such as hypertension and diabetes, who are potentially exposed to the virus and who might not have a fever to consult with a doctor sooner rather than later
- Surprising Finding: 70% of the patients sick enough to be admitted to the hospital did not have a fever
Findings Confound Our Early Expectations
- Throughout March, as the pandemic gained momentum in the United States, much of the preparations focused on the breathing machines that were supposed to save everyone’s lives.
- Now five weeks into the crisis, a paper published in the Journal of American Medical Association (JAMA) about New York State’s largest health system suggests a reality that like so much else about the novel coronavirus, confounds our early expectations. [Read the JAMA study here: Clinical Characteristics, Comorbidities, and Outcomes Among Patients With COVID-19 Hospitalized in the NYC Area]
- Researchers found that 20% of all those hospitalized died — a finding that’s similar to the percentage who perish in normal times among those who are admitted for respiratory distress.
- “This disease permeates every aspect of life,” says Erik Blutinger, an emergency room doctor in New York, who recently finished his residency. (Mount Sinai Queens Hospital/The Washington Post)
- But the numbers diverge more for the critically ill put on ventilators. 88% of 320 covid-19 patients on ventilators who were tracked in the study died. That compares with the roughly 80% of patients who died on ventilators before the pandemic, according to previous studies — and with the roughly 50% death rate some critical care doctors had optimistically hoped when the first cases were diagnosed.
- “For those who have a severe enough course to require hospitalization through the emergency department it is a sad number,” said Karina W. Davidson, the study’s lead author and a professor at the Feinstein Institutes for Medical Research at Northwell.
- The mortality rates in the JAMA study only include patients who died or were discharged. About half of patients treated during the period of the study were still hospitalized when the analysis was conducted so their final outcomes were unknown.
- The analysis is the largest and most comprehensive look at outcomes in the United States to be published so far. Researchers looked at the electronic medical records of 5,700 patients infected with covid-19 between Mar. 1 and Apr. 4 who were treated at Northwell Health’s 12 hospitals located in New York City, Long Island, and Westchester County — all epicenters of the outbreak. 60% were male, 40% female and the average age was 63.
- “It’s important to look to American data as we have different resources in our health care system and different demographics in our populations,” Davidson said.
- The paper also found that of those who died, 57% had hypertension, 41% were obese and 34% had diabetes which is consistent with risk factors listed by the CDC. Noticeably absent from the top of the list was asthma. As doctors and researchers have learned more about covid-19, the less it seems that asthma plays a dominant role in outcomes.
- One other surprising finding from the study was that 70% of the patients sick enough to be admitted to the hospital did not have a fever. Fever is currently listed as the top symptom of covid-19 by the CDC, and for weeks, many testing centers for the virus turned away patients if they did not have one.
- Davidson said that as a result of that findings, Northwell is encouraging people with underlying health conditions, such as hypertension and diabetes, who are potentially exposed to the virus and who might not have a fever to consult with a doctor sooner rather than later.
1. Financial Times reports that Gilead’s coronavirus drug (remdesivir) flops in first trial
[NOTE: As reported in our 4/17 Update, some early leaks regarding the efficacy of remdesivir sounded very promising. Today, the World Health Organization inadvertently posted a Chinese study of remdesivir. After reviewing the study, the Financial Times reported that remdesivir is a flop (the FT story is summarized below). Both Gilead and other scientists have since stated that the Chinese study was incomplete and inconclusive. As noted last week, clinical trials are underway in the US, and formal results of those trials are expected by the end of April. In our opinion, it is too soon to draw overall conclusions on the effectiveness of remdesivir.]
- Gilead Sciences Inc.’s experimental coronavirus drug failed its first randomized clinical trial, the Financial Times reported on Thursday, citing draft documents published accidentally by the World Health Organization.
- The Chinese trial showed the antiviral remdesivir did not improve patients’ condition or reduce the pathogen’s presence in the bloodstream, the report said.
