7/15/20 COVID Update: New numbers, new research, vaccine shows promise

I’m still not a doctor. Thankfully, I don’t need to be one for these updates. As I’m not here to give any medical opinion what-so-ever. This is a collection of medical opinions from those within the medical community. All I’m here to do is re-package it and give it to you.

If you feel as though this post is incomplete and missing a vital piece of recent news about COVID-19, please consult the Archives. I’ve been keeping up with COVID-19 since February and chances are, I’ve probably covered it. If you can’t find it there, search the site!

New Numbers

Firs, here is a look at stats from the WHO, CDC and Johns Hopkins.

	Total	New Today
World Health Organization
Worldwide Cases	12964809	196775
Worldwide Deaths	570288	3634
CDC
US Cases	3355457	58858
US Deaths	135235	351
Johns Hopkins
Worldwide Cases	13290153
Worldwide Deaths	577980
US Cases	3431574
US Deaths	136466

Regional Numbers

Now here is a look at the numbers from the state health departments in Mississippi, Alabama, Tennessee, Arkansas and Louisiana.

	Total Cases	Tested	Deaths	%-positive	Mortality Rate
MS	37542	363662	1272	10.32%	3.39%
LA	82042	976055	3337	8.41%	4.07%
AL	56441	528275	1136	10.68%	2.01%
TN	66788	1071320	767	6.23%	1.15%
AR	29733	395212	331	7.52%	1.11%
Total	272546	3334524	6843	8.17%	2.51%

	Hospitalized	Ventilators
MS	825	126
LA	1362	146
AL	1353	N/A
TN	3378*	N/A
AR	445	91
Total	3985	363

The * indicates that Tennessee numbers for hospitalizations is a running total, not a “current” number.  That number is omitted from the “Total” tally.

Making Estimates from past research

I know I say this every time, but it is worth repeating: I’ve talked about research from the Cruise Ships and how it may be relevant to estimating the number of cases without testing everyone (since that isn’t a feasible option). Plus, this type of estimate would make a good “first guess” at the number of asymptomatic people (the people who don’t feel sick, but are still infected), too.

This type of estimating isn’t perfect. In fact, it is far from it. And it is just an estimate. But based on the past research, it is at least a start.

	Est Symptomatic	Est Asymptomatic	Est total
MS	57,259	12,569	69,828
LA	125,130	27,468	152,598
AL	86,084	18,896	104,980
TN	101,865	22,361	124,226
AR	45,349	9,955	55,303
Total	415,687	91,248	506,936

Again, this is an estimated number of the total cases to date, not a look at the current number of cases.

I can’t run the numbers for each state, but I can show the “estimated current cases” numbers for Mississippi.

That image may be a bit small, you can look at the full-size here.

It shows the estimated number of symptomatic positive cases at 10,978. With an additional 3,675 asymptomatic cases. That is a total of 14,653 currently “sick” people in Mississippi.

And again, I want to reiterate that these numbers are based on past research and studies. And are simply an application of their findings to a larger population. This isn’t “my opinion” but rather the mathematical outcomes of the medical researchers applied to our population.

Herd immunity

In Mississippi, Governor Tate Reeves took a moment the other day to talk about what kind of numbers would be needed in order to reach “herd immunity” in Mississippi. In short, it was a lot.

Gregory Poland, M.D. part of the Vaccine Research Group at the Mayo Clinic breaks it down:

The idea of reaching “herd immunity” without a vaccine would mean that – roughly – 227 million Americans get the virus. The average hospitalization rate is about five-percent, so that means of the 227 million infected, 11.35 million end up in the hospital. And with a death rate around two-percent that means there will be about 4.5 million deaths.

In other words, reaching herd immunity without medical intervention seems like a less than ideal scenario.

Skin disorders may increase transmission rate of COVID-19

Pre-print alert. This is a quick blurb about a study that is in pre-print and has not went through the rigors of peer review. Another reminder that I am not a doctor, so I cannot offer an opinion on the validity of this study. But I wanted to share this one as I know a fair number of people with skin issues.

