Early Alert Warning: Numerous reports are warning of potential shortages of pork, beef and/or poultry in the near future due to the shutdown of processing plants arising from the spread of the virus among workers. If you want a reliable supply of meat products, you may want to consider stockpiling additional supplies now.
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“Let’s stop suspending common sense. There’s no reason other parts of the economy can’t open sooner rather than later.”
— Former Wisconsin Governor Scott Walker
- Recent Developments and Headlines
- Numbers and Trends
- Potential Treatments – Heartburn remedy might be an effective treatment
- What Can We Learn From Past Outbreaks of Infectious Diseases?
- The Road Back? – Are Lockdowns The Answer?
- Did Almost Everyone Get It Wrong? – End of the World vs. Nothingburger
- Stories From The Frontline – Georgia Reopens
- Lessons From Abroad
- Is Patience for the Lockdowns Wearing Thin?
- Practical Tips – How to clean a mask
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A. Recent Developments and Headlines
Note: All changes noted in this Update are since the 4/26 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
- Worldwide Total Cases = 2,993,262 (+2.5%) (+73,858)
- Worldwide New Cases (3 day avg) = 92,152 (-2.6%) (-2,411)
- US Total Cases = 987,160 (+2.8%) (+26,509)
- US New Cases (3 day avg) = 35,652 (-4.5%) (-1,659)
- Worldwide deaths = 206,915 (+1.9%) (+3,751)
- Europe deaths = 121,885 (+1.5%) (+1,767)
- US deaths = 55,413 (+2.1%) (+1,157)
- NY deaths = 22,275 (+1.7%) (+367)
- World reports 4th straight drop in daily death toll
- Dr. Birx predicts coronavirus toll will fall ‘dramatically’ by end of May
- Dr. Fauci: U.S. COVID-19 Testing Numbers Should Soon Double
- “They’ve Got To Feed Their Children” – Cash-Strapped Businesses Reopen In Georgia As 16 States Join Push To End Lockdowns
- Reopening of America accelerates as states prepare to relax coronavirus restrictions
- States begin to reopen as coronavirus pandemic intensifies
- Maryland Gov. Larry Hogan ‘Hopeful’ State Could Begin Reopening Early May
- NY Gov. Cuomo: New York May Partially Reopen May 15
- NY Gov. Cuomo outlines rough plan for reopening New York in ‘phases’ amid pandemic
- NYC tailor defies state order: ‘I’m opening my doors come hell or high water’
- Virginia State Health Commissioner Predicts Reopening ‘Will Be a Two Year Affair’
- Lockdown Devastates Jersey Shore’s Historic Fishing Boat Industry
- Michigan governor relaxes stay-at-home order after raucous protests
- NBA Training Facilities to Begin to Reopen Friday
- Experts worry ‘quarantine fatigue’ is starting
- U.S. response to virus splinters into acrimony and uncertainty
- Reopen The Economy While Protecting Those Truly At Risk… Or Risk Another Great Depression
- Small Businesses In Catch-22 Begin Revolt: ‘Defy State’s Stay-At-Home Order Or Face Collections’
- A Handful Of Cops Are Standing Up To Tyranny With The People
- Hawaii to Visitors: We’ll Pay You to Leave
- Study: Six Percent of the Miami-Dade Population Have Coronavirus Antibodies
- Most Americans Will Be Scared To Return To Malls When Stores Finally Reopen
- Oregon finds its distancing measures may have prevented 70k infections
- New York expands coronavirus testing to pharmacies
- Atlanta mayor issues grim warning for people going to nail salons
- Many Americans ready to travel once lockdown lifted, polls show
- Americans may be suffering ‘quarantine fatigue,’ going out more
- American Farms Cull Millions Of Chickens Amid Virus-Related Staff Shortages At Processing Plants
- U.S. Could Be Weeks From Meat Shortages With Shutdowns Spreading
- Alabama chicken plants scramble to slow outbreaks of coronavirus
- Coronavirus Forces Farmers to Destroy Their Crops — Amid pandemic, orders dry up; ‘You don’t want to see your crop rot and suffer’
- Muted and Vacant, Las Vegas Struggles to Survive Shutdown
- Elective surgeries set to resume, with complications and concerns
- Spain sees promising decline in deaths
- NY, Italy report encouraging drop in deaths
- Italy: Coronavirus Recoveries Outpace Infections For First Time
- FT estimates global deaths 60% higher than reported
- Mexico death toll likely 50% higher than reported
- Singapore scrambles to build more hospital space
- Sri Lanka reinstates 24-hour curfew after surge in coronavirus cases
- UK releases latest numbers: lowest daily death toll in a month
- Spain allows children outside for first time in 6 weeks
- France, Spain plan to release reopening plans
- WHO warns against “immunity passports”
- US decides against participating in global vaccine and drug initiative organized by the WHO
- UK deaths surpass 20k
- China says Wuhan hospitals cleared of virus
- Fringe activists in Germany are protesting the country’s lockdown, despite broad support for the rules
- Iranians crossing into Afghanistan have brought the virus with them
- In Kashmir, a lockdown worsens a mental health crisis
- Former UK Chancellor urges gov’t to share plan for reopening with the people
- National Guard Deployed At Nation’s Food Banks To Ensure Stability During Unprecedented Times
- Scientists Find More Evidence Novel Coronavirus Can Travel On Air Pollution Particles – Say It, Don’t Spray It!
- Is The World About To Panic Hoard Nicotine Products After France’s Promising Coronavirus Study?
- France limits sales of nicotine products after fewer smokers catch coronavirus
- Dr. Birx Slams “Slicey & Dicey” Mainstream Media For Fixation On Trump’s ‘Sunlight’ Comments
- Twitter Suspends Account Of Biotech Company Testing UV Light To Treat Coronavirus
- The COVID-19 Crisis Is Driving The EU To The Brink
- Singapore Man Jailed For 6 Weeks After Violating Quarantine Over “Irresistible Urge” For Pork Soup
- China Continues To Flood The World With Defective Medical Supplies
- “The Math Is Not Pretty” – COVID Concerns Spark “Existential Threat” For Many Colleges
- “Like A Black Mirror Episode”: Company Laid Off 406 People In 2-Minute Zoom Call
- The Coming De-Urbanization Of America
- Internet traffic is up 20% across Europe and US as lockdowns drag on
- Bitcoin’s Bull-Case Gets Big Boost As Calls For Negative Rates Mount
- Whistleblowing ER Docs Urge “Open Up Society Now” Because “Lockdowns Are Weakening Our Immune Systems”
- Capitalist Who Hoarded Masks And PPE To Resell From His Store Now Faces Jail Time Under Defense Act
- “Wuhan Plague” Plaques Featuring Chopstick-Wielding Pooh Holding Bat Appear In Atlanta
- Over 40% Of San Diego Residents Turned To Food Banks Last Month
- 1,000 Front-Line Medical Workers Forced Into Isolation Due To Faulty Chinese Masks
- UK ONS Figures Show Three Times More Deaths From Flu & Pneumonia Than COVID-19
- Clubbing Under Quarantine: People Are Paying To Log On To Zoom And Attend Virtual Concerts And Raves
- Violent Food & Fuel Shortage Riots Grip Venezuela Amid COVID-19 Lockdown
- NY Gov. Cuomo Under Fire for Requiring Nursing Homes Accept Patients With Virus
- NY Gov. Cuomo Blames Nursing Homes as Questions Mount over Coronavirus Directive
- Cuomo doubles down on ordering nursing homes to admit COVID-19 patients
- New York lacked common sense in nursing homes coronavirus approach
- Coronavirus Likely to Spark Mass Immigration Wave to Israel
- Gaza Factories Spring Back to Life Making PPE for Israel
- Pelosi: Trump’s China Travel Ban Wasn’t the ‘Great Moment’
- Navarro: ‘This Is a War — It’s a War That China Started by Spawning the Virus’
- UK National Health Service Facing a Shortage of One Billion Pieces of Personal Protective Equipment
- Japanese Mayor: Men Should Do Shopping Since Women Are ‘Indecisive And Take Forever’ [Note: Just a guess, but we suspect his odds of being re-elected plummeted as women are offended and men annoyed by his remark]
- Pope Francis Prays for Those Who Can No Longer Support Their Families
- Cowa-dumb-ba: Crowds ignore social distancing rules at Southern California beaches
- A spike in New Yorkers ingesting household cleaners following Trump’s controversial coronavirus comments
- Richard Branson races to find Virgin Atlantic buyer – On Brink of Collapse
- One in 3 death certificates were wrong before coronavirus. It’s about to get even worse.