- Researchers studied 237 patients, giving the drug to 158 and comparing their progress with the remaining 79. The drug also showed significant side effects in some, which meant 18 patients were taken off it, according to the Financial Times.
- Interest in Gilead’s drug had been high as there are currently no approved treatments or preventive vaccines for COVID-19, and doctors are desperate for anything that might alter the course of the disease that attacks the lungs and can shut down other organs in extremely severe cases.
- The company is testing the drug in multiple trials and highly anticipated trial results from a study involving 400 patients hospitalized with severe cases of the illness are expected later this month.
- Remdesivir, which previously failed as a treatment for Ebola, is being tried against COVID-19 because it is designed to disable the mechanism by which certain viruses, including the new coronavirus, make copies of themselves and potentially overwhelm their host’s immune system.
H. Corona Collateral Damage
1. Where are the strokes and heart attacks?
- California’s hospital emergency departments are strangely quiet places these days.
- Before the coronavirus hit, tens of thousands of people across the state sought emergency help each day. But in the weeks since the virus began its spread throughout the U.S., those numbers have plummeted by a third to a half, according to physicians overseeing emergency departments in hospitals across Los Angeles County and elsewhere in California.
- The steep decline comes amid drastic measures hospitals have put in place to prepare for what health officials fear could be a wave of patients infected by the coronavirus like the ones that have overwhelmed hospitals in New York City and elsewhere.
- So far, the numbers of people sickened by the virus in California have been manageable. But now doctors and health officials are increasingly worried that steps taken to keep hospitals at the ready, along with a widespread public fear the virus is rife in emergency rooms, have left people who are in immediate need of lifesaving help unwilling to seek treatment.
- “Where are the strokes and the heart attacks? Where are the diabetics having complications?” said Dr. Larry Stock, an emergency physician at Antelope Valley Hospital. “These cases didn’t just vaporize with the virus. I worry people are suffering at home because they’re afraid our emergency rooms are radioactive.”
- Physicians and health officials are amending their urgent warnings about the virus to stress that emergency departments are not overrun and can treat people safely. The full effect of what Stock dubbed “corona collateral damage syndrome,” and another emergency physician called “a virus of fear,” has not yet been tallied as hospitals and state agencies begin to gather comprehensive figures.
- But from interviews with more than a dozen physicians working in rural and urban hospitals around the state, a portrait emerges of how emergency care in California has been upended by the virus. They worry people are dying at home from conditions that could have been treated and others who survive will now suffer from serious, chronic conditions resulting from their failure to seek help.
- Since state and county officials issued orders last month largely instructing residents to remain at home, the number of stroke cases coming to the hospital has dropped by half, Brown said. Overall, the number of patients coming to Hoag’s emergency department has fallen by half as well, hospital figures show.
- Seeing the brutal toll the coronavirus has taken in New York City and other hot spots, where infected people swamped hospital emergency rooms, California officials have implored the public to take its deadly potential seriously. And they have hammered on the importance of not seeking help at hospitals unless absolutely necessary in order to leave them able to handle a possible surge in cases here.
- The public push has been effective. And with people staying home, the number of car accidents, shootings and other trauma cases coming into emergency rooms is down, while people with non-urgent ailments have stayed away as well.
- But lost in that messaging, physicians and health officials now worry, was an important caveat: If you’re having a medical emergency, you should still go to the hospital.
- “It’s fear,” said Dr. Carrieann Drenten, an emergency physician in Sacramento. “People are afraid to come in because the emergency department is seen as this haven of infection and sickness.”
- Patients who resisted seeking help and then came to the hospital days late underscore the problem, physicians said.
- The apparent problem is nationwide, according a study of nine major cardiac centers around the country.
- Doctors and health experts also worry about people with injuries or illnesses that would not be critical in the moment but can become major problems if allowed to fester. Physicians interviewed offered gruesome accounts of patients arriving days after suffering lacerations, skin infections and ruptured appendixes.
- The fear of contracting COVID-19, the illness caused by the coronavirus, is largely misplaced, doctors said.
