As always, a reminder that I am not a medical doctor. I know a few, and they are all awesome! I know some nurses, too. They are great. Everyone should give a digital hug (not a real one) to any medical professionals you know. They are the heroes in all of this.
I am not one. Nor am I a healthcare professional of any kind.
These updates are my way of helping everyone sift through the riff-raff. My goal with these posts is to pass along relevant information from the medical community – direct from the source – with some translation into regular English.
A couple of stats before we begin
As of March 13th at 5pm (the CDC doesn’t update their website on the weekend):
Total United States cases: 1,629
— Travel-related: 138
— Close contact: 129
— Under investigation: 1,362
Total deaths: 41
States reporting cases: 46 states and District of Columbia
(Numbers pulled from other reliable resources) Total United States cases reported by other medical sites:
Johns Hopkins:
Total cases: 3,499
Total deaths: 63
Total recovered: 12
Across the World
Total cases: ~153,000
Total deaths: ~5,700
And growth of infections continues to rise.
Vaccine in the works, but don’t get excited
There were many headlines Sunday night about clinical trials for a vaccine against Coronavirus. I’ve done some digging for anything from federal websites and I couldn’t find any. That doesn’t mean it isn’t happening, but there are no press releases of official documentation.
But before you get too excited, clinical trials are a long way from a workable, useful, and successful vaccine.
From the medical community… on Twitter
There was a great thread of Tweets from a medical doctors about how the Coronavirus works and what it does to the human body. Not just symptoms, but literally how it changes your body on the inside. I highly recommend reading it.
Since my Harvard lab closed yesterday, I've been reading and interpreting this week's published papers on #COVID19. What follows is a thread of information, my interpretation, links to sources & predictions. Let's start with what you need to know… #coronavirus #COVIDー19
— David Sinclair, PhD AO (@davidasinclair) March 14, 2020
You can read the entire thread of posts here.
In short, Sinclair says that, “n lung, CoV2 prevents cells from making biological detergents to keep lung passages open. Acute respiratory distress follows. O2 levels fall” and “CoV genes 1 & 8 are predicted to interfere with heme, the red compound in blood, by kicking out the iron.” meaning “diabetics and elderly are more susceptible. Blood sugar levels usually increase as we get older, increasing the amount of glycated hemoglobin” thus “it destroys the lung so patients can’t take up oxygen AND reduces the body’s ability to carry oxygen.”
This is one doctors read of things. But he isn’t just making stuff up. He cited medical research papers to back up his tweets.
Blood, HbA1c, and chloroquinehttps://t.co/Bpac6gcR4W
CoV2 mutationshttps://t.co/a7DZHUhs0E
Symptoms https://t.co/c5MlxZSUW6
Susceptibility/Riskhttps://t.co/54ejW9kfGn
Fatalityhttps://t.co/kmCMEU9Y6K
Therapieshttps://t.co/h2bTQqJecS
Remdesivirhttps://t.co/o4VVQ4QeMX
☮️— David Sinclair, PhD AO (@davidasinclair) March 14, 2020
New from the CDC
The Centers for Disease Control issued new, strongly-worded, guidance for people to avoid large gatherings for the next eight weeks.
Guidance as of 3/15/2020
Large events and mass gatherings can contribute to the spread of COVID-19 in the United States via travelers who attend these events and introduce the virus to new communities. Examples of large events and mass gatherings include conferences, festivals, parades, concerts, sporting events, weddings, and other types of assemblies. These events can be planned not only by organizations and communities but also by individuals.
Therefore, CDC, in accordance with its guidance for large events and mass gatherings, recommends that for the next 8 weeks, organizers (whether groups or individuals) cancel or postpone in-person events that consist of 50 people or more throughout the United States.
Events of any size should only be continued if they can be carried out with adherence to guidelines for protecting vulnerable populations, hand hygiene, and social distancing. When feasible, organizers could modify events to be virtual.
This recommendation does not apply to the day to day operation of organizations such as schools, institutes of higher learning, or businesses. This recommendation is made in an attempt to reduce introduction of the virus into new communities and to slow the spread of infection in communities already affected by the virus. This recommendation is not intended to supersede the advice of local public health officials.
That means through Monday, May 10th. It likely means that sports will be ‘off the docket’ till then, too. And then teams need to get facilities in order, etc. So sports may not return until late May. At the earliest.
CDC reminds “at risk” people to take extra steps
The CDC warned people who are at a higher risk to take extra steps to be prepared for the coming weeks. Not because they are more likely to get infected, but rahter if infected, the symptoms can be more dire. The CDC recommends to take actions to reduce the risk of getting sick.
Take everyday precautions to keep space between yourself and others
When you go out in public, keep away from others who are sick, limit close contact and wash your hands often
Avoid crowds as much as possible
Avoid non-essential commercial travel
During a COVID-19 outbreak in your community, stay home as much as possible to further reduce your risk of being exposed.
