Lynne Peterson is the Senior Writer for Trends-in-Medicine.
This is Part 1 of a 2-part Covid-19 update, focusing on all things Covid-19.
Be careful, be safe, and be well.
Mitigation efforts aimed at slowing the SARS-CoV-2 virus and Covid-19, the disease it causes, appear to be working in the U.S. and Europe. The peak has likely been reached in the U.S and in many European countries, and steps — mostly baby steps — are being taken to re-open economies. It seems increasingly unlikely that President Trump’s prediction of a V-shaped recovery will occur in the U.S. or elsewhere. The outlook is for either a U-shaped recovery or a W-shaped recovery.
There are also predictions that there will be a second wave in the Fall, likely coinciding with the annual flu season. A University of Buffalo epidemiologist predicted that social distancing will not be able to be discontinued in the U.S until mid-2020, and the pandemic won’t really end until July 2022.
There will be another Coronavirus Update soon looking at the resumption of elective surgery and more.
Meanwhile, President Trump’s valet, Vice President Pence’s press secretary, and more than a dozen Secret Service members have tested positive for Covid-19, turning the WH into a potential hotspot. Dr. Anthony Fauci, HHS Alex Azar, and FDA Commissioner Stephen Hahn have placed themselves in a 14-day quarantine after being in contact with someone who tested positive for the virus.
Covid-19 By the Numbers
Worldwide, more than 3.8 million people have been infected with the coronavirus. In the United States, total cases passed the 1.2 million mark. As of May 7, the virus has killed 268,887 people worldwide, with 28% of those in the U.S.
For the most up-to-date tallies, visit:
Among the countries we are monitoring — looking over the past 10 days, not at just one point in time:
- The rate of cases per capita — a good way to compare what is going on in different countries — is highest in Spain at 0.54%, followed by the U.S. at 0.37% and Italy at 0.36%. This compares to a 0.05% rate worldwide. France, Italy, and Spain appear to have stabilized, but the U.K. continues to creep up.
- Looking at fatality rates (deaths per 100,000 people), Spain, again, is the worst at 55 (or roughly 1 in every 2,000 people). Germany is lowest at 9, followed by the U.S. at 22 (or roughly 1 in every 5,000 people), with most other European countries nearly double the U.S. rate (U.K. 45, France 39, Italy 49). Interestingly, Sweden has a higher rate (29) than the U.S., so its lack of a formal lockdown has not spared lives. In all the countries monitored, the fatality rate per 100,000 people has slowly but steadily increased over the last 10 days; none have stabilized, and worldwide, the rate has creeped up to 3.5. The comparison of France and the U.K. is particularly interesting, since they have comparable populations.
- On the key metric of new cases per day, there seems to be a steady increase worldwide. However, there is a flattening in Spain, Italy, and the U.S, though not the U.K. All of the states followed have flattened, and a couple — New York and Washington state — are trending down.
Key Questions About Covid-19
- Did the virus accidentally escape from the Biosafety Level 4 laboratory in Wuhan, China? Maybe, but that is still just a theory. What really has some governments around the world suspect was China’s failure to give the world a timely alert about the dangers of this virus and to let experts into the country to study the virus. As President Trump pointed out, China banned flights out of Wuhan to other parts of China (e.g., Beijing) but continued to allow flights from Wuhan to other countries.
- Is the virus man-made or genetically modified? That idea appears to have been debunked. A statement by the U.S. Office of Director of National Intelligence said, “The Intelligence Community also concurs with the wide scientific consensus that the Covid-19 virus was not man-made or genetically modified.”
- Can patients get Covid-19 twice? There were reports of 263 patients in South Korea who got the virus, cleared the virus, and then tested positive again, suggesting reinfections or reactivations, so no immunity. However, South Korean researchers now say the second positive tests were due to inactivated RNA from dead virus, not true positives, because the RT-PCR tests used cannot differentiate between live and dead genetic viral material.
- Do antibodies confer immunity to a new Covid-19 infection? The FDA and other experts continue to caution that the presence of antibodies has not been proven to confer any immunity. And, if there were immunity, there are no data on how long that immunity would last — days, weeks, months, a year, forever?
- Will the mutant strains all be susceptible to the same vaccine? The original virus from China, which was the strain that first hit Washington state, is not the more contagious strain that has done so much harm in Europe and New York, according to a preprint, non-peer-reviewed study that appears online in medRxiv. Initially, the virus was not thought to mutate significantly, so the expectation was that a vaccine for SARS-CoV-2 would provide lifetime protection like a measles vaccine, rather than requiring a new vaccine yearly as with influenza.