- UK Prime Minister Boris Johnson returns to face growing virus divisions in UK
- Passengers entering UK to be quarantined for 2 weeks in new plans to halt coronavirus spread
- Ramadan begins in Iran amid fears of ‘fresh outbreak’ of virus
- Parisians defy lockdown by dancing, briefly, in the street
- German police bust cellar hairdressers
- China is still blatantly lying about its coronavirus deaths
- Sen. Cotton: Chinese students shouldn’t be allowed to study science in US
- Schumer: Bootleg coronavirus test kits pose ‘disaster’ for recovery efforts
- Dutch students complete trans-Atlantic voyage forced by coronavirus
- Belgians urged to eat more fries during coronavirus pandemic to help with potato surplus
- Hasbro toy factory now making coronavirus face shields
- Barbershops — and golf courses — should reopen
- Tennessee, Mississippi and Montana to allow some businesses to reopen this Monday (4/27/20)
- Safer sex in the city: STD cases plummet amid coronavirus pandemic
- Life after lockdown: Electronic monitoring, fines and compulsory face masks
- Trash, urine, vomit: Subway cars putting essential workers at risk amid coronavirus crisis
- NYC paramedic could only give daughter ‘air hug’ on her birthday
- New York doctor heartbroken over missing baby daughter’s ‘little milestones’
- Bronx elder-care employee living at facility 24/7 during pandemic
- Staten Island healthcare worker living in an RV to protect family
- Coronavirus isolation could mean death for America’s opioid addicts
- Coronavirus may destroy 40% of the US economy, officials say
- Getting coronavirus ‘will take 13 years off your life’, UK researchers claim
- US blocks Palestinian coronavirus relief over fear it may aid terrorism
- This McDonald’s is offering drive-thru coronavirus testing
- Business booming for psychics and astrologers during coronavirus pandemic
- ‘F—ked’: Inside the sad life of a bookie during coronavirus
- US, Russia, India and China are no-shows at global coronavirus video conference by WHO
- Trial for potential coronavirus drug (remdisivir) running ahead of schedule
- China reports no coronavirus deaths for 10th straight day
- Rutgers University to freeze tuition in plan to offset coronavirus hardships
- China’s first wave of coronavirus cases may have been four times bigger than originally reported
- China says it could have coronavirus vaccine ready by ‘early next year’
- Miami goes 7 weeks without a homicide for first time in decades
- Coronavirus can live up to 72 hours on bus and subway surfaces, Cuomo says
- Celebs are ‘super-spreaders’ of coronavirus fake news, study says
- Just plane wrong: Man details flight packed with mask-less passengers
- ‘Bank on it’: Cuomo warns another global pandemic will happen
- Soldiers busted after sneaking through hole in base fence to party during pandemic
- De Blasio calls on state to extend NYC eviction moratorium
- Driver passes out after wearing N95 mask for hours, crashes into pole
- Gov. Cuomo says world was too slow to react to coronavirus
- Canada rejects one million failed masks from China
- Arctic surfers in Norway take advantage of country’s flexible lockdown
- Trump vows to supply more countries with ventilators amid coronavirus
- Sicily is wooing tourists with $54M in slashed airfare, hotel vouchers
- Australia will make it a crime to use coronavirus tracing data for non-health purposes
- Company execs may face prison time for keeping coronavirus loans
- Black cat paste sold as coronavirus cure amid rumor it leaves you feline all right
- Ricky Gervais slams celebs who lecture ‘normal nobodies’ about coronavirus
- EU report on Chinese, Russian coronavirus disinformation watered down after pressure from Beijing: reports
- In four U.S. state prisons, nearly 3,300 inmates test positive for coronavirus — 96% without symptoms
- The known global death toll surpasses 200,000, but the real toll is a mystery
- Cuba is sending doctors to South Africa and around the world to fight the pandemic
- Children in Spain go outside for the first time in weeks as the country’s lockdown begins to ease
- Two Dutch mink farms are quarantined after the animals are infected with the virus
- Masked Hong Kong crowds resume antigovernment protests amid the outbreak
- A less social Ramadan to help contain the virus
- Domestic abuse cases rise during London’s lockdown
- Australia releases a coronavirus tracing app
- ‘There Are No Viruses Here’: Leader of Belarus Scoffs at Lockdowns
B. Numbers & Trends
Note: 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.
1. Confirmed Total Cases and New Cases
- Total Cases = 2,993,262 (+2.5%)
- New Cases = 73,858 (-18.7%) (-16,929)
- New Cases (3 day average) = 92,152 (-2.6%) (-2,411)
- Total Cases = 1,276,808 (+1.9%)
- New Cases = 24,992 (-10.6%) (-2,872)
- New Cases (3 day average) = 27,844 (-0.81%) (-277)
- Total Cases = 472,276 (+2.5%)
- New Cases = 11,612 (-6.7%) (-836)
- New Cases (3 day average) = 12,333 (-3.6%) (459)
- Total Cases = 987,160 (+2.8%)
- New Cases = 26,509 (-25.6%) (-9,104)
- New Cases (3 day average) = 35,652 (-4.5%) (-1,659)
- 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 = 55.3% of Total US Cases (-0.5%)
- NY & NJ = 40.8% of Total US Cases (-4.2%)
- For more information on US States and territories, see https://ncov2019.live/data & https://www.worldometers.info/coronavirus/country/us/
2. Serious or Critical Cases
- Worldwide serious or critical cases = 57,600 (-602)
- US series or critical cases = 15,143 (+33)
- US serious or critical cases = 2.0% of Active Cases compared with worldwide percentage of 3.3%
- Worldwide deaths = 206,915 (+1.9%) (+3,751)
- Europe deaths = 121,885 (+1.5%) (+1,767)
- US deaths = 55,413 (+2.1%) (+1,157)
- NY deaths = 22,275 (+1.7%) (+367)
- Deaths per 1M population of 5 Countries with Largest Number of Confirmed Cases:
- Spain: 496
- Italy: 441
- France: 350
- US: 167
- Germany: 71
- 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 = 877,411 (+4.9%) (+40,799)
- Worldwide recoveries = 29.3% of Total Worldwide Cases
- US recoveries = 118,781 (+0.5%) (+619)
- US recoveries = 12.0% of Total US Cases (+2.2%)
C. Potential Treatments
1. New York clinical trial quietly tests heartburn remedy against coronavirus
- The fast-growing list of possible treatments for the novel coronavirus includes an unlikely candidate: famotidine, the active compound in the over-the-counter heartburn drug Pepcid.
- On 7 April, the first COVID-19 patients at Northwell Health in the New York City area began receiving famotidine intravenously, at nine times the heartburn dose. Unlike other drugs the 23-hospital system is testing, including Regeneron’s sarilumab and Gilead Science’s remdesivir, Northwell kept the famotidine study under wraps to secure a research stockpile before other hospitals, or even the federal government, started buying it. “If we talked about this to the wrong people or too soon, the drug supply would be gone,” says Kevin Tracey, a former neurosurgeon in charge of the hospital system’s research.
