Looks like all leaders are getting a significant approval boost from COVID-19 with a few exceptions: Obrador (Mexico), Bolsanoro (Brasil), Abe (Japan), see above. Trump’s approval is up from -10 to -5. The approval ratings surged much more dramatically for Johnson (GB), Merkel (Germany), Trudeau (Canada), Morrison (Australia), and Macron (France).
And this is not reflected in consumer confidence, see below.
Full story: see Morning Consult “Approval Rises for World Leaders Amid Pandemic”
What We Pretend to Know About the Coronavirus Could Kill Us
https://www.youtube.com/watch?v=qxF_CDDJ0YI
Tony Schwartz: The Truth About Trump | Oxford Union Q&A. This is the guy who wrote “The Art of the Deal”. The interview dates to Nov 4th 2016.
from Healthcare Dive.
The nation’s health insurers are responding to the coronavirus pandemic with changes to coverage associated with COVID-19 as the number of cases continues to swell across the U.S.
The biggest payers have said they will waive patient cost-sharing — copays, coinsurance and deductibles — for testing. Although some, such as Cigna and Humana, have gone farther by eliminating cost-sharing for all COVID-19 treatment.
In addition to coverage decisions, insurers are weighing the ways they can reduce administrative barriers to promote quicker access to care for those infected with the novel coronavirus. All are cutting back on prior authorization in various ways to ease access to care.
Hospitals say that’s not enough, and are calling on the biggest payers to follow actions taken by Congress and CMS to help resolve cash flow issues, by accelerating payments or opting into releasing interim periodic payments. The American Hospital Association also is urging payers to eliminate administrative burdens such as prior authorizations.
“This crisis is challenging for all of us, and everyone has a role to play,” AHA said in its letter to the nation’s largest insurers. “You could make a significant difference in whether a hospital or health system keeps their doors open during this critical time.”
Despite the policy changes by payers, employers with self-funded plans can opt out of these policies. A majority of workers are covered by self-insured plans, which essentially allow employers to decide coverage decisions given they’re paying for the claims and having insurers simply perform administrative services.
Below is a tracker with the latest coverage decisions for the nation’s largest insurers.
The BCBSA is eliminating cost-sharing for COVID-19 diagnostic testing. It will also waive cost-sharing for treatment at in-network or Medciare rates through May 31, including inpatient stays.
BCBSA will remove prior authorization requirements for testing and for services that are medically necessary to treat an infected patient. BCBSA also is waiving limits on early refills to make it easier to access medications and expanding access to telehealth services.
Molina is halting cost-sharing for testing and treatment. That policy applies to Medicare, Medicaid and marketplace members nationwide.
Aetna will waive cost-sharing for certain members admitted to an in-network hospital with COVID-19 or complications from the disease. The policy applies to all of Aetna’s commercial plans, though self-insured members can opt out. The policy will apply to admissions through June 1. Aetna also is waiving cost-sharing for testing and associated visits, including telehealth.
Aetna also is attempting to make access to hospitalization faster for those with COVID-19 by easing prior authorization requirements, particularly in areas hard hit by the outbreak like New York and Washington.
The nation’s second largest commercial insurer will waive cost-sharing for COVID-19 treatment and will reimburse providers at either in-network or Medicare rates through May 31. The policy applies to Anthem’s fully insured, individual, Medicaid and Medicare Advantage members. Self-insured plans can opt out. Anthem also is waiving cost-sharing for COVID-19 testing and in-network visits associated with testing whether it’s conducted at a physician’s office, urgent care or ER.
Anthem also is easing its limits on early refills for 30-day prescriptions. Anthem said it would waive cost sharing for telehealth visits, including those for mental health for a period of 90 days starting March 17. Self-insured plans have the option to opt in the new virtual care policy.
Centene will waive cost-sharing for COVID-19 related screening, testing and treatment for its Medicaid, Medicare and Marketplace members through June 30.
Centene also will eliminate prior authorization requirements for care for all its Medicare, Medicaid and Marketplace members. The company is also working to supply federally qualified health centers with personal protective equipment and assistance in providing small business loans to behavioral health providers and long-term service support organizations.
Cigna will waive cost-sharing for all COVID-19 treatment, including testing and telehealth screenings through May 31. The policy applies to Cigna’s fully-insured group plans, individual coverage and Medicare Advantage plans. Self-insured plans can opt out.