The current thinking is that the spike mutations (and there are at least 14 of them) are not likely to make the virus immune to a general SARS-CoV-2 vaccine or to require a new vaccine each year because the mutations are not in a key area. However, that is yet to be proven.
And, another study — a computational analysis of 6,000 coronavirus sequences from around the world — by researchers at Los Alamos National Laboratory, posted preprint, and not peer reviewed, on BioRxiv.org, found that the New York strain (D614G), while more highly transmissible, is not more lethal, but it may make people more vulnerable to a second infection. The researchers also warned that if the pandemic doesn’t wane with summer, the virus could mutate further, potentially making the effectiveness of vaccines currently under study less effective and/or reducing any natural immunity from having Covid-19 the first time.
The World
- WHO: The World Health Organization extended its declaration that the Covid-19 pandemic continues to warrant a public health emergency of international concern. WHO’s Covid-19 emergency committee recommended development of guidance for the resumption of passenger travel and expressed concern about disruptions of food and supply shipments in some countries.
- BRIC: China continues to report nearly flat cases and deaths, but the other BRIC countries — Brazil, Russia, and India — are still in the upward trajectory. India is planning to repatriate hundreds of thousands of its citizens stranded abroad.
- International travel: Travel around the world has virtually ground to a halt, and there are no signs this is likely to improve in the near future (or even for many months). Many countries are banning travelers and/or quarantining new arrivals for 14 days, which pretty much ends movement. Australia and New Zealand are considering a “trans-Tasman bubble,” that would allow travel between the two countries only.
- Austria: Declared the outbreak now under control.
- France: The first case of Covid-19 in France was likely a patient in a hospital near Paris thought to have pneumonia on December 27, 2019, who actually had Covid-19. This indicates the virus reached Europe earlier than previously thought.
- The country will start to loosen restrictions on May 11. Prime Minister Édouard Philippe told Parliament, “We are going to have to learn to live with the virus. We must learn to live with Covid-19 and to protect ourselves from it.”
- All incoming travelers will be quarantined for 14 days.
- Germany: Federal tourism commissioner Thomas Bareiss said Germans may be able to travel for vacations this summer to certain European locations (e.g., Austria, Belgium, France, Greece, Majorca, Netherlands, Poland), but details are being worked out.
- India: After a lockdown slowed/halted production in Baddi, India, this pharma production hub is back at work, though supply chain concerns remain.Iran allowed 132 mosques in lower risk areas – and drive-in movie theaters (for the first time since 1979) – to re-open.
- Japan: The government extended the state of emergency until the end of May. The island of Hokkaido, which was the first place in the country hit with the virus, is back in lockdown after lifting the shutdown resulted in a new outbreak.
- U.K.: The U.K. has become the hardest hit country in Europe, with the highest total number of deaths — even higher than Spain or Italy — but the U.K.’s per capita death rate is still lower than Spain or Italy. The best comparison for the U.K. may be France because the two countries have similar populations (~67 million), and the U.K. has a higher per capita case rate, a higher per capital death rate, more total cases, and more total deaths than France. Prime Minister Boris Johnson says the U.K. is “past the peak” of the coronavirus outbreak.
United States
- U.S. fatality rate: President Trump predicted that deaths from Covid-19 in the U.S. are likely to be about 100,000, far above the 74,073 estimate from the University of Washington’s Institute for Health Metrics and Evaluation (IHME) on April 28. Then, the next day, IHME once again raised its estimate of projected U.S. deaths through August 4, 2020, this time to 134,475, its highest estimate yet. The continuous changes in the IHME projections, first step-wise down from the initial 90,000, then steadily up, raise questions about the reliability of any of its estimates or “adjustments.” This suggests that the estimate that the pandemic won’t end until July 2022 might need to be given more credence.
- Contact tracing: As the economy opens up, testing and contact tracing gain even more importance. This is a well respected system for limiting disease outbreaks, but to use it in a pandemic situation requires a scale far above what Centers for Disease Control and Prevention (CDC) is capable of doing nationwide by itself. Contact tracing means anyone who a Covid-19-positive patient may have exposed will need to be contacted and tested. It’s a big job. New York Gov. Andrew Cuomo estimated it will take an “army” of tracers, estimating that could mean 6,400-17,000 tracers in New York alone. In states with fewer cases of Covid-19, state and local health departments may be able to handle the tracing.