The paper titled, “If the link missed: Could inflammatory skin disorders with barrier dysfunction increase the risk of COVID-19?” dives into the potential for inflamed skin to allow easier access for the virus to enter the system. The authors suggest ACE2 in skin might be a way of transmitting SARS-CoV-2.

The authors found “the elevated ACE2 level of patients with psoriasis but downregulated after IL-17 antibody treatment. Further results showed that ACE2 expression increased either in psoriasis or in atopic dermatitis, which were typical inflammatory skin disorders with barrier dysfunction … Furthermore, inflammatory skin disorders with barrier dysfunction increased the penetration of topical FITC conjugated spike protein into the skin. Conversely, improvement in skin permeability barrier could prevent this penetration. Thus, indicating the special link between inflammatory skin disorders with skin barrier dysfunction and increasing risk of COVID-19.”

This study still needs to go through peer review and it still quite new. The top question that needs to be answered is how easy can the virus move from the infected skin into the blood stream and then to the lungs? Or does the virus simply infect a different part of the body when it enters the body in this way?

This information isn’t available yet and requires more study. But it is worth noting that this study may bet he first step toward understanding if there is another “at risk” group to watch.

Other pre-print news

You may begin to hear more about a paper titled, “Discovery of clinically approved drugs capable of inhibiting SARS-CoV-2 in vitro infection using a phenotypic screening strategy and network-analysis to predict their potential to treat covid-19” that is in pre-print. I’m not going to dive into it here because it make a few claims that I’m not comfortable with.

Not because in my opinion they are incorrect, as I am not educated enough to make that discernment. But rather I’m not educated enough so I don’t have enough information to decide if it is worthwhile or not.

I just wanted people to know that I have seen it, and I’m still waiting on the peer review process to do the work. Or, at the very least, I’m waiting for some people in the medical community to share their thoughts publicly, so that I can then share them with you.

Keep track of the tests

There are a lot of different ways the medical community can determine if a person is – or has been – infected with COVID-19. The Mayo Clinic breaks it down:

The FDA approved two types of tests for diagnosing COVID-19 — molecular and antigen.

Molecular test:

This test detects genetic material of the virus using a lab technique called polymerase chain reaction (PCR). Also called a PCR test, a health care worker collects fluid from a nasal or throat swab or from saliva. Results may be available in minutes if analyzed onsite or one to two days if sent to an outside lab.

Molecular tests are considered very accurate when properly performed by a health care professional, but the rapid test appears to miss some cases. The FDA also approved certain COVID-19 at-home test kits, available only with doctor approval: A nasal swab kit and a saliva kit. The sample is mailed to a lab for testing. The FDA warns consumers against buying unapproved home tests, because they may be inaccurate and unsafe.

Antigen test:

This newer COVID-19 test detects certain proteins that are part of the virus. Using a nasal or throat swab to get a fluid sample, antigen tests can produce results in minutes. Because these tests are faster and less expensive than molecular tests are, some experts consider antigen tests more practical to use for large numbers of people.

A positive antigen test result is considered very accurate, but there’s an increased chance of false negative results — meaning it’s possible to be infected with the virus but have negative antigen test results. So antigen tests aren’t as sensitive as molecular tests are. Depending on the situation, the doctor may recommend a molecular test to confirm a negative antigen test result.

If you think you were sick with COVID-19 earlier in the year and are considering getting an antigen test, the Mayo Clinic has some advice: “The timing and type of antibody test affects accuracy. If you have testing too early in the course of infection, when the immune response is still building up in your body, the test may not detect antibodies, so you may have to wait several days to get tested. Also, the U.S. Food and Drug Administration (FDA) authorized and verified certain antibody tests, but many tests with questionable accuracy are now on the market.”