- As of Saturday, 187 COVID-19 patients in critical status, including many on ventilators, have been enrolled in the trial, which aims for a total of 1174 people. Reports from China and molecular modeling results suggest that the drug, which seems to bind to a key enzyme in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), could make a difference. But the hype surrounding hydroxychloroquine and chloroquine—the unproven antimalarial drugs touted by President Donald Trump and some physicians and scientists—has made Tracey wary of sparking premature enthusiasm. He is tight-lipped about famotidine’s prospects, at least until interim results from the first 391 patients are in. “If it does work, we’ll know in a few weeks,” he says.
- A globe-trotting infectious disease doctor named Michael Callahan was the first to call attention to the drug in the United States. Callahan, who is based at Massachusetts General Hospital in Boston and has extensive connections in the biodefense world, has spent time in disease hot zones around the world, including the 2003 outbreak of another coronavirus disease, SARS, in Hong Kong. In mid-January, he was in Nanjing, China, working on an avian flu project. As the COVID-19 epidemic began exploding in Wuhan, he followed his Chinese colleagues to the increasingly desperate city.
- The virus was killing as many one out of five patients over 80 years of age. Patients of all ages with hypertension and chronic obstructive pulmonary disease were faring poorly. Callahan and his Chinese colleagues got curious about why many of the survivors tended to be poor. “Why are these elderly peasants not dying?” he asks.
- In reviewing 6,212 COVID-19 patient records, the doctors noticed that many survivors had been suffering from chronic heartburn and were on famotidine rather than more-expensive omeprazole (Prilosec), the medicine of choice both in the United States and among wealthier Chinese. Hospitalized COVID-19 patients on famotidine appeared to be dying at a rate of about 14% compared with 27% for those not on the drug, although the analysis was crude and the result was not statistically significant.
- But that was enough for Callahan to pursue the issue back home. After returning from Wuhan, he briefed Robert Kadlec, assistant secretary for Preparedness and Response at the Department of Health and Human Services, then checked in with Robert Malone, chief medical officer of Florida-based Alchem Laboratories, a contract manufacturing organization. Malone is part of a classified project called DOMANE that uses computer simulations, artificial intelligence, and other methods to rapidly identify U.S. Food and Drug Administration-approved drugs and other safe compounds that can be repurposed against threats such as new viruses.
- Malone had his eyes on a viral enzyme called the papainlike protease, which helps the pathogen replicate. To see if famotidine binds to the protein, he would ordinarily need the enzyme’s 3D structure, but that would not be available for months. So Malone recruited computational chemist Joshua Pottel, president of Montreal-based Molecular Forecaster, to predict it from two crystal structures of the protease from the 2003 SARS coronavirus, combined with the new coronavirus’s RNA sequence.
- It was hardly plug-and-play. Among other things, they compared the gene sequences of the new and old proteases to rule out crucial differences in structure. Pottel then tested how 2,600 different compounds interact with the new protease. The modeling yielded several dozen promising hits that pharmaceutical chemists and other experts narrowed to three. Famotidine was one. (The compound has not popped up in in vitro screens of existing drug libraries for antiviral activity, however.)
- “If it does work, we’ll know in a few weeks,” says Northwell Health’s Kevin Tracey, who leads the famotidine study.
- With both the tantalizing Chinese data and the modeling pointing towards famotidine, a low-cost, generally safe drug, Callahan contacted Tracey about running a double-blind randomized study. COVID-19 patients with decreased kidney function would be excluded because high doses of famotidine can cause heart problems in them.
- After getting FDA approval, Northwell used its own funds to launch the effort. Just getting half of the needed famotidine in sterile vials took weeks, because the injectable version is not widely used. On 14 April, the U.S. Biomedical Advanced Research and Development Authority (BARDA), which operates under Kadlec, gave Alchem a $20.7 million contract for the trial, most of which paid Northwell’s costs.
- Anecdotal evidence has encouraged the Northwell researchers. After speaking to Tracey, David Tuveson, director of the Cold Spring Harbor Laboratory Cancer Center, recommended famotidine to his 44-year-old sister, an engineer with New York City hospitals. She had tested positive for COVID-19 and developed a fever. Her lips became dark blue from hypoxia. She took her first megadose of oral famotidine on 28 March. The next morning, her fever broke and her oxygen saturation returned to a normal range. Five sick coworkers, including three with confirmed COVID-19, also showed dramatic improvements upon taking over-the-counter versions of the drug, according a spreadsheet of case histories Tuveson shared with Science. Many COVID-19 patients recover with simple symptom-relieving medications, but Tuveson credits the heartburn drug. “I would say that was a penicillin effect,” he says.
- After an email chain about Tuveson’s experience spread widely among doctors, Timothy Wang, head of gastroenterology at Columbia University Medical Center, saw more hints of famotidine’s promise in his own retrospective review of records from 1,620 hospitalized COVID-19 patients. Last week, he shared the results with Tracey and Callahan, and he added them as a co-authors on a paper now under review at Annals of Internal Medicine. All three researchers emphasize, though, that the real test is the trial now underway. “We still don’t know if it will work or not,” Tracey says.
- Callahan has kept busy since his return from China. Kadlec deployed him on medical evacuation missions of Americans on two heavily infected cruise ships. Now back to doing patient rounds in Boston, he says the famotidine lead underscores the importance of science diplomacy in the face of an infectious disease that knows no borders. When it comes to experience with COVID-19, he says, “No amount of smart people at the [National Institutes of Health] or Harvard or Stanford can outclass an average doctor in Wuhan.“
D. What Can We Learn From Past Outbreaks of Infectious Diseases?
1. The spread of the coronavirus has predictable features
[Note: The following is a summary of an excellent article that applies more than a century of studying infectious diseases to provide insights into what can expect in the future regarding the transmission and effect of the coronavirus. A copy of the article, which is published in Science magazine, is attached to this Update.]
- Modern history is riddled with pandemics that have shaped the study of infectious disease. In the past 200 years, at least seven waves of cholera, four new strains of influenza virus, tuberculosis, and HIV have spread across the world and killed at least 100 million people.
- Virtually all transmissible diseases continue to evolve and transmit globally once established.
- More than a century of studying the size and timing of outbreaks, including which interventions are effective in stopping them, has given rise to a well-founded quantitative and partially predictive theory of the dynamics of infectious diseases
- Principles derived from influenza virus infections and other infectious diseases allow two predictions to be made with confidence:
- the coronavirus is here to stay, and
- the high transmission rate will continue to force a choice between widespread infection and social disruption, at least until a vaccine is available. The difficulty of this choice is amplified by uncertainty, common to other respiratory pathogens, about the factors driving transmission.
- An epidemic dies out when an average infection can no longer reproduce itself. This occurs when a large fraction of an infected host’s contacts are immune. This threshold—between where an infection can and cannot reproduce itself—defines the fraction of the population required for herd immunity.
- Herd immunity is constantly eroded by the births of new, susceptible hosts and sometimes by the waning of immunity in previously infected hosts. The durability of immunity to the coronavirus is not yet known, but births will promote virus survival. Thus, like other transmissible pathogens, the coronavirus is likely to circulate in humans for many years to come.
- The coronavirus and influenza virus are epidemiologically similar in that they are both highly transmissible by the respiratory route, they both cause acute infections, and they both infect and are transmitted by adults.
- This suggests that in the absence of widespread, carefully coordinated and highly effective interventions to stop transmission of the coronavirus, the virus could persist through similar migratory patterns, assuming it is influenced by similar seasonal forces
- As a recent report warns, dramatic interventions to reduce transmission of the virus might not substantially change the long-term, total number of infections if behavior later returns to normal. The high costs of current interventions underscore a need to quickly identify the most helpful measures to reduce transmission until healthcare capacity can be increased and immunity boosted through vaccination.
- Containing the SARS coronavirus in 2003 required intensive contact tracing coordinated by multiple countries. Control [of SARS] was feasible because the onset of infectiousness coincided with the onset of symptoms, which were consistently severe.