- Cruises: Carnival Cruise Line said it will resume cruises with just eight of its 109 ships in August 2020 at ports where most passengers arrive by car instead of by plane, and it has a waiting list of people anxious to take a cruise. On the other hand, Norwegian Cruise Line said it may have to file for bankruptcy.
U.S. Economic situation
- Total unemployment in the last six weeks has risen to more than 33 million.
- Treasury Sec. Steven Mnuchin said that paycheck protection program (PPP) loans above $2 million from the small business administration will get a full audit to make sure they are valid.
Meat packing plants: Outbreaks have been extensive, leading to closures, creating backups in the supply chain and shortages at stores and restaurants. President Trump invoked the Defense Production Act (DPA) to order the plants to remain open. The problem is both finding a way to add social distancing to a workplace not conducive to that and finding workers not infected and willing to work. More than 6,500 workers (~3% of all workers) in 115 meat processing facilities across 19 states have been infected, with 30 deaths thus far. Note: The FDA insists the virus is not spread on or through food.
Nursing homes and long-term care facilities: There are ~15,600 nursing homes in the U.S, with ~1.3 million residents. More than 7,000 nursing home patients in the U.S. have died from Covid-19 (including ~4,800 in New York, >1,500 in New Jersey, 395 in Texas, and 325 in Florida). Nursing home deaths account for ~64% of Covid-19 deaths in Colorado, 45% of Texas deaths, and ~10% nationally.
Pets: Two tigers, a lion, two cats, and a dog have caught Covid-19 in the U.S., and the CDC is now recommending social distancing for pets. But they don’t need to wear masks.
Schools: All but four states canceled school for the rest of this school year.
Sequencing: The CDC announced a consortium aimed at expanding the use of whole genome sequencing (WGS) of the SARS-CoV-2 virus — SPHERES (Sequencing for Public Health Emergency Response, Epidemiology, and Surveillance). The national network will connect sequencing laboratories to speed release of SARS-CoV-2 sequence data into the public domain.
Stay-at-home orders: At least 21 states loosened their stay-at-home orders on May 1, and 31 will have done that by May 11. However, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), said he is “concerned that some states are leapfrogging over the first checkpoint [in the Task Force guidelines].”
Toilet paper shortage: In the first few days/weeks of the stay-at-home orders, a shortage of toilet paper might have been understandable as people stocked up on that as well as food and other supplies. However, the shortage has continued. It is still hard to find toilet paper and other paper products. Why is the shortage continuing? One reason may be that, with people staying home, they are using their bathroom more often — instead of public restrooms — and public restroom toilet paper can’t just be switched to consumer use.
Travel: TSA said travel last week was up 20% over the previous week. Most airlines said they won’t assign the middle seat, flight attendants will wear a mask, and passengers will be required to wear a mask. There is also discussion of some form of testing of passengers at airports, but those details are not yet worked out.
White House Coronavirus Task Force: Vice President Pence said there are preliminary discussions ongoing at the White House about phasing out this task force on or before mid-June. President Trump initially said there needs to be a different group set up for the re-opening, but then he said that the Coronavirus Task Force will continue indefinitely.
President Trump
- Did not extend the federal government social distancing guideline when they expired on May 1, leaving re-opening decisions to the governors.
- Said Fauci will be allowed to testify before a Senate committee but that none of the White House Coronavirus Task Force members will be testifying at this time before any House committees.
U.S. States and Cities
Only a few states have not yet peaked in Covid-19 cases — Arkansas, Mississippi, Nebraska, North Dakota, South Dakota, and Utah. By May 15, all of these are expected to have peaked.
States are starting to re-open. By the end of this week at least 14 states are likely to have eased restrictions. Most of those opening have Republican governors, and most of the strictest closures are in states with Democratic governors. Most governors (even Republican governors) are not following the White House Coronavirus Task Force guidelines but are making their own decisions on timing and what to open. This prompted Dr. Fauci to say on CNN, “How many deaths and how much suffering are you willing to accept to get back to what you want to be some form of normality sooner rather than later?”
The things on which all governors appear to agree:
- Continuing the no visitation rule for nursing homes remains in place.
- When restaurants open, inside seating is or will be restricted to 25% capacity.
- No large gatherings or fans at sporting events. Fauci said, “We are not ready for sports to resume this year.”
- At least some elective surgeries can resume.
- Masks should be used in public, but that is voluntary in some states and mandatory in others.
There is no agreement on the re-opening of:
- Barbershops and hair salons: open in Georgia, closed in California.
- Movie theaters: open in Texas, closed in most states.
