As always, a reminder that I am not a medical doctor. I know a few, and they are all awesome! But 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.
Latest Numbers
Total United States cases: 7,038
— Travel-related: 269
— Close contact: 276
— Under investigation: 6,493
Total deaths: 97
States reporting cases: 50 states, District of Columbia, Puerto Rico, Guam, and US Virgin Islands
(Numbers pulled from other reliable resources) Total United States cases reported by other medical sites:
Johns Hopkins:
Total cases: 7,324
Total deaths: 115
Total recovered: 17 (newer numbers unavailable)
Regional Numbers:
Mississippi: 34
Louisiana: 240
Arkansas: 22
Tennessee: 73
Alabama: 46
Quick notes
I’m still trying to track down any research information regarding the long-term lung damage that was shown in a few patients in China. I wrote about that the other day. I can’t find any published research to support the claim made by the doctor of that hospital. That isn’t to say he was wrong, but rather, those types of long-term effects may not be frequent enough to be researched (yet). Until I see some research, or a larger portion of the medical community report it, I’m going to remain optimistic that it was a problem specific to those few patients.
I’ve talked to two friends of mine that work in hospitals. One is an ER doctor the other is an ICU nurse. Both on the West Coast. They have been working 12+ hour days, with no days off, trying their best to stay healthy (for both their own sake, and their family’s). They don’t sleep well, they are on-call when they are sleeping and it is all-hands-on-deck.
If you know ANY medical professionals that work in a setting where they are dealing with this thing directly, call them. Text them. Give them words of encouragement. They need our strength.
In Italy
A lot of researchers and medical professionals have been looking at Italy as a comparison model for the United States. Despite what you may have read on facebook about how it is “good news” that people are dying in Italy because they are “all older people” in the country, it is a good comparison for the United States.
The Italian National Institute of Health’s daily update for March 17 reports 28,293 cases (3,235 new), including 2,629 healthcare workers (290 new), and 2,003 deaths (306 new) nationwide.
The ‘Elephant in the room’ of sorts
Okay. So. If you had a chance to see the Imperial College projection floating around social media or on the national news, you know it seems pretty grim. If you don’t know what I’m talking about, let me give a brief synopsis:
A research team out of the UK ran a ‘global pandemic model’ (a lot like our weather models) to predict the number of cases that would eventually develop and – sorry, there is no nice way to say this – how many people will die. They then plotted this on a graph (like spaghetti plots with hurricanes) to try to help explain where this COVID19 thing is going.
And it was grim. But the findings are still being discussed and disputed by other research teams, mathematicians and scientists.
The Imperial College research team said that we continue to live life as we normally live it that nearly 3/4 of America would get the virus and about 4-million people would die. Of those deaths, it would include about 10-percent of the population over 70.
When I tell you that reading that broke my heart. Words do not do that justice.
If we restrict movements, and wash hands, practice social distancing still leaves us with 2-million deaths.
If we do all of that, and go into lockdown like Italy and China: a few thousand deaths.
That is still heart-breaking.
— Now for the part that is under the greatest scrutiny —
The Imperial College team argued that if the restrictions were lifted – at any time – before a vaccine was found that we would be right back in the same boat that we are right now with a massively quick spread and potential deaths.
This is under such dispute that a researchers already published a rebuttal, “REVIEW OF FERGUSON ET AL “IMPACT OF NON-PHARMACEUTICAL INTERVENTIONS…”
They write:
[Imperial College] make structural mistakes in analyzing outbreak response. They ignore standard Contact Tracing [2] allowing isolation of infected prior to symptoms. They also ignore door-to-door monitoring to identify cases with symptoms [3]. Their conclusions that there will be resurgent outbreaks are wrong. After a few weeks of lockdown almost all infectious people are identified and their contacts are isolated prior to symptoms and cannot infect others [4]. The outbreak can be stopped completely with no resurgence as in China, where new cases were down to one yesterday, after excluding imported international travelers that are quarantined.
Now, scientists as a whole rarely agree on stuff. So direct wording like this isn’t uncommon. As an aside, this is why when you hear that 95-percent of scientists agree Climate Change is a thing, it means something.