Cigna will reimburse providers either at in-network or Medicare rates depending on the member. Cigna also is easing access to maintenance medication by offering free shipping for a 90-day supply. Cigna is easing prior authorization requirements for patients being discharged from the hospital to post-acure stays.
Humana is waiving cost-sharing for testing and treatment, including hospital admissions for COVID-19 cases. The policy applies to its Medicare Advantage plans, fully-insured commercial plans, Medicare supplement and its Medicaid plans. The policy is indefinite with no current end date. Cost-sharing will be waived for all telehealth visits and members can opt to refill prescriptions early.
Humana also is easing administrative barriers to allow infected patients to easily move from a hospital to post-acute care settings. It’s suspending prior authorization and referral requirements and requesting notification within 24 hours. It’s also implementing an expedited claims process to reimburse providers faster, Humana said.
The nation’s largest commercial insurer, will waive cost-sharing for COVID-19 treatment through May 31. The policy applies to its fully-insured commercial, Medicare Advantage and Medicaid plans. United also is waiving cost-sharing for COVID-19 testing at approved locations in accordance with Centers for Disease Control guidelines. There will be no cost-sharing for visits related to testing including at physician offices, urgent care, ERs and telehealth visits. The policy applies to United’s commercial, Medicare Advantage and Medicaid members.
UnitedHealthcare is opening a special enrollment period for some of its commercial members who opted out of coverage during the traditional enrollment period with their employers. This enrollment period will end April 6. The insurer also is easing prior authorization requirements through May 31, suspending prior approval for post-acute care and switching to a new provider.
This is a very interesting paper! It is a detailed virological and immunological study of 9 patients with COVID-19, presenting from Jan 23 – 27, 2020, all with mild upper respiratory symptoms (not requiring ICU admission or ventilators) in Germany.
I will try to summarize it.
Bottom line:
PS: 17.9% of persons with COVID-19 are asymptomatic (have no symptoms what so ever) and are still producing virus and infecting others. That is 1 in 5 infected people have no symptoms. Think about it.
The headlines and what the reasoning is behind them:
Austria makes masks compulsory as protection debate shifts!
Four European countries make masks mandatory!
From Czech Doctors & Citizens – The CRUCIAL MISSING Coronavirus Protection Guideline https://www.youtube.com/watch?v=hVEVve-3QeM
A University of San Fransisco research scientist shows how anyone can make a mask using a long sleeved T shirt, scissors and a paper towel as a filter. He shows how to cut the t-shirt and it is utterly simple and easy to do. He tells us the scientific data on masks and what materials work.
How Czech Republic Maintains Low Contagion https://www.youtube.com/watch?v=T2dOs-LhJaQ
How to make your own mask https://www.youtube.com/watch?v=4FB–BOyTiU
I would add that I use construction masks that I got at Home Depot: less than $10 for one box with 50 masks. Not sure whether they are still available.
I love it!
Mike Francesa has given Donald Trump the handwave.
The longtime New York-based sports radio gasbag took to the airwaves on Monday night, offering a takedown of Trump and his response to the coronavirus pandemic plaguing the nation, and specifically, New York.
“There’s a disconnect. We’re watching one thing happen in our city on the 11 o’clock news every night. We’re watching people die,” Francesa says. “And now we know people who died. And we’re not seeing one or two people die now in our neighborhood. We’re seeing them die by the 10s and 20s by the day. They’re bringing people out of the hospital in Queens in body bags. …
“Treat this like the crisis this is,” Francesa continued. “And how can you have a scoreboard that says 2,000 people have died, and tell us it’s OK if another 198,000 died, that’s a good job. How is that a good job in our country? It’s a good job if nobody else dies.”
Francesa, as you may know, is one of the kings of sports radio — but is also New York’s Numbah 1 in bad takes, inaccurate takes and “I nevah said that!”s in the history of broadcast radio.
But Francesa is also known for his political takes, as — for some reason — listeners across the tri-state area tuned in to Francesa in 2016 for his political opinions during the election year. While it’s largely speculated that Da Sports Pope cast his vote for Trump, he hadn’t publicly stated that he did. He was a big Trump supporter during his election run, however.
