Quick reminder, like always, that I am not a doctor. I am not an expert in any medical field. Nor should you infer from these posts that I think of myself as one. I am not. At all. These updates are my way of helping everyone sift through the riff-raff with some translation into regular English.
I know there is a lot of stuff floating around – especially on the cable news networks and social media – and my goal here is to cut through the junk and offer some insight into the science of what is going on and relay some guidance from the medical professionals.
Also, in the case, be warned: There are no pictures and a whole lotta text. But this is good info.
The latest statistics
Here are a few numbers from some of the reputable sites collecting and releasing data….
CDC & WHO Numbers
Total Worldwide Cases: 332,218
Total Worldwide Deaths: 14,510
Total United States cases: 33,404
— Travel-related: 449
— Close contact: 539
— Under investigation: 32,416
Total deaths: 400
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 Worldwide Cases: 395,647
Total US cases: 46,485
Total US deaths: 591
Total US recovered: 178 (or more, new data not available this morning)
Regional Numbers
Louisiana: 1,172
Arkansas: 206
Tennessee: 615
Mississippi: 320
Alabama: 196
From the Mayo Clinic
The May Clinic released another podcast.
In it, two things that are important, and really stick out. The FDA approved the use of a machine that can test people in about an hour. And that machine will be available to distribute later this week. And, one of the symptoms – not originally included – within a small group of people being monitored was diarrhea. And, according to the doctor in the podcast, diarrhea was an indicator of a more severe infection. This happens in about 3-to-10 percent of people who are infected. But the study is still being peer reviewed.
New from the CDC
The CDC came out with new guidance for owners, administrators, operators, workers, volunteers, visitors, and residents of retirement communities and ILF.
Residents can follow the recommendations for persons at higher-risk of COVID-19 to protect themselves and others:
- Clean your hands often
- Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing, or having been in a public place/common area.
- If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
- To the extent possible, avoid touching high-touch surfaces in public places – elevator buttons, door handles, handrails, handshaking with people, etc. Use a tissue or your sleeve to cover your hand or finger if you must touch something.
- Wash your hands after touching surfaces in public places.
- Avoid touching your face, nose, and eyes.
Additionally, they can avoid close contact:
- Stay in your homes or outdoors away from groups of people, as much as possible.
- Limit visitors to persons essential to maintaining their health, well-being, and safety. Social interaction is important; however, in-person social interactions are associated with increased risk of infection.
- Learn and practice alternative ways to interact, including replacing in-person group interactions with video or telephone calls.
- Learn more about managing stress and anxiety during COVID-19.
Establish a “buddy” system to ensure they stay connected.
Residents can seek out a “buddy” who will regularly check on them (using preferably non-face-to-face communication) and help care for them if they get sick. This person cannot be a person who is at higher risk of complications if they become ill with COVID-19.
Ensure continuity of the regular care and medical services they receive.
Residents can work with their primary caretakers to identify alternative caretakers to ensure continuity of care should there be any interruptions to the regular services they receive. Telemedicine services may be available to them. They can work with their medical providers to determine if any elective procedures or non-emergent services can be delayed without negatively impacting their health. They can ask their medical providers if they have a formal “telehealth” system for their regular appointments and, if not, ask if they can still communicate by telephone (instead of visits) to reduce the number of face-to-face interactions.
Have medication and supplies on hand.
Residents may want to consult with their healthcare providers and, if possible, plan to keep an extra supply of their regular prescriptions. Mail-order medications also could be considered as an alternative for those unable to get longer supplies of medication. They can ensure that they have an adequate supply of food and everyday essentials in their homes should a disruption occur for an extended period.
Keep their homes clean and disinfected.
It is important that residents keep their homes clean and disinfected by following these instructions. If they become ill or if they are caring for someone who is ill, they can follow the guidance found here.
The CDC also posted some guides for parents during this difficult time.
Stay in touch with your child’s school.