- With the coronavirus, transmission can occur before symptoms develop, and symptom profiles are heterogeneous. Substantial asymptomatic and presymptomatic transmission make containment-based interventions, especially those depending on recognition of early symptoms or limited testing, more challenging and potentially infeasible alone
- This pandemic illuminates choices in managing respiratory pathogens. Most people do not have access to or opt out of the seasonal influenza virus vaccine, although influenza virus kills more than half a million people per year globally.
- Populations have long differed in their formal and informal support for infection control, for example, whether people who feel ill wear face masks or can easily stay at home. The consequences are somewhat predictable.
- The coronavirus is an evolving virus, and whether this evolution will erode the effectiveness of a future vaccine is currently unknown.
- The choices faced now will continue to matter.
E. The Road Back?
1. The Data Is In… Stop The Panic & End The Total Isolation [Opinion]
- The tragedy of the COVID-19 pandemic appears to be entering the containment phase. Tens of thousands of Americans have died, and Americans are now desperate for sensible policymakers who have the courage to ignore the panic and rely on facts.
- Leaders must examine accumulated data to see what has actually happened, rather than keep emphasizing hypothetical projections; combine that empirical evidence with fundamental principles of biology established for decades; and then thoughtfully restore the country to function.
5 key facts being ignored by those calling for continuing for near-total lockdown:
- Fact 1: The overwhelming majority of people do not have any significant risk of dying from COVID-19
- The recent Stanford University antibody study now estimates that the fatality rate if infected is likely 0.1 to 0.2 percent, a risk far lower than previous World Health Organization estimates that were 20 to 30 times higher and that motivated isolation policies.
- In New York City, an epicenter of the pandemic with more than one-third of all U.S. deaths, the rate of death for people 18 to 45 years old is 0.01 percent, or 11 per 100,000 in the population. On the other hand, people aged 75 and over have a death rate 80 times that. For people under 18 years old, the rate of death is zero per 100,000.
- Of all fatal cases in New York state, two-thirds were in patients over 70 years of age; more than 95 percent were over 50 years of age; and about 90 percent of all fatal cases had an underlying illness. Of 6,570 confirmed COVID-19 deaths fully investigated for underlying conditions to date, 6,520, or 99.2 percent, had an underlying illness. If you do not already have an underlying chronic condition, your chances of dying are small, regardless of age. And young adults and children in normal health have almost no risk of any serious illness from COVID-19.
- Fact 2: Protecting older, at-risk people eliminates hospital overcrowding
- We can learn about hospital utilization from data from New York City, the hotbed of COVID-19 with more than 34,600 hospitalizations to date. For those under 18 years of age, hospitalization from the virus is 0.01 percent per 100,000 people; for those 18 to 44 years old, hospitalization is 0.1 percent per 100,000. Even for people ages 65 to 74, only 1.7 percent were hospitalized. Of 4,103 confirmed COVID-19 patients with symptoms bad enough to seek medical care, Dr. Leora Horwitz of NYU Medical Center concluded “age is far and away the strongest risk factor for hospitalization.” Even early WHO reports noted that 80 percent of all cases were mild, and more recent studies show a far more widespread rate of infection and lower rate of serious illness. Half of all people testing positive for infection have no symptoms at all. The vast majority of younger, otherwise healthy people do not need significant medical care if they catch this infection.
- Fact 3: Vital population immunity is prevented by total isolation policies, prolonging the problem
- We know from decades of medical science that infection itself allows people to generate an immune response — antibodies — so that the infection is controlled throughout the population by “herd immunity.” Indeed, that is the main purpose of widespread immunization in other viral diseases — to assist with population immunity. In this virus, we know that medical care is not even necessary for the vast majority of people who are infected. It is so mild that half of infected people are asymptomatic, shown in early data from the Diamond Princess ship, and then in Iceland and Italy. That has been falsely portrayed as a problem requiring mass isolation. In fact, infected people without severe illness are the immediately available vehicle for establishing widespread immunity. By transmitting the virus to others in the low-risk group who then generate antibodies, they block the network of pathways toward the most vulnerable people, ultimately ending the threat. Extending whole-population isolation would directly prevent that widespread immunity from developing.
- Fact 4: People are dying because other medical care is not getting done due to hypothetical projections
- Critical health care for millions of Americans is being ignored and people are dying to accommodate “potential” COVID-19 patients and for fear of spreading the disease. Most states and many hospitals abruptly stopped “nonessential” procedures and surgery. That prevented diagnoses of life-threatening diseases, like cancer screening, biopsies of tumors now undiscovered and potentially deadly brain aneurysms. Treatments, including emergency care, for the most serious illnesses were also missed. Cancer patients deferred chemotherapy. An estimated 80 percent of brain surgery cases were skipped. Acute stroke and heart attack patients missed their only chances for treatment, some dying and many now facing permanent disability.
- Fact 5: We have a clearly defined population at risk who can be protected with targeted measures
- The overwhelming evidence all over the world consistently shows that a clearly defined group — older people and others with underlying conditions — is more likely to have a serious illness requiring hospitalization and more likely to die from COVID-19. Knowing that, it is a commonsense, achievable goal to target isolation policy to that group, including strictly monitoring those who interact with them. Nursing home residents, the highest risk, should be the most straightforward to systematically protect from infected people, given that they already live in confined places with highly restricted entry.
- The appropriate policy, based on fundamental biology and the evidence already in hand, is to institute a more focused strategy like some outlined in the first place:
- Strictly protect the known vulnerable,
- Self-isolate the mildly sick, and
- Open most workplaces and small businesses with some prudent large-group precautions.
- This would allow the essential socializing to generate immunity among those with minimal risk of serious consequence, while saving lives, preventing overcrowding of hospitals and limiting the enormous harms compounded by continued total isolation.
- Let’s stop underemphasizing empirical evidence while instead doubling down on hypothetical models. Facts matter.
Source: ZeroHedge here.
F. Did Almost Everyone Get It Wrong? End of the World vs. Nothingburger
1. The Facts That Prove Almost Everyone Is Wrong About This Pandemic [Opinion]
- When it comes to COVID-19, most Americans seem to be gravitating toward one of two extremes. Some are treating this pandemic like it is the end of the world, while many others are dismissing it as a “nothingburger”. But the truth is somewhere in between.
- Nobody can deny that lots of people are getting sick and lots of people are dying. In fact, the U.S. death toll has doubled in a little over a week and it has now shot past the 50,000 mark. And as this pandemic progresses, a lot more people are going to get sick and a lot more people are going to die, and this is going to be true whether the lockdowns continue or not. The lockdowns were never going to stop COVID-19, and anyone that believed that was just being delusional.
- The only time a lockdown should be instituted is if a pandemic has gotten so bad in an area that hospitals are being absolutely overwhelmed, because if people can’t get treatment that is a factor that could potentially increase the overall death toll substantially.
- In most of the United States that is not happening right now, and so in most of the nation the lockdowns should be immediately ended.
- But won’t a lot more people start getting sick if that happens?
- Of course, and this is something that the “nothingburger” crowd doesn’t understand. Lifting the lockdowns is going to cause the virus to cycle through our population at a much faster rate, and the numbers will get pretty ugly. But as long as the medical system can handle it, lockdowns are not necessary.
- What “the end of the world” crowd does not understand is that when you are dealing with a virus that spreads as easily as this one, it is inevitable that most of the population will eventually become infected. You can “flatten the curve” and delay the inevitable with lockdowns, but that also prolongs the pandemic. In the end, roughly the same number of people will get sick and roughly the same number of people will die no matter how the pandemic is “managed”.
- This week, the “nothingburger” crowd has made a really big deal out of the fact that a study conducted in L.A. county discovered that about 4 percent of all residents had already developed COVID-19 antibodies, and they were trying to use that study to prove that this pandemic is not much of a threat at all.
- Actually, it shows just the opposite.
- This pandemic is not going to be over until herd immunity is achieved, and according to Johns Hopkins that does not happen until 70 to 90 percent of a population has developed immunity
- When most of a population is immune to an infectious disease, this provides indirect protection—or herd immunity (also called herd protection)—to those who are not immune to the disease.