- If a hospital has implemented widely used safety measures such as screening patients for symptoms of the illness before they enter the emergency department, cleaning thoroughly and isolating anyone who shows signs of the virus, the risk is low, they said.
- Health officials are now trying to spread that message. Dr. Christina Ghaly, director for the Los Angeles County Department of Health Services, last week urged people to get help if they are having an emergency, saying they “do not need to be worried” about getting infected. Hospitals and medical associations have put out similar messages.
- The effect of people forgoing treatment could be deep and long-lasting. Physicians said they believe people are dying in their homes and expect to see a rise in cases of congestive heart failure, major strokes and other chronic problems that are the result of people failing to be treated during the current crisis.
- “Down the road, we don’t want to look back and see high mortality rates in cases we could have helped if people had come in,” said Dr. Sam Torbati, co-director of the emergency department at Cedars-Sinai. “We need to bring the pendulum back to a reasonable spot.”
I. Play Ball!?
1. MIT professor believes arenas can be nearly as safe as public parks
- As the coronavirus pandemic forces all sports leagues to evaluate how to once again host thousands of fans at stadiums across the country, at least one prominent data scientist at the Massachusetts Institute of Technology says there are steps teams can take that will make arenas “as safe as public parks.”
- Professor Alex Pentland, the head of the human dynamic lab at MIT, released a white paper this week suggesting companies can use digital tools to help create safer environments — and told ESPN there are applications to sports as well.
- “The big things are distancing practices,” such as asking fans to wear masks, Pentland said.
- Other steps Pentland recommends include filling only half the seats to maintain distancing (families can sit together) and checking fans’ temperature as they enter the stadium. Checking temperature “detects infection surprisingly well,” he said.
- The virus has decimated the sports world with the NBA and NHL suspending seasons indefinitely and Major League Baseball postponing the start of its season. The NCAA basketball tournaments also were canceled, as were college spring sports.
- Pentland said what would be perhaps the most dramatic change to the game day experience are his recommendations on regulating pedestrian traffic flow within the stadium. Pentland suggests teams make aisles one way — think of a one-way street — so fans aren’t crossing each other.
- He also recommends fans who are seated in the same location enter from one gate and then sit together, because it “helps keep outbreaks localized to one physical area.”
- Any game day staff that cut across areas should be, Pentland said, “safe,” meaning people who would not transmit the virus.
- “If you can do this,” Pentland said, “then I think that sports events may become nearly as safe as public parks.”
J. The Road Back?
1. ‘Pandemic drone’ test flights are monitoring social distancing
- A series of “pandemic drones” is taking part in a test flight in a COVID-19 hotspot in Connecticut with the goal of monitoring social distancing efforts and detecting the virus’ symptoms.
- Drone manufacturer Draganfly is working with the police department in Westport, Connecticut, to test the drones. Located in Fairfield County — adjacent to New York City — Westport was the first town in the state to report several coronavirus infections, according to a Wednesday press release from Draganfly.
- The drones include specialized sensor and computer vision systems that can display a person’s temperature, heart and respiratory rates, as well as detect people sneezing or coughing in a crowd, the release said. The technology can accurately detect infectious conditions from 190 feet away, as well as measure social distancing efforts, according to Draganfly.
- The drones don’t use facial recognition technology, and won’t be used at people’s private residences, according to a release from the Westport Police Department. Rather, they’re used to identify patterns within the population, allowing officials to better track the spread and make decisions about public places while keeping first responders safe, the department said.
- The Westport Police Department has had a drone program since 2016.
- “The Westport Police Department along with first responders around the world are looking for effective ways to ease the spread of COVID-19 and keep their communities safe,” Westport Chief of Police Foti Koskinas said in the Draganfly release. “This technology not only enhances the safety of our officers and the public, but the concept of using drones remains a go-to technology for reaching the most remote areas with little to no manpower needed. It also helps our officers acquire decision quality data they need to make the best choices in any given situation.”
K. Is Herd Immunity the Inevitable Endgame?
1. Maybe the Experts Were Right the First Time [Opinion]
- It’s time to confront an awful possibility about the lockdowns in which many of the world’s economies now find themselves: The experts might have been right the first time.