“I think it’s about doing a good job. His ego will not let him do anything but a good job,” Francesa said of Trump in 2016.
Francesa’s afternoon drive spot — originally from 1 p.m. to 6:30 p.m. ET — is now tucked into a nice, half-hour spot on WFAN 101.9 from 6-6:30 p.m. He was recently given another show on Sundays while the sports radio world struggles to find something to talk about.
Interesting to see if Trump will be back aftah this.
This is probably the most exciting thing I have read related to COVID in some time.
This from the NYT
“Kinsa’s thermometers upload the user’s temperature readings to a centralized database; the data enable the company to track fevers across the United States.
Owners of Kinsa’s thermometers can type other symptoms into a cellphone app after taking their temperature. The app offers basic advice on whether they should seek medical attention.
Kinsa has more than one million thermometers in circulation and has been getting up to 162,000 daily temperature readings since Covid-19 began spreading in the country.”
The technology was first published in 2018 and used to track annual influenza outbreaks:
A Smartphone-Driven Thermometer Application for Real-time Population– and Individual-Level Influenza Surveillance. Miller AC1, Singh I2, Koehler E2, Polgreen PM3.
Now Kinsa is tracking spikes of “atypical fever”, fever that does not follow the historical flu patterns and was not predicted:
Note the red part of the curve (March 9-20) did not follow the predicted patterns, and was perhaps due to COVID-19 , designated “atypical”. Very interesting is the dip (orange) that follows after March 20 to levels below “2% ill”. This dip in the curve is being attributed to effective social distancing measures. It would be the first measure of the effectiveness of such regulations and it certainly would help guide public policy.
Especially interesting are the interactive maps on the Kinsa website:
The above map shows the location of “atypical” illness (presumed COVID-19). It is the “amount of unexpected illness expressed as additional share of the population affected by influenza like illness above the expected values”
Note the concentration in Florida. That is fascinating because the RT-PCR testing for the coronavirus has not yet really shown the expected rise in cases (Florida ranks #6):
I presume the Kinsa technology is much faster at detecting trends, than counting positive cases and deaths. I am thinking that most of those people that are having atypical fevers have not yet been tested for the virus of they are waiting for a result. (Some people that I know well have been waiting for 9 days or more.)
This map is fascinating too: it depicts trends. By placing the cursor over your county, you can get very local data:
This is a 7 day rolling average of change in the illness level expressed as percent change up or down.
In Suffolk County, NY, the illness (atypical fevers) trend is decreasing by 4.3% and thankfully the decreasing trend is seen across the country. There is only one county in Texas (Hardeman Cty) where the trend is not decreasing.
This map (above) shows you how much influenza-like illness is being detected throughout the country. It is a map of how severely the population is being affected by atypical influenza like disease. I presume this data lags the data in the above graph on location of “atypical” illness where Florida was mostly in the red?
Here is what the company concludes:
(3/24/2020): Due to widespread social distancing, school closures, stay-at-home orders, etc. feverish illness levels are dropping in many regions. This does not mean that COVID-19 cases are declining. In fact, we expect to see reported cases continue to surge in the near term, but it may indicate these measures are starting to slow the spread. See CDC COVID-19 Cases in U.S. for details.
Dated March 30, 2020
Dear Colleagues and Friends:
Three days ago I had no Covid-19 patients in the hospital. Two days ago there were two in critical care. One of the two, a patient for more than 20 years, died Sunday (March 29) at 3pm. Her daughter cried to me “She didn’t deserve to die this way, all alone.” She’s right. My first, not my last, patient to die of Covid-19. When the daughter gave me details of who else was exposed to her mother, those that need for testing, I said ashamedly that I have no access to testing or tracking of exposed individuals. Another patient of mine is intubated. I am hoping he will survive.
Before Trump’s inauguration, there was a warning from the Obama administration: ‘The worst influenza pandemic since 1918’ would be coming and Obama officials briefed the incoming administration on this exact scenario.
What’s Trump’s planning approach: “Trump ties coronavirus decisions to personal grievances”. Trump took to Twitter Sunday afternoon to tout the ratings of his news conferences, claiming without evidence that mainstream media are going “CRAZY” because of his popularity on television”.
In the absence of both medical equipment and testing in the world’s richest country, many are debating how to allocate scarce medical resources. Patient-level decisions are being made with this perspective.