- For example, if 80% of a population is immune to a virus, four out of every five people who encounter someone with the disease won’t get sick (and won’t spread the disease any further). In this way, the spread of infectious diseases is kept under control. Depending how contagious an infection is, usually 70% to 90% of a population needs immunity to achieve herd immunity.
So let’s do some really quick math
- Let’s assume that the study conducted in L.A. County is representative of the nation as a whole and that approximately 4 percent of all Americans have now developed antibodies.
- And let’s also assume that herd immunity for COVID-19 will be achieved when 80 percent of the total population has developed antibodies.
- If 47,000 Americans have died at the current 4 percent level of exposure, that means that we could potentially be looking at an overall death toll of 940,000 once we hit an 80 percent exposure level.
- Does anyone in the “nothingburger” crowd want to try to claim that 940,000 dead Americans is not a big deal?
- I keep hearing people say that this virus “is just like the flu”, and that is absolutely absurd. As Mike Adams of Natural News has pointed out, COVID-19 has killed more Americans in the last 17 days than the flu did in the last year…
- In the last 17 days, the Wuhan coronavirus has killed more Americans (35,087) than the regular flu kills in an entire year (34,157 for the last year). It obliterates any last shred of the argument — still heard across the independent media — that the coronavirus is “no worse than the flu.”
- The coronavirus remains the No. 1 cause of death in America on a day-to-day basis, clocking in at 2,804 deaths just today. Total deaths in the USA will exceed 46,000 tomorrow, confirming our earlier projection that estimated 46,000 to 93,000 deaths from coronavirus in the USA by the end of July. It’s not even the end of April, and we’re already beyond 45,000. (At the time we made the projection, it was dismissed as “crazy” by the very same people who still claim the coronavirus is “no worse than the flu.” Those are the people who can’t do math.)
- And actually the number of Americans dying from the coronavirus is being seriously undercounted.
- In New York City, if someone dies at home they are typically not tested to see if they have the coronavirus. So even though the number of city residents dying at home is now nearly ten times higher than normal, the vast majority of those cases are never showing up in the official numbers.
- But the “end of the world” crowd seems to think that if we just keep everyone at home long enough that we can significantly reduce the final death toll from this pandemic, and that just isn’t accurate either.
- Right now, the virus continues to spread even though most of the U.S. has now been locked down for weeks. In fact, there were nearly 30,000 more confirmed cases during the 24 hour period that just ended. Whether it does it relatively quickly or relatively slowly, this virus will continue to rip through our population until we eventually get to the point of herd immunity.
- “Experts” such as Bill Gates are suggesting that the lockdowns are “buying us time” until our scientists can develop a “vaccine”, but the truth is that is really not much more than a pipe dream.
- As I pointed out yesterday, there has never been a successful vaccine for any coronavirus in all of human history, and now that scientists have discovered approximately 30 different strains of the virus that will just make the task of trying to develop a vaccine even more complicated.
- Sadly, the reality of the matter is that this virus is going to be with us for a very long time to come. Eventually herd immunity will hopefully be achieved, but until then a lot of people are going to get sick and a lot of people are going to die.
- And fear of this virus is going to be with us for a long time to come as well, and that is going to paralyze our economy whether there are lockdowns or not.
- The bottom line is that this virus is not going to be stopped, and the economic collapse that has now begun is not going to be stopped either.
- But this isn’t the end of the world, and most of us will get through this. Of course even bigger challenges lie beyond the end of this pandemic, but that is a topic for another article.
- As of this moment, COVID-19 has killed more than 184,000 people around the globe, and by the end of this pandemic the overall death toll is likely to be much, much higher than that.
- There is no way that you can possibly call that a “nothingburger”, and sticking your head in the sand is not going to help anything. But on the other hand, trying to lock down the entire planet is not going to solve this crisis either. It will simply delay the inevitable, because this virus is just going to continue to spread no matter what actions our politicians take.
G. Stories From The Frontline
1. Georgia Reopens: Observations from Atlanta Metro Area
[Note: Georgia is leading the charge to reopen its economy. While the path taken by Georgia (the “Georgia Model”) is unquestionably controversial, only time will tell if the model is a good strategy or too aggressive. The stakes are high, particularly in light of President Trump’s criticism of some aspects of the plan, Much will depend on its success or failure of the Georgia Model as the outcome will undoubtedly influence the approach taken by other States. As a key contributor to our Updates (Brian Sivy) lives in the Atlanta Metro Area, we will be able to get some on the ground reporting on the reopening. Below is his first report.]
- On Friday, 4/24, Georgia Governor Brian Kemp, citing an economy in which small businesses are suffering, incrementally opened gyms, hair and nail salons, tattoo and massage parlors, and bowling alleys. Gov Kemp noted that the hospitalization system is not under stress and there is excess capacity. In addition, the Governor indicated testing is expanding as he announced a partnership with the university health system.
- Gov Kemp also announced that on Monday, 4/27, private dine-in restaurants, restaurants, theaters, private social clubs (bars, nightclubs, amusement parks are excluded) will be allowed to reopen provided they meet the social distancing and monitoring protocols with respect to the safety of workers and customers
- I jumped on the opportunity and scheduled an appointment with my barber on Friday, April 24th. Below are some of my thoughts and observations regarding the experience:
- Appointments only, no walk-ins allowed
- Customers were told to wait in their cars until notified by the barber
- The barbershop had 4 chairs that were less than 6 feet apart
- There were no customers waiting inside the barbershop
- Barbers were wearing masks – when asked about his mask supply, my barber indicated he had four N95 masks (he didn’t know how to clean them)
- Customers were not asked to wear masks – my barber said they would get in the way
- When asked about taking temperatures, my barber said he considered it but the type of thermometer needed was too expensive so he didn’t buy one
- The barber said that when the Governor announced plans to reopen barbershops, his phone lit up and his entire day (Friday, April 24th) was booked within 1-2 hours.
- He also indicated that during the “lockdown” he was providing haircuts (i.e., an example of the underground economy) with the blinds down
- We will continue to monitor the results of the Georgia Model in the coming weeks for trends related to new hospital cases. On the morning of Friday, 4/24, total hospitalizations were 4,154 and as of Sunday, 4/26 the number of hospitalizations totaled 4,377 (+223)
- According to the IHME database, the statistics as of 4/24 were as follows:
- Hospitalization Usage: 2,098 beds (8,323 beds available)
- ICU beds needed: 557 beds (590 beds available)
- Ventilators needed: 498 ventilators
H. Lessons From Abroad
1. This Japanese Island Lifted Its Coronavirus Lockdown Too Soon and Became a Warning to the World
- Japan’s northern island of Hokkaido offers a grim lesson in the next phase of the battle against COVID-19. It acted quickly and contained an early outbreak of the coronavirus with a 3-week lockdown. But, when the governor lifted restrictions, a second wave of infections hit even harder. Twenty-six days later, the island was forced back into lockdown.
- A doctor who helped coordinate the government response says he wishes they’d done things differently. “Now I regret it, we should not have lifted the first state of emergency,” Dr. Kiyoshi Nagase, chairman of the Hokkaido Medical Association, tells TIME.
- Hokkaido’s story is a sobering reality check for leaders across the world as they consider easing coronavirus lockdowns: Experts say restrictions were lifted too quickly and too soon because of pressure from local businesses, coupled with a false sense of security in its declining infection rate.
- “Hokkaido shows, for example, that what’s happening in the U.S. with individual governors opening up is very dangerous; of course you can’t close interstate traffic but you need to put controls in place,” says Kazuto Suzuki, Vice Dean of International Politics at Hokkaido University. “That’s what we now know: Even if you control the first wave, you can’t relax.”
- The Japanese prefecture of 5.3 million people, known for its rugged mountain beauty and long history of farming and fishing, was the first area of Japan to see a major coronavirus outbreak. It’s very different from Japan’s main island, Honshu, with its frenetic sprawling cities. And its response to COVID-19 has also been very different. Hokkaido’s leaders acted early and decisively, even as the national government was criticized for moving too slowly to stop the spread elsewhere. Japan still has relatively few confirmed COVID-19 cases compared to other countries—12,400—but the numbers have more than doubled in the last two weeks, alarming international health officials.