- “The first time” was not so long ago—February to mid-March—when official opinion on how best to grapple with the new coronavirus pandemic was very different. The distinguishing characteristic was modesty.
- The stated goal was not to vanquish the virus but merely to try to control its spread so as not to overwhelm health-care systems. Officials also understood public patience with draconian measures would wear thin quickly and demanded politicians exercise caution when asking the public to take on burdens.
- Those opinions now are widely derided, often in insulting terms. Yet subsequent events suggest they’re mainly correct. Let’s take each in turn.
- We can’t stop the virus, we can only slow it. This is the biggest fact about the pandemic that remains politically impossible to say. The trouble started in mid-March when “herd immunity,” previously the tacit or acknowledged endgame for most of the world, became a toxic phrase. Critics pointed out that allowing the virus to spread in a controlled manner would cost lives. They presented a stark alternative of total lockdown or the disaster of Italian hospitals, with no middle ground.
- But if those experts have a more plausible plan than taking a controlled path to herd immunity, the world is waiting to hear it. Experts propose instead either that we await the arrival of a vaccine or that we ramp up testing and contact tracing of the infected. Good luck. A vaccine is a year or more in the future, if one ever emerges. An effective mass test-and-trace regime would require a level of competence and focus that typically eludes modern governments—not to mention an invasion of privacy that, at least in the U.S., might be unconstitutional.
- Events will provide two tests of whether the experts were right the first time. Sweden is conspicuous not only for its lack of a formal lockdown but also for its leaders’ laser focus on the question of health-system capacity.
- Sweden’s fans are perhaps too quick to overlook the human tragedy of the resulting higher death toll. But its critics should be more curious about whether, if permanent suppression of the virus is impossible, this approach might stave off subsequent disaster by moderating future peaks of the virus—with fewer of the human costs associated with a lockdown.
- We’d better hope Sweden’s approach works, because the alternative gives little cause for optimism. We can’t lock down our economies waiting for a vaccine that may never arrive. And as Germany, Denmark, Austria and other European countries emerge from their lockdowns, officials all but admit the virus will start spreading again. That’s why they are reopening in stages. The virus’s second surges in China, Singapore and Hong Kong serve as a warning. The original conventional wisdom acknowledged the reality that draconian lockdowns merely delayed the inevitable spread and that sheltering populations rather than slowly cultivating herd immunity would lead to quickly rising infection rates once countries reopened.
- We can’t ask the public to lock down indefinitely. This was articulated most forcefully in the U.K., where Prime Minister Boris Johnson took merciless flak for trying to delay the sternest pandemic-mitigation efforts on the grounds that the public would find it hard to comply for long.
- Mr. Johnson’s critics promptly fell down the rabbit-hole of investigating the scientific basis for that insight within the field of behavioral studies (turns out there isn’t a lot) while overlooking its obvious truth in observed human nature. Sustained, severe curtailment of daily liberties has only ever been enforceable at the point of a spear or a gun.
- Sure enough, nearly five weeks into Britain’s lockdown, its police forces worry the public won’t tolerate much more enforcement. Rule-loving Germans comply less and less with social distancing, to judge by a University of Mannheim tracker poll that found that more than 50% of respondents had violated rules against visiting friends at least once in the week ending April 21, up from around 30% in the last week of March. Protests have erupted in the U.S., and near-riots in some of Paris’s volatile suburbs.
- Leaders are asking us to do the impossible—cut off almost all social contact indefinitely—at often incalculable individual cost, and then belittling those who object as anti-science rubes. At the start of this pandemic some leaders seemingly understood how destructive the resulting loss of trust between rulers and citizenry would be. They abandoned that insight at their, and our, peril.
- We’ve all placed our bets now and can only hope for the best. But it will be well worth it for voters and students of public policy alike to ask in coming years whether policy makers’ first instincts were their best—and, if so, why we made it so difficult for them to follow those intuitions.