Stock up on supplies now in preparation
Contact your healthcare provider to ask about obtaining extra necessary medications
Be sure you have over-the-counter medicines and medical supplies
Have enough household items and groceries (have enough to last a few days, up to one week)
Who else is “at risk” of serious illness?
On their site, the Kaiser Family Foundation notes a couple of points of interest:
— 4-out-of-10 adults 18-years and older is “at risk” (they suggest 105.5 million people)
— More than 70-percent are 60-and-older and 30-percent ages 18-59 with an underlying medical condition.
— KFF estimates 5.7 million of the “at risk” adults are uninsured, including “3.9 million adults under age 60 and 1.8 million who are ages 60-64”
That is pretty eye-opening. The KFF also broke down things by state.
You can find the interactive version of that map, here.
KFF notes:
… a large segment of the U.S. adult population – 41 percent of adults ages 18 and older – have a higher risk of serious illness if they do become infected due to their age or underlying medical condition. One group particularly at risk are the 1.3 million people living in nursing homes in the US. As the number of people who test positive for coronavirus continues to rise, and as more is learned about the progression of illness and treatment among those who become seriously ill, the current set of risk factors available to estimate the size of the at-risk population is likely to be refined.
New research
A new not-yet-peer-reviewed paper out, titled, “Temperature and latitude analysis to predict potential spread and seasonality for COVID-19” is trying to find a link between the climate and the spread of Coronavirus.
The researchers found that the average temperature in places with similar outbreaks fell between 41F and 51F degrees with a Relative Humidity between 47-percent and 79-percent.
Researchers note:
Temperature and humidity are also known factors in SARS-CoV, MERS-CoV and influenza survival. Furthermore, new outbreaks occurred during periods of prolonged time at these temperatures, perhaps pointing to increased risk of outbreaks with prolonged conditions in this range. Besides potentially prolonging half-life and viability of the virus, other potential mechanisms associated with cold temperature and low humidity include stabilization of the droplet and enhanced propagation in nasal mucosa, as has been demonstrated with other respiratory viruses.
Before you get too excited, though, there is direct evidence to contradict this research in the southeast where the spread is happening pretty quickly in places like Florida, south Alabama, Mississippi and Louisiana. While perhaps not at the same pace as New York, Italy or Washington State, it is still spreading with some speed.
Researchers noted that as the Northern Hemisphere warms as we move into Spring, the area of concern for greatest infections will shift north. While this paper is not yet peer-reviewed, the authors did note that this is a testable hypothesis and encouraged others to examine the data and run experiments. The researchers did note, though, that while in the Northern Hemisphere the 41F to 51F range would be shrinking, it would also be growing in the Southern Hemisphere.
Another new research paper, “Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study” released a few days ago looked at the timeline for infections (and deaths) in people with Coronavirus.
I did not get a chance to read the full study, but it is summarized well by the WHO:
The study involved 191 hospitalized COVID-19 patients (54 deaths, 137 discharged) in Wuhan, China. Notably, the study describes the timing of various aspects of disease progression in hospitalized patients, including the time from first symptom onset to the onset of various symptoms/conditions, including dyspnoea, sepsis, and ARDS as well as their duration. The article also reports the time to and duration of ICU admission. The study found an increase in the odds of death with increased age, and the mean duration of viral shedding was 20 days from symptom onset in survivors and continuously until death in non-survivors (maximum duration: 37 days). The study found no evidence that antiviral treatment reduces the duration of viral shedding.
This study, as it says, found no evidence that any treatment helped people infected deal with or fight the virus.
Another new study that is not-yet-peer-reviewed, “Virtual Screening Based Prediction of Potential Drugs for COVID-19” looks as the genomic sequence of the Coronavirus responsible for COVID-19, as well as the experimentally-determined three dimensional structure of the Main protease. In the abstract, the authoss write, “The reported structure of the target Mpro was utilized in this study to identify potential drugs for COVID-19 using molecular docking based virtual screening. The results of this study confirm earlier preliminary reports based on studies of homologs that some of the drugs approved for treatment of other viral infections also have the potential for treatment of COVID-19.”
In the paper, the authors note that, “Saquinavir and Beclabuvir were identified as the best candidates for COVID-19 therapy based on virtual high throughput screening of clinically approved drugs and the structure of SARS-CoV-2 Mpro determined from X-ray diffraction data. The results of this study also rationalize the limited data regarding effectiveness of drugs for COVID-19 therapy, and provide information that can be utilized for choice of candidate drugs for in vitro studies and in vivo studies. ”
A different research papers, titled, “COVID-19: combining antiviral and anti-inflammatory treatments” looks to Artificial Intelligence to find a combination of drugs that may be effective against he virus. Sadly,
Three different papers, three different outcomes. What does this all mean? Is there a vaccine or drug to protect us?