- Hokkaido’s story starts Jan. 31, at the annual snow festival in the island’s capital city of Sapporo. More than 2 million people attended the wintry carnival, to marvel at giant ice sculptures and dine on crab hotpot. Many were Chinese tourists, on vacation for the Lunar New Year.
- Around the start of the festival, Hokkaido doctors saw their first coronavirus patient, a woman from Wuhan, China. Then several more Chinese tourists fell ill and soon the virus was circulating in the general population.
- On Feb. 28, exactly a month after the first case was reported, there were 66 cases, the highest of any prefecture in Japan, and infections were accelerating, so the governor declared a state of emergency. At a press conference at the time, Nagase praised the government’s fast response and said it could be a model for the country.
- Schools closed, as did many restaurants and businesses, even though they weren’t legally compelled to shut. In Japan, the government can’t use police or military to enforce a lockdown, it can only ask—and in some cases beg—businesses to close. That’s in part because the country’s constitution, written after the Second World War with the help of the Americans, has strict protections for civil liberties in order to avoid a return to fascism.
- Mostly though, people complied. “Hokkaido residents are pretty obedient, plus it’s cold that time of year, so people usually lock themselves inside with a hot water heater anyway,” said Yoshfumi Tokosumi, a former editor for the Hokkaido Shimbun newspaper.
False sense of security
- By mid-March, the health crisis was stabilizing—new cases were in the low single digits and even zero on some days—but complaints from businesses were increasing.
- Hokkaido’s two main industries—agriculture and tourism—had been devastated. Farmers watched produce rot because restaurants and school lunch programs stopped buying it. An estimated 50 food processing companies went bankrupt. And Hokkaido’s dairy industry was hit so hard that the Ministry of Agriculture launched a video campaign featuring a ministry official dressed as a cow, to encourage people to drink more milk.
- Similarly, tourism was decimated by travel restrictions and the state of emergency measures. In Kutchan, a resort area that gets more snow than almost anywhere else on Earth, skiers and other tourists vanished, says Mayor Kazushi Monji. “We’ve seen almost no new hotel reservations since the state of emergency was declared and the damage to small businesses has been severe.”
- Rishiriya Minoya, a 30-year-old seaweed company in Otaru, saw sales drop 95% from last year. Owner Kazuomi Minoya, 50, who inherited the business from his father has struggled to keep it afloat with so few tourists and local shoppers. Across the island, bar owners, taxi drivers and restaurateurs recounted similar stories.
- In March, Hokkaido Governor Naomichi Suzuki grappled with whether to maintain the lockdown and endure more economic pain, or lift it and risk the health consequences. Suzuki is a popular figure, with a nearly 90% approval rating. At 39, he’s the country’s youngest governor. He also has close ties to the national government, which enjoys strong support from the business sector and is responsive to pressure from it, says Suzuki, the international politics professor.
- “Hokkaido’s business sector was opposed to the state of emergency, but the governor also wanted Hokkaido to be an example to the rest of Japan for how to control the virus,” says Aya Hasegawa, a reporter for the Hokkaido Shimbun newspaper.
- On March 18, Suzuki assembled his advisers and decided it was time to ease restrictions. Nagase, the doctor who helped coordinate the government’s response, says that at that time, officials had only a limited understanding of the virus and how quickly it could spread. “Hokkaido was the first big outbreak here, so we were really operating in the dark.” Without sufficient data, doctors based their recommendations on the idea that the coronavirus spread like influenza. Nagase says he now regrets not pushing for more testing from the beginning.
- The next day, the governor announced he would lift the state of emergency, but asked residents to continue to restrict social interaction and stay home if they felt unwell. He also said Hokkaido would keep 34 government-run facilities closed, as well as many schools. He called it “The Hokkaido Model,” in which residents would work to prevent infection while still continuing social and economic activities.
Second wave is bigger than the first
- The announcement lifting restrictions came just before a three-day weekend; Hokkaido residents spilled onto streets and lingered in cafes, celebrating the conclusion of their weeks-long confinement. That likely kicked off the second wave of infections, says Nagase.
- Further fueling it, people from other parts of Japan saw that Hokkaido had relaxed restrictions and began travelling there. Some were university students in big cities, who returned home to Hokkaido when classes were cancelled in April, says Nagase. Others were employees of large companies that typically start new job rotations at that time of year; when the state of emergency was lifted, businesses sent a fresh crop of workers from Tokyo and Osaka to Hokkaido.
- That likely seeded even more infections and soon the second outbreak was in full bloom. By April 9—exactly three weeks after the lockdown was lifted—there was a record number of new cases: 18 in one day. “Officials thought about people coming from overseas but never considered that domestic migration could bring the virus back,” said Hironori Sasada, professor of Japanese politics at Hokkaido University.
- On April 14, Hokkaido was forced to announce a state of emergency for a second time. The island had 279 reported cases, an increase of about 80% from when the governor lifted the first lockdown less than a month before. As of Wednesday, there were 495 cases in Hokkaido.
- Businesses are now preparing for the long haul. Tetsuya Fujiawara, CEO of Smile Sol, a group of ten pub restaurants in Hokkaido, says even though sales are down 60%, he’d rather a strong, consistent lockdown than “lukewarm measures” that would only perpetuate the cycle of restrictions being lifted and then reinstated as infections resurge.
- Nagase worries that Japan as a whole has not learned from Hokkaido’s mistakes, though. “I’m on the board of the Japan Medical Association and we’ve been pushing the central government for stronger national measures, but it comes back to the economy: because of the economic situation, it’s really hard to lock down in Japan.”
- Prime Minister Shinzo Abe did announce a state of emergency on April 7 for seven prefectures, but did not include Hokkaido. On April 16, he extended it nationwide, noting that the virus was spreading as people moved between prefectures. In early May, the country will celebrate one of its biggest holidays of the year, Golden Week, when people typically travel around the country on vacation. National officials have advised people to stay put and Suzuki, the Hokkaido governor, has warned against non-essential outings.
- As for Nagase, the doctor involved in Hokkaido’s response, the hard lesson he and the prefecture have learned, he says, is that until there’s a vaccine or medicine, everyone has to take personal responsibility and understand that, “it really may not be until next year that we can safely lift these lockdowns.”
2. How Singapore flipped from virus hero to cautionary tale
- In the early days of the coronavirus pandemic, Singapore was a global standard bearer for taming the deadly illness. Now it’s home to Southeast Asia’s largest recorded outbreak and is racing to regain control.
- One reason behind this reversal can likely be traced back to six days in February, when the earliest sign of what would become an explosion in cases among migrant laborers first appeared. It’s a cautionary tale of how even countries experienced in handling epidemics can be wrong-footed by this elusive disease, particularly when it takes root in disadvantaged communities.
- In early February, Singapore had a low-level outbreak that it was containing effectively without disruptive measures like closing schools. It was being globally lauded for its calm, measured approach to the virus. Around the same time, a 39-year-old Bangladeshi national, one of an army of almost 1 million foreign laborers in Singapore, developed symptoms of the coronavirus.
- In the days after he fell ill, the laborer visited a clinic and a hospital for help, only to be sent home each time. Home for the worker was a dormitory where men sleep about 10 to a room, sharing toilets and cooking facilities. He also visited the Mustafa Centre, a 24-hour shopping mall popular with migrant laborers and locals alike. It wasn’t until Feb. 7 that he was admitted to hospital and a day later, tested positive for the virus.
- The Bangladeshi was Singapore’s patient number 42, and the first apparent case among low-wage foreign workers in the city’s dormitories. Infections among migrant laborers now account for more than 70 percent of the country’s 9,125 infections, and Singapore is seeing record daily increases in its tally, with new cases exceeding 1,000 on Monday and Tuesday.