— Many schools are offering lessons online (virtual learning). Review assignments from the school, and help your child establish a reasonable pace for completing the work. You may need to assist your child with turning on devices, reading instructions, and typing answers.
— Communicate challenges to your school. If you face technology or connectivity issues, or if your child is having a hard time completing assignments, let the school know.
— Create a schedule and routine for learning at home, but remain flexible.Have consistent bedtimes and get up at the same time, Monday through Friday.
— Structure the day for learning, free time, healthy meals and snacks, and physical activity.
— Allow flexibility in the schedule—it’s okay to adapt based on your day.
— Consider the needs and adjustment required for your child’s age group.
— The transition to being at home will be different for preschoolers, K-5, middle school students, and high school students. Talk to your child about expectations and how they are adjusting to being at home versus at school.
— Consider ways your child can stay connected with their friends without spending time in person.
— Look for ways to make learning fun.Have hands-on activities, like puzzles, painting, drawing, and making things.
— Independent play can also be used in place of structured learning. Encourage children to build a fort from sheets or practice counting by stacking blocks.
— Practice handwriting and grammar by writing letters to family members. This is a great way to connect and limit face-to-face contact.
— Start a journal with your child to document this time and discuss the shared experience.
— Use audiobooks or see if your local library is hosting virtual or live-streamed reading events.Watch for signs of stress in your child.
— Some common changes to watch for include excessive worry or sadness, unhealthy eating or sleeping habits, and difficulty with attention and concentration. For more information, see the “For Parents” section on CDC’s website, Manage Anxiety and Stress.
— Take time to talk with your child or teen about the COVID-19 outbreak. Answer questions and share facts about COVID-19 in a way that your child or teen can understand.
— Go to CDC’s Helping Children Cope with Emergencies or Talking with Children About COVID-19 for more information.
Even more from the CDC about treatments
They have been busy! I want to pass along information pulled directly – I’m literally copy and pasting – from the CDC. I want there to be no confusion that I, Nick Lilja, did not do this research or collect this data. The CDC did. They are the experts. They have the access to the doctors and researchers. And it is very, very important that we listen to them.
Remdesivir
Remdesivir is an investigational intravenous drug with broad antiviral activity that inhibits viral replication through premature termination of RNA transcription and has in-vitro activity against SARS-CoV-2 and in-vitro and in-vivo activity against related betacoronaviruses [1-3].
There are currently four options for obtaining remdesivir for treatment of hospitalized patients with COVID-19 and pneumonia in the United States:
- A National Institutes of Health (NIH)-sponsored adaptive double-blinded, placebo-controlled trial of remdesivir versus placebo in COVID-19 patients with pneumonia and hypoxia is enrolling non-pregnant persons aged 18 years and older with oxygen saturation of ≤94% on room air or requiring supplemental oxygen or mechanical ventilation (https://clinicaltrials.gov/ct2/show/NCT04280705external icon). Exclusion criteria include alanine aminotransaminase or aspartate aminotransaminase levels >5 times the upper limit of normal, stage 4 severe chronic kidney disease or a requirement for dialysis (i.e., estimated glomerular filtration rate (eGFR) <30);
- Two phase 3 randomized open-label trials of remdesivir (5-days versus 10-days versus standard of care) are open to enrollment in persons aged 18 years and older with COVID-19, radiographic evidence of pneumonia and oxygen saturation of ≤94% on room air (severe disease https://clinicaltrials.gov/ct2/show/NCT04292899external icon) or >94% on room air (moderate disease https://clinicaltrials.gov/ct2/show/NCT04292730external icon). Exclusion criteria include alanine aminotransaminase or aspartate aminotransaminase levels >5 times the upper limit of normal, participation in another clinical trial of an experimental treatment for COVID-19, requirement for mechanical ventilation, or creatinine clearance <50 mL/min; and
- Finally, in areas without clinical trials, COVID-19 patients in the United States and other countries have been treated with remdesivir on an uncontrolled compassionate use basis. The manufacturer is currently transitioning the provision of emergency access to remdesivir from individual compassionate use requests to an expanded access program. The expanded access program for the United States is under rapid development. Further information is available at: https://rdvcu.gilead.com/external icon