Others are thinking about estimating the cost of this pandemic. Academics are calculating how we can decrease social distancing after implementing contact tracing and adequate testing
Still, others are trying to put pen to paper imagining a better health system that includes planning for the next pandemic. Meanwhile, Scott Gottlieb and Mark McClellan (excellent Repub policymakers) have detailed options for the current pandemic.
To put any long term health reform ideas into place, we need members of Congress and an executive branch interested in long term health reform not just tearing down health systems.
Via Ask Nurses and Doctors, I am in the process of organizing round tables for incumbent members of Congress and encouraging people to write letters to the editor such as these. The picture in the excellent LTE by Barbara Floyd is worth a thousand words. Happy to help anyone who is interested in putting “pen to paper”.
In the meantime, my physician colleague has been extubated and continues to improve but is still in the hospital.
Norbert Goldfield MD
The numbers are normalized per 100,000 population. Since the US is a far larger country the number of deaths will be far larger. Daily deaths are predicted to peak after around three months if people don’t change their behaviour. Image: Imperial College COVID-19 Response Team
From a medical consultant in London. This was sent initially to his family on Sat March 28th, 2020. It is a frank assessment. Expect the same situation here in New York and elsewhere in the USA. (NB: this was sent to me via my British family)
Published
Dr. Posnett: This is from Dr. Price at New York Hospital – it is invaluable info from someone taking care of many patients every day. This hospital is completely over-run by COVID-19. Please share widely with all your friends or patients
https://vimeo.com/399733860?ref=em-share
Earlier today, March 28, 2020 and According to News 12
Suffolk County Executive Steve Bellone says 4,138 people in the county have tested positive for coronavirus.
Bellone also says 409 people are hospitalized due to coronavirus, with 139 in the ICU. “There are 2,644 hospital beds, with 570 available. There are also 309 ICU beds, with 78 available.” Clearly, we will soon run out of necessary beds and of course ventilators.
Bellone says there are 30 deaths in the county due to coronavirus.
7 deaths have occurred in the retirement home Peconic Landing
At Peconic Landing, the Greenport retirement home, there was another death today, the seventh. There are about 40 people known to have tested positive. Peconic Landing has perhaps 377 staff, and well over 300 residents (301 independent “members” and 86 nursing home patients). Peconic Landing is the hotbed of COVID-19 in Suffolk county. Think of it as a “Cruiseship”. And it is full of frail elderly clients. Find the updated information regarding Peconic Landing and COVID here.
The leadership of Peconic Landing claims there are no available tests for their home. I understand that there may be a rush on tests, but isn’t the situation at Peconic Landing a quasi emergency? Their residents are mostly over 80 years old. If they get sick with COVID-19 one would expect a mortality rate of 10-20% at least. For the rest of us, the mortality (risk of dying if we get the virus) is more like 1-2% .
Some say “well aren’t they going to die anyway?” How would you feel if your parent or grandparent were there?
Why is it important to test everyone at Peconic Landing?
There are currently 2 types of testing:
Both tests should be done because the combined information might be useful:
Here are the 4 possible outcomes and what they mean.
you have COVID-19, symptomatic or asymptomatic. You should take precautions (self-isolation) to avoid transmission of virus to your loved ones. You absolutely may not have any contact with residents at a home, like Peconic Landing.
you are likely recovering from COVID-10 (1-3 weeks out); you may have been symptomatic or not. Because you are still PCR+ you need to take precautions (isolation). Isolation should be for 10 days after symptom onset or for the duration of symptoms plus 3 days after resolution of symptoms. You absolutely may not have any contact with residents at a home, like Peconic Landing.
you never had COVID-19. You are susceptible, and if you live or work in a high risk situation, such as Peconic Landing, you shouldn’t be there. But if that is impossible, you should take very stringent precautions.
you are fully recovered from COVID-19. Generally, this group could be considered “immune” and possibly
On the Diamond Princess Cruise ship, all elderly passengers and those with underlying medical conditions, and all crew were tested. Passengers who had negative [SARS-CoV-2] RT-PCR test results, no respiratory symptoms, and no close contact with a person with a confirmed case of COVID-19 completed a 14-day ship-based quarantine before disembarking. In other words, testing helped make informed decisions to save as many lives as possible.