The authors of this rebuttal go on to write that given other research (like what is touched on below) that suggests that you need a certain number of infected people in the community not just a certain percentage, and that once a person is no longer sick – the virus is “dead” in so many words – that person can no longer pass the virus along.
According to what I’ve read, it looks like (A lot like weather models) projections with epidemics are difficult because they include a lot of assumptions and can be susceptible to errors and “math gone wild” where things can look worse (or better) than things actually are.
Sort of like those spaghetti models and hurricanes.
The take home point from this “Elephant in the room” is to take the necessary steps to protect you and your family from this virus and follow the CDC guidelines. But, try not get too worried about one study showing one thing. A lot like we try to say “don’t get worried about the one spagheti line that takes the hurricane to South Mississippi.”
How fast does it spread?
Fast. COVID19 has an R0 value of between 2 and 3. That means for every one person that has it, that person can spread it to someone else. For reference, the regular flu R0 value is a 1.3, meaning you pass the flu on to one other person.
The higher R0 value creates the possibility for exponential growth. But, only under the right conditions as highlighted by a published paper titled, “Early dynamics of transmission and control of COVID-19: a mathematical modelling study.”
Even if the reproduction number is as high as in Wuhan in early January, it could take several introductions for an outbreak to establish, because high individual-level variation in transmission makes new chains of transmission more fragile, and hence it becomes less likely that a single infection will generate an outbreak. This factor highlights the importance of rapid case identification and subsequent isolation and other control measures to reduce the chance of onward chains of transmission.
We estimated that the median daily reproduction number (Rt) in Wuhan declined from 2·35 (95% CI 1·15-4·77) 1 week before travel restrictions were introduced on Jan 23, 2020, to 1·05 (0·41-2·39) 1 week after. Based on our estimates of Rt, assuming SARS-like variation, we calculated that in locations with similar transmission potential to Wuhan in early January, once there are at least four independently introduced cases, there is a more than 50% chance the infection will establish within that population.
The take-away from that is that four independentncases in a population show a 50-50 chance it will become established. That may feel scary. However, the researchers also found that once restrictions were in place – and followed – it trimmed the transmission rate down to below the regular flu.
But the restrictions – self isolation, social distancing, etc – are pretty strict. And it remains to be seen if the United STates will implement such restrictions.
Incubation period
If this is your first time here, Johns Hopkins was involved in a research paper titled, “The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application” that found the incubation period for Coronavirus to be about five days.
The results of the research found that 5.1 days was the average time of incubation and around 97-percent of those who develop symptoms will do so within about 11 days. On top of that, researchers noted that only 101 out of every 10,000 cases will develop symptoms after 14 days.
Researchers did note that the available data may have been skewed as severe cases may be over-represented in the data. That means, the incubation period may be different for mild cases. Perhaps longer. Perhaps shorter. That is unknown.
Plus, the transmission rate and resulting problem was discussed by another recent paper, “From Containment to Mitigation of COVID-19 in the US,” where the authors wrote:
Eighty percent of patients infected with SARS-CoV-2 have minimal or mild symptoms.2 Combining these characteristics and the emergence of community transmission, it is likely that silent spread has already occurred in multiple US locales. As a result, COVID-19 containment is no longer realistic and further emphasis on containment strategies may have the unintended consequence of hampering effective health care delivery for patients infected with COVID-19 and others who require general hospital care.
More research has noted that the virus can be spread when people are pre-symptomatic. That means even if you feel fine today, but were in contact with someone who was infected yesterday, you may also have the virus. And you would be able to spread it to others.
From the Annals of Internal Medicine
Annals On Call – Understanding the Spread of COVID-19: Dr. Centor discusses the epidemiology of the novel coronavirus responsible for COVID-19 with Dr. David Fisman of the University of Toronto.
From the CDC
If you run a business – of any size – the CDC is encouraging businesses to make some changes.
— Actively encourage sick employees to stay home
– Encourage people who are sick to stay home until they are fever-free (without the use of medicine) and are also symptom-free for at least 24 hours.
– Ensure that your sick leave policies are flexible and consistent with public health guidance and that employees are aware of these policies.