Hydroxychloroquine and Chloroquine
Hydroxychloroquine and chloroquine are oral prescription drugs that have been used for treatment of malaria and certain inflammatory conditions. Chloroquine has been used for malaria treatment and chemoprophylaxis, and hydroxychloroquine is used for treatment of rheumatoid arthritis, systemic lupus erythematosus and porphyria cutanea tarda. Both drugs have in-vitro activity against SARS-CoV, SARS-CoV-2, and other coronaviruses, with hydroxychloroquine having relatively higher potency against SARS-CoV-2 [1,4,5]. A study in China reported that chloroquine treatment of COVID-19 patients had clinical and virologic benefit versus a comparison group, and chloroquine was added as a recommended antiviral for treatment of COVID-19 in China [6]. Based upon limited in-vitro and anecdotal data, chloroquine or hydroxychloroquine are currently recommended for treatment of hospitalized COVID-19 patients in several countries. Both chloroquine and hydroxychloroquine have known safety profiles with the main concerns being cardiotoxicity (prolonged QT syndrome) with prolonged use in patients with hepatic or renal dysfunction and immunosuppression but have been reportedly well-tolerated in COVID-19 patients.
Due to higher in-vitro activity against SARS-CoV-2 and its wider availability in the United States compared with chloroquine, hydroxychloroquine has been administered to hospitalized COVID-19 patients on an uncontrolled basis in multiple countries, including in the United States. One small study reported that hydroxychloroquine alone or in combination with azithromycin reduced detection of SARS-CoV-2 RNA in upper respiratory tract specimens compared with a non-randomized control group but did not assess clinical benefit [7]. Hydroxychloroquine and azithromycin are associated with QT prolongation and caution is advised when considering these drugs in patients with chronic medical conditions (e.g. renal failure, hepatic disease) or who are receiving medications that might interact to cause arrythmias.
Hydroxychloroquine is currently under investigation in clinical trials for pre-exposure or post-exposure prophylaxis of SARS-CoV-2 infection, and treatment of patients with mild, moderate, and severe COVID-19. In the United States, several clinical trials of hydroxychloroquine for prophylaxis or treatment of SARS-CoV-2 infection are planned or will be enrolling soon. More information on trials can be found at: https://clinicaltrials.gov/external icon.
There are no currently available data from Randomized Clinical Trials (RCTs) to inform clinical guidance on the use, dosing, or duration of hydroxychloroquine for prophylaxis or treatment of SARS-CoV-2 infection. Although optimal dosing and duration of hydroxychloroquine for treatment of COVID-19 are unknown, some U.S. clinicians have reported anecdotally different hydroxychloroquine dosing such as: 400mg BID on day one, then daily for 5 days; 400 mg BID on day one, then 200mg BID for 4 days; 600 mg BID on day one, then 400mg daily on days 2-5.
Any drugs or treatments that are discussed by any medical outlet need to be prescribed and monitored during treatment by medical professionals. I saw the report that two people ended up trying to take some of these drugs because they had them on-hand (not sure why) and it killed one of them and the other is still in the hospital. It is an awful story. And I would really prefer it not be repeated.
Also of note, these drugs are treatments, not vaccines. These will not prevent people from getting sick, but simply make the symptoms of the sickness more bearable.
Things you should be doing now
I know this can all seem overwhelming at times. The sheer amount of information being kicked out by every media outlets is like an avalanche.
So, here are some things: Stay home if you can! Gotta work? That’s understandable. Need food? Sure, head to the store. But try to skip any “for fun” activities in public where you would be interacting with others or in a place with multiple other people.
Some CDC’s guidance:
— Know where to get your local / state-level information
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
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
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. 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
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 if you are at a higher risk
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.
— Take steps to mitigate your infection
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
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.