- The country didn’t record its first deaths until late March, but fatalities now stand at 11, and its less socially restrictive strategy has been replaced by a partial lockdown that’s being tightened and extended until June 1.
- Many governments have been caught out by the unexpectedly infectious pathogen, with opportunities for early containment lost as patients were sent home instead of being immediately tested and quarantined.
- But unlike other Asian nations such as South Korea, some health experts say Singapore was slow to revise a response plan honed during its experience in 2003 with Severe Acute Respiratory Syndrome, or SARS. That strategy saw the nation focus on hunting down people who had come into contact with an infected person, a classic public health approach known as contact tracing.
- Covid-19 — highly contagious and manifesting in some with little or very mild symptoms — has turned out to be “nothing like SARS,” said Jeremy Lim, an adjunct associate professor at the National University of Singapore’s Saw Swee Hock School of Public Health.
- “The old playbook has to be thrown out and a new one written,” he said. “The difficulty for countries including Singapore is that one needs to write the playbook as they execute measures. It’s like the metaphor — fixing an airplane’s engine while mid-flight.”
- The case of Singapore’s Patient 42 shares similarities with that of a patient in South Korea who triggered a turning point in that country’s epidemic, which has exceeded more than 10,000 cases.
- Ten days passed between South Korea’s Patient 31 going to a hospital with symptoms, and when she was finally quarantined. In the days between, the woman, a member of a religious sect, attended services where people worshiped sitting on the floor, elbow-to-elbow for two hours at a time.
- Until then, South Korea was — just like Singapore — testing people found through contact tracing. But faced with an explosive outbreak within a group that has more than 200,000 worshipers, Korean officials rapidly pivoted to a strategy known as community testing: it compelled church leaders to hand over a list of its members and began testing them all, regardless of whether they showed symptoms or had had contact with an infected person.
- Because of its rapid pivot to community testing, South Korea’s epidemic spiked quickly but also ebbed rapidly. It managed to slow the growth of infection by early March and never had to institute a lockdown. Hong Kong also widened its virus response beyond contract tracing to include community testing as it became apparent the coronavirus was different to SARS, where those infected fell seriously — and obviously — ill.
- After the emergence of Patient 42, Singapore didn’t appear to immediately undertake large-scale community testing within the foreign labor community, despite their living conditions being favorable to the spread of infectious disease and calls from worker advocacy groups. The country tested and quarantined 19 people who were in contact with the worker and asked companies that operate the often cramped dormitories to undertake more cleaning and take residents’ temperatures.
- Singapore’s Ministry of Health didn’t respond to questions on how many foreign laborers were tested in the weeks after Patient 42, but officials’ comments indicate that large-scale community testing didn’t start until much later.
- During a briefing on April 14 — by which time hundreds of infected workers were being discovered almost daily — the health ministry’s director of medical services, Kenneth Mak, said some 1,500 workers had been tested and there were plans to test 5,000 more. More than 200,000 of the laborers, many of whom toil on Singapore’s construction sites, live in the dormitories.
- Singapore’s early public rhetoric indicated a reluctance to test widely, with a focus on those with symptoms to avoid wasting tests. On March 10, Mak said that “community testing for all people, irrespective of whether they have symptoms or not, will generate a lot of activity” but have a low yield.
- Low-wage foreign workers comprise a fifth of the overall population in Singapore, but largely live separate from the local community. The dormitories — where clogged toilets and overflowing rubbish chutes have been reported — are a far cry from the country’s glitzy skyline showcased in Hollywood blockbusters like “Crazy Rich Asians.”
- This is not the first time that an infectious disease has hit Singapore’s foreign workers, who earn as little as $18 a day.
- In 2008, some were infected in an outbreak of chikungunya, a disease carried by mosquitoes that triggers debilitating joint pain. Their dormitories lacked ventilation and insect screens. In the same year, a worker who subsequently died from chicken pox spread it to 10 others and the dormitory director was eventually sentenced to jail. Singapore has dozens of worker dormitories, which are operated by private companies like Keppel Corp. and Centurion Corp.
- “It’s hard to explain why the authorities did not up the ante in terms of infection controls at the dorms — perhaps there was a policy blind spot with the focus being on Singaporeans,” said Eugene Tan, a political commentator and law professor at the Singapore Management University. But “in public health, the migrant workers are very much a part of the community, and the early vigilance against community spread did not embrace the foreign workers.”
- On Tuesday, Prime Minister Lee Hsien Loong said that most migrant worker infections being discovered are mild cases and vowed that the government would look after their health, welfare and livelihoods.
- Singapore is now entering the third week of a partial lockdown it calls a circuit breaker. Social gatherings are banned and only essential businesses are allowed to operate. Schools are now shut, as well. The implementation has been unusually bumpy for a country used to being lauded as being efficiently run and whose citizens are known to be law-abiding. The penalty for flouting new social-distancing rules on the first offense went from a warning to a $300 fine within days, and just before the lockdown started, the government banned all personal gatherings after earlier only prohibiting those of more than 10 people.
- “The many changing instructions — sometimes a few times a day — doesn’t give confidence that we’re indeed gold standard,” said Inderjit Singh, a former Member of Parliament with the ruling People’s Action Party.
- National Development Minister Lawrence Wong told reporters April 14 that Singapore adjusts its measures based on the circumstances: “Our posture has not changed, our strategies, our approach has not changed,” said Wong, who co-chairs a ministerial task force to tackle the virus.
- Singapore says it’s now aggressively testing in the foreign laborer community. It is also accelerating the construction of some worker dormitories and has shifted thousands of healthy laborers working in essential industries to temporary housing facilities that offer more space. These include vacant military camps, public housing units and lodgings built out at sea commonly used in the marine industry.
- Manpower Minister Josephine Teo has said that the standard of living in dormitories should be bolstered. Doing so over the objection of employers who must bear the higher costs is “not only the right thing to do but also in our own interests,” she wrote in a Facebook post on April 6.
- As for Patient 42, his condition is now stable after two months in intensive care on a ventilator, but he missed the birth of his first child while in the hospital, the advocacy group Migrant Workers Centre said on April 16 in a Facebook post. “He is able to breathe on his own and will require speech therapy moving forward as part of his recovery process.”
Source: Japan Times here.
3. Are European Countries Flattening The Curve?
- As the coronavirus spreads rapidly around the world, Statista’s Katharina Buchholz notes that some European countries have begun flattening the curve of infections.
- According to numbers by Johns Hopkins collected by the website Worldometers, the start to a flattening is especially visible in Germany, where a total of around 150,000 cases had been recorded most recently.
- In Italy and France, where there are currently almost 190,000 and 160,000 cases respectively and public life has shut down, some progress has also been made. Spain has had the steepest curve despite also adhering to a strict lockdown. There are more than 210,000 known infections in the country.
- The UK, where the outbreak started later, does not yet show any signs of infections slowing down. The same is true across the pond in the U.S., currently the country with most known infections and a curve that is still pointing upwards. Infections are nearing 850,000 stateside.
- The countries’ collective aim is to “flatten the curve” of infections. While South Korea was able to (more or less) stabilize its outbreak at around 10,000 cases – due to widespread free testing (including the now infamous drive-thru testing), quarantine measures and the harnessing of mobile technology for public information – China has stabilized theirs at around 83,000 cases.
- South Korea hit 100 cases on February 20 and managed to leave the steep upward trajectory around 14 days later.
- In the case of China, more than 100 cases were first recorded on January 20, and quarantine and testing measure succeeded in breaking the upwards trajectory by February 12 – around three and a half weeks later.
- European countries and the U.S. are already three to five weeks into their respective outbreaks and are now beginning to level curves in some places.
I. Is Patience for the Lockdowns Wearing Thin?
1. Wait, how long are we supposed to stay in lockdown? [Opinion]
- What are we waiting for? The question can be posed in either a wild, irresponsible way — or a sane, measured way. In New York, our “pause” will continue until at least May 15, and New Yorkers are asking, in a measured, sane way: What exactly are we waiting for?