- Beaches : closed in Orange County, California; open in Texas and most of Florida.
Los Angeles, California is offering free coronavirus testing for all residents, and there is no limit on how many times a person can be tested (at least for now).
Maryland will open Ocean City boardwalk beaches on May 9 — but only to residents, though police reportedly will not be checking license plates or IDs. This sounds like a prescription for a crowd, since relatively few people live there compared to the number of people who have vacation condos/homes there.
Massachusetts started adding people who die at home from apparent, not necessarily confirmed, Covid-19 to the state’s official numbers. The state is also going back and examining death certificates as far back as March 1, 2020, to catch victims who may have been missed in the official numbers.
Michigan: Gov. Gretchen Whitmer extended her blanket stay-at-home order until May 28, despite protests.
New York:
- Gov. Andrew Cuomo said on April 29th that new hospitalizations had declined for 15 straight days, and on May 5th he said the state is coming down the other side of the mountain.
- Preliminary results from a 3-day survey of 100 New York state hospitals found that 66% of the people hospitalized were people who claimed they had been staying at home (either retirees or unemployed) and 22% were from nursing homes and assisted living facilities. In New York City, 45% of patients in the survey were African-American or Latino. Gov. Cuomo called the findings “shocking.” How did people at home get the virus if they were really staying home?
- Gov. Cuomo ordered the closure of New York City subways every day from 1am to 5am for disinfecting. One thing being used to kill the coronavirus on subways is: ultraviolet light.
- Thomas Frieden, MD, MPH, the former head of the CDC, said two months (March and April 2020) of deaths in New York were worse than any 2-month period during the 1917 Spanish flu.
- The emergency Covid-19 hospital that the Army Corps of Engineers created at the Javits Center was dismantled, and the USNS Comfort returned to Norfolk.
- At least 25 children (mostly in New York but also elsewhere in the country) have been hospitalized with symptoms that might be related to the coronavirus. Instead of the respiratory symptoms generally seen in adults with Covid-19, the children are presenting with a rash, eye redness, and/or circulatory problems. The syndrome is being referred to as “pediatric multisystem inflammatory syndrome.” It appears similar to Kawasaki disease, a rare childhood illness that can lead to inflammation of the blood vessels, particularly the coronary arteries. The children are generally responding to treatment.
- A federal judge ordered the state to hold its Democratic presidential primary on June 23, as originally planned.
Texas: Nearly half the people who have died in Texas were in a nursing home or assisted living facility (395 of 884 as of May 3).
Regulatory News
The Centers for Medicare and Medicaid Services (CMS):
- Increased payments for telehealth visits by ~140% and agreed to cover telehealth physical therapy.
- Suspended the Advance Payment Program for physicians that had been put in place in late March to help offset the financial damage to healthcare providers from the Covid-19 pandemic.
- Eased the requirements for coverage of Covid-19 tests.
- Detailed how hospitals can protect staff and patients as they re-open for non-emergent (and non-Covid-19) care.
- Litigation: Senate Majority Leader Mitch McConnell (R-KY) said the Senate will not pass more coronavirus relief unless there is also legislation to protect businesses from health and safety lawsuits related to Covid-19 in order to prevent a post outbreak “lawsuit pandemic.”
The FDA:
- Created a new “umbrella” pathway for serology (antibody) tests seeking an emergency use authorization (EUA). Under this pathway, the tests will be submitted to an interagency testing group and will be run against a panel of ~30 samples confirmed positive for anti-SARS-CoV-2 antibodies as well and 80 pre-Covid-19 samples that are antibody negative. This will help determine the test’s specificity and sensitivity in a standardized fashion.
- The FDA released new guidance outlining exclusions and exemptions to certain Drug Supply Chain Security Act requirements as a result of Covid-19. The exemptions apply to distribution of drugs under an EUA and to other products approved for diagnosing, treating, preventing, mitigating, and curing Covid-19.
- Senate Democrats introduced a bill that would federalize the medical supply chain and increase production of personal protective equipment (PPE), testing supplies, and other items needed for Covid-19 treatment. The Senators said they would push to have this bill included in the next Covid-19 relief/stimulus package. The legislation would establish a new executive officer to oversee the production of supplies and to issue weekly reports on the supplies that are needed. The executive officer would then be required to issue purchase orders under the Defense Production Act for those needed supplies and oversee their distribution.
Lynne Peterson, Contributing Writer, Senior Writer for Trends-in-Medicine
Cat ID: 190
Topic ID: 79,190,730,933,190,520,926,192,927,151,928