No. Not yet. But this is a start.
It means that other researchers can now look at this information and run their own experiments and test to se if they can confirm or dispute the findings. But this is how science works and how treatments are developed. Piece by piece, step by step. It is usually a long process. That is why, despite what some politicians have said, there isn’t likely going to be a vaccine or treatment “by April.”
Other research on viral spread
It turns out, that according to researchers in the New England Journal of Medicine, the average person with Coronavirus “spreads the disease to two or three others — an exponential rate of increase” and there is some evidence that is can be “transmitted by people who are just mildly ill or even presymptomatic.”
That could be a problem for those who are trying to avoid becoming sick. As people may be walking around, infected, and infecting others, before they are even aware they are infected. This could become an even bigger issued for folks who are “at risk” as it can take five to 14 days for symptoms to develop, according to research by Johns Hopkins.
This is why social distancing is also such a big deal.
From the Mayo Clinic
Did you know that this new Coronavirus is in the same family as the common cold and Ebola? The Mayo Clinic’s Dr. Joseph Sirven explains…
Dr. Sirven recommends practicing good respiratory etiquette, as well as being more vigilant about hand hygiene, and sanitizing surfaces around your home and workspace.
What does Coronavirus do to people
The coronavirus is very contagious. And only causes symptoms of a fever and cough for most people. That may be the biggest concern for people. It seems innocuous until it is deadly. And it spreads quickly within an infected community.
Here is a snippet from a research paper from Ying Liu, Albert A Gayle, Annelies Wilder-Smith, and Joacim Rocklöv in the Journal of Travel Medicine:
[transmission] estimates for SARS have been reported to range between 2 and 5, which is within the range of the mean [transmission] for COVID-19 found in this review. Due to similarities of both pathogen and region of exposure, this is expected. On the other hand, despite the heightened public awareness and impressively strong interventional response, the COVID-19 is already more widespread than SARS, indicating it may be more transmissible
For the medical community, they are also focused on identifying the symptoms and how to resolve them.
Currently, the medical community says symptoms are fever and cough, “which frequently lead to lower respiratory tract disease with poor clinical outcomes” for people who are older or have pre-existing health conditions. And diagnosis can only be made based on the symptoms, the history of exposure, as well as chest imaging.
That means if you have a runny nose and headache, it is less likely to be coronavirus. If you have a stuffy nose and clogged up sinuses, it is less likely to be coronavirus.
And if you have not been to China or been exposed to someone who has been to China is it unlikely you have Coronavirus.
Are facemasks a good idea
This is straight from the CDC:
CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory illnesses, including COVID-19. You should only wear a mask if a healthcare professional recommends it. A facemask should be used by people who have COVID-19 and are showing symptoms. This is to protect others from the risk of getting infected. The use of facemasks also is crucial for health workers and other people who are taking care of someone infected with COVID-19 in close settings (at home or in a health care facility).
Things to do right now
As the meme says: Keep Calm & Carry On. There is no evidence to suggest, within the research nor from government officials, that buying supplies to survive in complete isolation will be necessary. While I understand that it may be a bit late to spread that message, it is an important one to repeat.
Even if you are asked to self-quarantine, it doesn’t mean that, as a society, you will be left to fend for yourself. In America, we help our neighbors and look after those who need assistance. I would find it highly unlikely, and close to impossible, that society would break down to the point where it was a “Every Man For Himself!” situation.
If you want to “stock up” on items, that is fine. The CDC even encouraged it for those who are “at risk” a few days ago. But treat it like a Hurricane Kit or an Earthquake kit. While you won’t need a flashlight or a whistle, other items may be useful. Things like some extra water, non-perishable foods, medicicines, hand soap, etc.
But, given what the government officials are suggesting, the rush to buy toilet paper and hand sanitizer may prove to be unnecessary.
For now, simply keep tabs on the news with Coronavirus. Continue to wash your hands – just like you would do to combat the spread of the common cold or the regular flu – and avoid touching your face. Try to practice social distancing by keeping six-feet between you and others around you when in a public space.
That is the great thing about the virus, it is totally beatable with a few easy steps!
And be aware that the biggest concern is for those with compromised immune systems and people over 60. So if you have those people in your house or in your life, take extra steps to make sure you don’t accidentally pass along the virus to them.
The other thing to do is to keep this potential outbreak in perspective. While, yes it is dangerous to those infected, and yes there is the potential that it could spread through the United States, at this time the best thing to do is remain calm and do what you would normally do to fight against the regular flu. Plus limiting contact with others to suppress the spread of the virus.
And, as a reminder, the regular flu is still out there, too. This isn’t comparative suffering. Both are bad. The flu has sent 21,000,000 people to the doctor and – according to the CDC – is responsible for up to 46,000 deaths. So protect yourself from the regular flu, too.