- In the beginning, we had a goal: to flatten the curve. We were warned that COVID-19 would overtake our hospitals and cause a health-system collapse. We were to stay home to give our medical heroes a fighting chance.
- So we did, and thanks to the strength of our system, it worked. The Javits Center never filled up; the USS Comfort is sailing away. Three weeks ago, Gov. Andrew Cuomo was vowing to seize ventilators from upstate hospitals and send them to Gotham. Last week, we were dispatching our ventilators out to other states.
- We did our part; we flattened the curve. So why is there no move to loosen regulations?
- In February and March, expert and elite opinion seemed to understand that patience with lockdowns would at some point wear thin. But not anymore. Last week, Cuomo used a graphic in his daily presentation that listed the lengths of various wars and previous pandemics. The 1910 cholera outbreak lasted a year. World War II lasted six years. And so on.
- The message: We haven’t been living through this that long, and our ancestors had it far worse. But if we are looking at years of lockdown, we need to be informed of it, we need a debate — and we need a plan.
- Otherwise, it isn’t relevant that the Vietnam War lasted eight years, and the governor has to stop shaming us for looking for a light at the end of this hell-tunnel.
- It’s also becoming apparent that staying closed is some weird poke in the eye to President Trump. Hyper-polarization means that if the president wants to awaken the nation from its devastating economic coma, it must mean that he and his cornpone followers are wrong. Smart people — who tend to have lockdown-immune jobs in academe, government and media — must know better, and they have a license to mock and demean.
- But it isn’t true, as they say, that those of us who want a roadmap to reopening play down the virus or minimize its deadliness. We lost a lot in New York. We’ve watched our friends, family and neighbors succumb to this horrible disease. We understand what’s at stake.
- But there is life beyond COVID-19, too. There are pro-life concerns on both sides. The pause has meant people are skipping cancer screenings. The lines at food pantries are scarily long. Last week, Cuomo admitted that domestic violence is on the rise. “Very bad.” But, he added, it’s “not death.” Maybe not yet. But these costs are very real, and they have to be tallied.
- No one sane is pushing to return to “normal.” Normal won’t be back for a long time, and no one expects it to. If restaurants, bars or movie theaters opened tomorrow, people still wouldn’t flock to them. We are walking around in masks and sanitizing our groceries. We get it — we’re far from normal. We just want to start on the road back. We want to know the road exists.
- It’s less that we need to know when this ends than we need to know how it ends. Are we waiting for deaths to fall below a certain daily number? What is that number? Are we waiting for hospitalizations to evaporate? For better treatment? For a vaccine? Antibody tests? Herd immunity? New Yorkers are tough, we can handle the truth.
- But this uncertainty can’t last, or people will decide to leap into irresponsibility. We need a plan, and we need it now.
J. Practical Tips and Other Useful Information
1. A Study Looks at How to Disinfect Your Mask at Home
- Due to the unknown numbers of asymptomatic people infected with the SARS-CoV-2, the CDC has recommended that all citizens wear face coverings when in public. More recently, some states have mandated face coverings. Many people are wearing homemade coverings, but these mandates potentially increase demand for medical face masks, exacerbating shortages for first responders and medical staff.
- One way to to extend the supply of disposable masks is to disinfect them and reuse them. We have just published a paper in the Journal of the International Society for Respiratory Protection that looks into whether disposable masks can be disinfected by heating them without compromising their effectiveness. We also compared the effectiveness of medical-grade masks with homemade ones, and looked into the feasibility of improving masks with homemade nose clips.
- A new study suggests that disposable surgical masks can be disinfected with heat multiple times without harming their effectiveness. A homemade plastic nose clip, used here, may add another layer of protection.
- Prior work by others on disinfection of disposable masks has shown that heating for 30 minutes at 158 degrees F (70 C) or above can effectively destroy SARS, influenza and the novel SARS-CoV-2 coronavirus. This can be done in a home oven. As such, we did no testing with viruses. Instead we focused on whether repeated heat disinfection affected how well the masks worked for removing particles in the same size range as coronavirus.
- To do this, we put masks onto mannequin heads, and rigged the heads to “breathe” through their noses and mouths, using a vacuum pump. We then exposed the mannequins to black carbon (i.e, soot) from a kerosene lamp, which generates particles that overlap in size with those of the coronavirus. We determined filtration efficiency by comparing black-carbon levels on both sides of the masks worn by the mannequins. We did this with two brands of disposable N95 respirators and one brand of disposable surgical mask, as well as with one design of homemade face covering. We tried this out repeatedly, and in a variety of ways.
- First, to measure the maximum filtration efficiency and resilience of the disposable masks, each disposable mask type was tested while taped or modified to tightly fit a plastic mannequin’s face when new, and again after each heating cycle. We found that one N95 brand (3M) and a surgical mask (HSl brand) stood up to the 10 cycles of heat disinfection and reuse, with no reduction in performance. Filtration efficiency was greater than 95 percent over all 10 cycles for N95 respirators, and greater than 70 percent for surgical masks. (In contrast, we found that the nose-pad of another N95 brand, the Moldex, was unable to withstand multiple cycles of being put on and off the mannequin, whether or not it was heated in between uses.)
- These tests show the maximum filtration efficiency possible, but they are not representative of how people normally wear masks, where the fit can be much looser. So, for a second set of tests, we obtained a head form covered in soft silicone to mimic the pliability of the human face. We then assessed the effectiveness of the masks as they are commonly worn, by simply putting the elastic straps around the head or ears without additional tightening. As expected, the filtration efficiency of all the disposable masks decreased substantially, to around 40 percent. This confirms that the effectiveness of such masks relies upon a tight fit, and this may be hard for many people to achieve.
- We also tested the filtration efficiency of three homemade cloth coverings made following instructions on the CDC website. We made one from a cotton dress, one from a cotton sweater, and the third from polyester cloth. All three were worn in a normal mode on the silicone head form as directed by the CDC. The filtration efficiency of the cotton homemade cloth coverings in normal use was 55 percent, while the polyester covering came in at near 40 percent—about the same as loosely fitted medical-grade masks. This suggests that homemade cotton masks might actually work better than loosely fitted disposable masks, while polyester might be about the same.
- We heated up the homemade masks for disinfection, which appeared to not affect the filtration efficiency. The CDC recommends washing and drying such coverings at home and we anticipate negligible effects on efficiency from this as well. When disinfecting your masks at home, we recommend you to place masks in an oven bag or a pressure cooker during heating, rather than directly put masks inside of the oven.
- Finally, to see if we could improve the fit for the public, we designed a process that uses heat-moldable plastic strips to make homemade customized nose clips molded to an individual’s face. By adding the customized nose clip to a normally worn disposable mask on a silicone head form, the filtration efficiency of the 3M N95 returned to greater than 95 percent, and the filtration efficiency of the surgical masks was measured at 88 percent. The nose clips passed two five-hour wearing tests for comfort. But due to the use of heat moldable plastic, the customized nose clips cannot be disinfected with heat; rather, they must be disinfected by soaking in solutions of alcohol or bleach.
- This work has certain limitations. For one, our tests were all done under static conditions at a constant flow rate of air similar to how an adult breathes when sitting. We did not take into account the increase in breathing, nor the reduction in fit that can occur when someone is talking or active.
- Our study is just one of many looking into how masks may be disinfected and reused. Others have been carried out or are in progress using not only heat, but ultraviolet light, vaporized hydrogen peroxide, or soaking in ethyl alcohol or bleach solutions. Most of these are aimed at medical personnel using specialized equipment. The soaking methods have been shown to reduce the effectiveness of certain types of N95 masks. Ours is a relatively modest effort aimed at everyday usage. Far more work needs to be done, but everything we know so far suggests that wearing almost any kind of mask in public is better than nothing; that a tight fit is best; and that, with certain limits, many types of masks can be reused outside of medical settings.