Furthermore, the Mayo Clinic suggests consulting your doctor first to see if you would be a good candidate for the test. Describe your symptoms and sickness and allow your doctor to decide – in the medical sense – if a antigen test is a good idea for you.

How reliable are these tests? Well, Harvard Medical has some bad news. The test is looking for viral “RNA” in a sample taken. If the RNA is found, the test is deemed “positive” and if a positive test is found, Harvard Medical says, “it is almost certain that the person is infected.”

A negative test result, in their words, is less definite.

“An infected person could get a so-called “false negative” test result if the swab missed the virus,” it stats on their website. “For example, or because of an inadequacy of the test itself. We also don’t yet know at what point during the course of illness a test becomes positive.”

From Harvard Medical:

If you get the nasal/throat swab or saliva test, you will get a false negative test result:

100% of the time on the day you are exposed to the virus. (There are so few viral particles in your nose or saliva so soon after infection that the test cannot detect them.)
About 40% of the time if you are tested four days after exposure to the virus.
About 20% of the time if you develop symptoms and are tested three days after those symptoms started.

In other words, if you start to feel sick and come down with symptoms, it may be beneficial to wait until the symptoms are with you for a few days before getting tested for COVID-19.

Harvard says that if you have COVID-19 symptoms and get a negative test result, there is no real reason to get another test unles you get sicker. If your symptoms do worsen, they recommend calling your doctor for guidance on further testing.

And if you are sick at all: Self-isolate at home. Wear a mask when interacting with members of your household. And practice social distancing.

Vaccines showing promise

Talk about burying the lede, Nick! You’re right. But I was hoping this would encourage everyone to read a bit more about some of the other news, too.

In the New England Journal of Medicine, a paper titled, “An mRNA Vaccine against SARS-CoV-2 — Preliminary Report” was published documenting how one of the trials for a vaccine is going.

The authors wrote:

After the first vaccination, antibody responses were higher with higher dose (day 29 enzyme-linked immunosorbent assay anti–S-2P antibody geometric mean titer [GMT], 40,227 in the 25-μg group, 109,209 in the 100-μg group, and 213,526 in the 250-μg group).

After the second vaccination, the titers increased (day 57 GMT, 299,751, 782,719, and 1,192,154, respectively).

After the second vaccination, serum-neutralizing activity was detected by two methods in all participants evaluated, with values generally similar to those in the upper half of the distribution of a panel of control convalescent serum specimens. Solicited adverse events that occurred in more than half the participants included fatigue, chills, headache, myalgia, and pain at the injection site.

Systemic adverse events were more common after the second vaccination, particularly with the highest dose, and three participants (21%) in the 250-μg dose group reported one or more severe adverse events.

The authors report “no trial-limiting safety concerns were identified. These findings support further development of this vaccine,” noting:

“In this interim report of follow-up of participants through day 57, we were not able to assess the durability of the immune responses; however, participants will be followed for 1 year after the second vaccination with scheduled blood collections throughout that period to characterize the humoral and cellular immunologic responses. This longitudinal assessment is relevant given that natural history studies suggest that SARS-CoV and MERS-CoV (Middle East respiratory syndrome coronavirus) infections, particularly mild illnesses, may not generate long-lived antibody responses.”

But before we all get too excited, there are two things to note. First, here is a list of the documented side effects…

And the sample-size was rather small, and – with no better way to put this – racially uniform. There were only 45 participants and only 7 were not tagged under the ethnicity, “white.”

A smaller sample size and limited diversity may lead to skewed data when attempting to apply the findings to a larger, more diverse, population.

That said, it shows promise. It is a good starting block. And, as the authors put it, the findings support “further development” of the vaccine. But not yet “distribution” of this vaccine.

The other vaccine, “The Oxford Vaccine” is gaining attention, too. However, I could not find any medical journals or research documentation regarding it so I can’t pass along any information.

As a lot of you have noticed, I don’t post information from other media outlets here. And I won’t unless there is literally no other option. And in this case, I would rather wait for the medical community to release information than get it from a second-hand source.