– Work with other companies that provide your business with contract or temporary employees
– Do not require a healthcare provider’s note for employees who are sick with acute respiratory illness to validate their illness or to return to work, as healthcare provider offices and medical facilities may be extremely busy and not able to provide such documentation in a timely way.
– Employers should maintain flexible policies that permit employees to stay home to care for a sick family member. Employers should be aware that more employees may need to stay at home to care for sick children or other sick family members than is usual.
— Perform routine environmental cleaning
– Routinely clean all frequently touched surfaces in the workplace, such as workstations, countertops, and doorknobs. And note that, according to the CDC, “no additional disinfection beyond routine cleaning” is recommended at this time.
– Provide disposable wipes so that commonly used surfaces (for example, doorknobs, keyboards, remote controls, desks) can be wiped down by employees before each use.
— Notes for those who travel for business
– Don’t travel is you are sick.
– Check the CDC’s Traveler’s Health Notices for the latest guidance and recommendations for each country to which you will travel. Check each state department of health website if you’re traveling to another state.
— Additional Measures in Response to Currently Occurring Sporadic Importations of the COVID-19
– Employees who are well but who have a sick family member at home with COVID-19 should notify their supervisor and refer to CDC guidance for how to conduct a risk assessment of their potential exposure.
– If an employee is confirmed to have COVID-19, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA). Employees exposed to a co-worker with confirmed COVID-19 should refer to CDC guidance for how to conduct a risk assessment of their potential exposure.
The WHO COVID-19 Situation Report for March 17 reported 179,112 confirmed COVID-19 cases and 7,426 deaths across 160 countries/territories/areas, an increase of 11,526 cases, 475 deaths, and 8 countries from the previous day. The new data from the WHO shows yesterday was the first day where – globally – the numbers didn’t increase at a faster rate than the previous day. That is good news. However, obviously, there were still more cases reported. If you are in an area where there are cases of COVID-19 you need to take the risk of infection seriously. Follow the advice of WHO and guidance issued by national and local health authorities. For most people, COVID-19 infection will cause mild illness however, it can make some people very ill and, in some people, it can be fatal. Older people, and those with pre-existing medical conditions (such as cardiovascular disease, chronic respiratory disease or diabetes) are at risk for more severe symptoms. I know. It can seem overwhelming with the amount of information and updates flying around. But I think it is best to follow the CDC’s guidance at this point. — Know where to get your local / state-level information If you live in a state outside of the region, head to google and type in, “dept of health” followed by whatever state you live. Google should take you to that state’s department of health and on the main page, most states have a link to an update on the Coronavirus. — Know the Symptoms Also recognize that body aches, weak stomach, nasal congestion, a sore throat, and other symptoms of the regular flu are not the same as the symptoms with Coronavirus. — Stay home when you are sick — Know if you are at a higher risk — Take steps to mitigate your infection — Create a Household Plan
What should I do, right now?
For Mississippi: https://msdh.ms.gov/msdhsite/_static/14,0,420.html
For Louisiana: http://ldh.la.gov/Coronavirus/
For Alabama: http://www.alabamapublichealth.gov/infectiousdiseases/2019-coronavirus.html
Look for things like a fever, dry cough, and shortness of breath. But also know when it may become an emergency. It becomes an emergency when you have difficulty breathing, a persistent pain or pressure in the chest, you develop general confusion, and if you develop bluish lips or face.
Any kind of sick. If you feel like you may have Coronavirus, call your health care provider’s office in advance of a visit. If you have any sickness, the CDC recommends to limit movement in the community, limit visitors, and practice good social distancing.
Know what additional measures those at higher risk and who are vulnerable should take. Those at higher risk include older adults (over 60), people who have serious chronic medical conditions (like heart disease, diabetes, lung disease). Some research has indicated that people with asthma may also be included in the higher risk category.
The CDC recommends to “Implement steps to prevent illness” by washing high-traffic areas more often, washing hands with soap and water and if someone is sick, to isolate the sick person into a low-traffic area of the home.
Create a household plan of action in case of illness in the household or disruption of daily activities due to COVID-19 in the community.