We should do the same for our senior friends at Peconic Landing.
In the March 19 issue of the Western Edition of The Southampton Press, the A section is devoted to articles about the coronavirus pandemic and the impact on Suffolk County and Southampton Town. There are quotes and statements from Governor Andrew Cuomo, Suffolk County Executive Steve Bellone, Southampton Town Supervisor Jay Schneiderman, mayors, school superintendents and hospital administrators. Conspicuously missing is any statement from Congressman Lee Zeldin.
On the congressman’s Facebook page and in his appearances on Fox News, from January through early March of this year, his comments included supporting President Trump against impeachment, criticizing New York for bail reform, insinuating that Democrats want to enable voting by undocumented residents, and the highlighting the danger of MS-13. But not one word about the growing epidemic.
Now that the pandemic has been declared a national emergency, his website has information for the public about the virus and his office has issued a series of press releases. But we know that Congress was informed by our intelligence services in January that the novel coronavirus that began in China at the end of 2019 had the potential to be a global pandemic. China released the genetic code for the virus at the beginning of January to help scientists in other countries prepare test kits and institute procedures to contain the virus. We did neither.
Instead, President Trump called it a Democratic hoax, Fox News repeated this misinformation campaign, and Zeldin focused on spreading lies about bail reform. Countries like Australia and South Korea that immediately implemented policies to test and contain the virus are in far better shape today.
No resident of the district should be surprised. Zeldin has not stood with protecting the public health of his constituents at any time in his tenure in Congress. He voted repeatedly to repeal the Affordable Care Act, voted for the GOP deficient replacement bill in 2017, and lied about that vote in the 2018 midterm election, pretending he supported protections for pre-existing conditions.
The constituents of the 1st District are now facing a grave danger to both the public health and economic health of our district. Our hospitals in Suffolk County are facing overwhelming numbers of emergencies. And our shuttered businesses and their employees are facing ruin.
We, the taxpayers of this district have the right to know why we are on a COVID-19 case accrual curve closer to Italy than to South Korea. Where was Congressman Zeldin when this threat was building? Why was he busy spouting right-wing talking points and propping up a president who was calling this a hoax rather than raising the alarm about the threat to our district and getting us the necessary resources?
We need answers.
By Barbara Weber-Floyd
Westhampton Beach
Watch a doctor demonstrate how to safely bring groceries home during the coronavirus crisis. This is very useful! Specially the latter half starting at 5:00 min.
Message from Dr. Norbert Goldfield (Ask Nurses and Doctors):
Dear Colleagues and Friends:
From the editorial board of the Washington Post: Trump is spreading false hope for a virus cure — and that’s not the only damage.
A man thought aquarium cleaner with the same name as the drug chloroquine (Plaquenil) would prevent coronavirus. It killed him.
To add insult to injury, and not surprisingly, the Trump team failed to follow NSC’s pandemic playbook.
And there are innumerable vacancies in addition to incompetent leadership in the executive branch.
A symptom of the above challenges: The daughter of one of my hospitalized Covid patients just called me and told me that many at her mother’s housing complex are coming down with the same symptoms. There is no case tracking here like in S. Korea – so there is nothing to be done.
My efforts to move Republican governors to early on support ‘shelter in place‘ didn’t work. As expected Florida and Texas are rapidly emerging as new potential epicenters.
I continue to organize in swing states and continue to organize roundtables for incumbent members of Congress. All suggestions welcome.
It seems like eons ago when I sent out the following advice: #StaytheFuckHome. Please stay healthy.
Let’s end with some good news. My retired physician colleague who was on a respirator for Covid has just been extubated!
If we only knew who had developed immunity to the virus. Immunity may occur in someone who had the virus (either with symptoms or without), got better and developed IgM and IgG antibodies. We know that happens. If you are declared immune, you can safely go back to work which might help the economy. You are safe as a healthcare worker. You are safe to go buy groceries. You are safe to be around your loved ones. You could donate plasma at the local Blood center and plasma with lots of antibodies could be administered to patients dying in the ICU (passive immunotherapy used previously against the Spanish flu and against Ebola for example).
There are some promising reports regarding testing for the presence of antibodies to the COVID-19 virus:
This is ultimately more important than the RT-PCR diagnostic test performed with throat or nasal swabs. This virus has only existed since Dec 2019. Anyone who has the antibodies was infected since that date. I assume they are making sure that the antibodies don’t react with previously known Coronaviruses (SARS and MERS). This will give us great information on what the actual number of infected persons has been. It will tell us what percentage of the population has not yet been infected and is still susceptible to the virus. This percentage will be dwindling as the pandemic progresses and the virus runs out of people to infect. For those that still don’t have antibodies, we might want to think about not having them around susceptible populations, as in a nursing home. This is an opportunity. Let’s not bungle it again. Everyone should get tested!
Patch.com just published the latest local figures for Suffolk County as of yesterday and they were obtained from the official county site here:
| conf. cases | deaths | population 2017 | cases per 1000 people * |
|
| Islip: | 395 | 333700 | 1.183697932 | |
| Huntington: | 358 | 203276 | 1.761152325 | |
| Brookhaven: | 281 | 486170 | 0.577987124 | |
| Babylon: | 271 | 213,603 | 1.268708773 | |
| Smithtown: | 120 | 117390 | 1.02223358 | |
| Southold: | 107 | 22284 | 4.801651409 | |
| Riverhead: | 39 | 33781 | 1.15449513 | |
| Southampton: | 33 | 58439 | 0.564691388 | |
| East Hampton: | 13 | 32000 | 0.40625 | |
| Shelter Island: | 2 | 2421 | 0.826104915 | |
| other towns | 261 | |||
| total County | 1880 | 18 | 1503064 | 1.25077841 |
| at Peconic Landing | 6 |
* some have proposed multiplying this number by 100 because most people are not getting tested (even those with symptoms).
Suffolk County Executive Steve Bellone reported 1,880 confirmed cases countywide which is a jump of 422 from the day before. Of that number, 163 are hospitalized, with 50 in intensive care.
Southold is particularly hard hit. The Peconic Landing retirement community in Greenport has reported a sixth death related to coronavirus.
Ventilators in Suffolk County
With the desperate need for ventilators , Bellone said 25 are headed to Suffolk County. While numbers were not known for how many are available countywide, Bellone said that number is “woefully inadequate for what that need will be.”
Personal Note (regarding testing)
Contrary to the incredible efficiency of the South Koreans in testing everyone and containing the virus, see this NYT article, we are still struggling. For instance, after a few attempts, costing me hours on the phone to get thru to the county health officials, I finally got them to agree to test me (I have a bad cough and fever). This was finally done 2 days ago, but the test result (Quest Labs) is not expected for one week. There are also no plans to have the 6 others staying in our house tested even though one of them also has symptoms! We have been under self-quarantine for weeks now. But some kind of public enforcement should occur. Even if it is just phone calls to follow up on our progress, from the health department. I highly recommend reading about how South Korea has flattened the curve.
Considering that this is the richest nation on earth, with supposedly the most advanced healthcare, we deserve an ‘F’. It is too late to change the course of COVID-19 in the US I fear. But in the meantime, we should all consider volunteering. There are many opportunities and there will be more.
I called the county to volunteer as a retired MD. I may perhaps be Corona virus-positive right now, but when I recover and come out of self-quarantine, I could not be safer, knowing that I will have acquired disease-fighting antibodies. Those of us that have recovered and those that test positive for the presence of antibodies will be ideally suited to help care for the sick and critical patients.
Gov. Cuomo has announced that he wants retired health care professionals to be recruited. Suffolk county is just starting an effort along these lines. I contacted Suffolk County Medical Reserve Corp. Here is their response:
Thank you for contacting us. Volunteer opportunities exist within the Suffolk County Medical Reserve Corp. Please visit this site for more information and to join through the NYS HCS:
https://suffolkcountyny.gov/Departments/FRES/Office-of-Emergency-Management/Medical-Reserve-Corps
From that point you will be contacted for an assignment.
Jennie Nedell , Volunteer Programs Coordinator
Jennie.Nedell@suffolkcountyny.gov
I will warn you about the sign-up process which puts you into NY.gov. It is cumbersome but I will gladly help you with it!
I urge you to sign up now. Jennie is very friendly and willing to help. They have possible jobs for all of us and much can be done from home (where you might be under self-isolation), electronically or by phone, etc. If you are elderly, or no longer registered as a health care professional or can’t travel around the county, don’t worry, they have jobs for you!
It will get crazy in 1-3 weeks when the system is overrun. Now is the time to sign up to volunteer.
David
This is a fascinating little paper in the medical journal Nature Medicine. It is written by an Australian group arguably the top leaders in the field of antiviral immune responses.
It describes a 47-year-old woman from Wuhan, Hubei province, China. She presented to an emergency department in Melbourne, Australia. Her symptoms commenced 4d earlier with lethargy, sore throat, dry cough, pleuritic chest pain, mild dyspnea and fevers. She had traveled from Wuhan to Australia 11 days earlier. She had no known contacts with COVID-19 cases and was otherwise healthy.
She had a fever of 38.5 °C, and pneumonia by clinical exam and chest XR. PCR tests for SARS-CoV-2 were first positive at 4d (4 d after symptoms onset). But PCR tests were no longer positiive after d7. She recovered and was discharged on d11.
There follows a detailed description of her immune response. It involved all components of the immune system known to partake in responses to other viruses like the flu.
Why is this important?
If it were possible to wave a magic wand and make all Americans freeze in place for 14 days while sitting six feet apart, epidemiologists say, the whole epidemic would sputter to a halt!
Here is another coronavirus curve (from March 22nd). The Germans claim it shows flattening of the curve for their country. I’ not so sure (yellow curve)! The more dramatic finding is the black curve (USA) which has the steepest incline showing that COVID-19 is spreading most aggressively here in the US than anywhere else.
My friend James, is vacationing in Mexico. Guess what, he is going to stay there for now! Good decision.
Why is this worrisome? The NYT ran his piece: “The Virus can be Stopped, but only with Harsh Steps” By
…coronavirus more often infects clusters of family members, friends and work colleagues, said Dr. David L. Heymann,
“You need to identify and stop discrete outbreaks, and then do rigorous contact tracing.”
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But doing so takes intelligent, rapidly adaptive work by health officials, and near-total cooperation from the populace. My thoughts: Right. Is that going to happen?
Americans must be persuaded to stay home, the experts said, and a system put in place to isolate the infected and care for them outside the home. Travel restrictions should be extended, they said; productions of masks and ventilators must be accelerated, and testing problems must be resolved.
It is not the “American way”. “The American way is to look for better outcomes through a voluntary system,” said Dr. Luciana Borio, who was director of medical and biodefense preparedness for the National Security Council before it was disbanded in 2018.
Many experts, some of whom are international civil servants, declined to speak on the record for fear of offending the president. But they were united in the opinion that politicians must step aside and let scientists both lead the effort to contain the virus and explain to Americans what must be done. My thoughts: is that going to happen? No. Americans distrust science.
The next priority, experts said, is extreme social distancing. If it were possible to wave a magic wand and make all Americans freeze in place for 14 days while sitting six feet apart, epidemiologists say, the whole epidemic would sputter to a halt.
…the police may be needed to enforce stay-at-home orders, as they were in China and Italy.
People in lockdown adapt. In Wuhan, apartment complexes submit group orders for food, medicine, diapers and other essentials. Shipments are assembled at grocery warehouses or government pantries and dropped off. In Italy, trapped neighbors serenade one another! Watch this Youtube video on life in Wuhan.
It’s an intimidating picture. But the weaker the freeze, the more people die in overburdened hospitals — and the longer it ultimately takes for the economy to restart.
So, here is the Trump response delivered by tweet last night”
“Mr. Trump has become frustrated with Dr. Fauci’s blunt approach at the briefing lectern, which often contradicts things the president has just said, according to two people familiar with the dynamic.”
“WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF,” Mr. Trump tweeted in all capital letters shortly before midnight. “AT THE END OF THE 15 DAY PERIOD, WE WILL MAKE A DECISION AS TO WHICH WAY WE WANT TO GO!”
It seems clear, Donald is taking charge as the ultimate expert for anything. Some think Dr. Fauci will be sidelined.
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Continue reading the main story
But doing so takes intelligent, rapidly adaptive work by health officials, and near-total cooperation from the populace.
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Continue reading the main story
But doing so takes intelligent, rapidly adaptive work by health officials, and near-total cooperation from the populace.
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R&R - Reachout and Rebuild 