+100%-

Just seven days ago, the U.S. had 131,000 confirmed cases. Today, it has 375,000 confirmed cases of the coronavirus, and we obliterated our past records of new confirmed cases with 30,000 each over the past three of the past four days. At this pace, the U.S. will hit 500,000 confirmed cases in the next week and a million in about three weeks.

That’s six times as many as China – whose numbers no one trusts anymore. (China, for some reason, does not count asymptomatic people who test positive.)  China, it turns out, has a lot to answer for.  The Washington Post reported that the CDC tried to get a team into China to get samples of the virus in early January, but were rebuffed and didn’t get the samples they needed to build the U.S.’s tests for weeks.

The U.S. continues to up its testing program dramatically and is now testing 100-150,000 people a day. Except perhaps for China, no country has come close to that and it’s going to get better. STAT news projects that in the next couple of weeks the U.S. will be running 200-300,000 tests a day.

Percent of positive coronavirus test results gives us a rough idea of how much virus is out there and how effective our testing is. A climbing percentage suggests the virus is continuing to spread.  A declining percentage suggests the opposite. Over the past three days, the percentage of positive tests in the U.S. has climbed from 18.3% to 18.6% to 19.4%.

Want to track the virus? Check out Health Rising’s new Coronavirus Tracking page for the many different ways to track its spread.

Tracking

Peaking?

Thankfully, the coronavirus outbreak is not a forever thing. It will peak – and will probably peak in the not very distant future in most countries. The virus will probably still be around, but the worst, at least for the time being, will hopefully be over.

The peak is important because it’s during the peak that health resources are most stretched, resulting in more fatalities. One of the goals of social distancing has been to push the peak back as far as possible to provide more time to produce the needed health resources (everything from masks to respirators) to deal with it.

The IHME models predict the peak outbreak times for countries, states and provinces across the world

The models most commonly used are coming out of The Institute for Health Metrics and Evaluation (IHME) in Washington, a worldwide health data gathering institute funded by the Bill and Melinda Gates Foundation.

The IHME’s models, which are being constantly updated using data from a variety of sources, are generally predicting an earlier and smaller peak to the virus than some other models. Let’s hope they are right.

The different models can vary greatly, but most suggest that the U.S. and other countries are moving into the thick of it and that a peak rate of infection and deaths will hit over the next couple of weeks to next month. The IHME suggests that the U.S. as a whole is 8 days from the peak, and on that date will be 36,000 hospitals beds, 16,000 hospital beds and 25,000 ventilators short (!). Now is not the time to get ill!

Once the peak came in China, it lasted for a week or more before declines came. That may be the situation Italy is in now.

The Hot Spots

New York City, New Orleans, and DetroitThe hot spots in the U.S., are believed to reach the peak of their outbreaks over the next week. Projections suggest that, at the peak, the virus will probably kill 500-700 people a day in NYC. New York crematoriums are now running 24 hours a day and even requesting that the dead be buried in cardboard boxes because they burn faster. The city put out a wireless emergency alert on Friday asking any licensed medical personnel to volunteer to fight the virus.

Italy’s hot spot, Lombardy, has been the scenario no one wants to repeat, yet the New York Times graphs (new weekly confirmed cases per thousand) suggest that the virus is on an even greater tear in New York City, Albany, Georgia, and New Orleans. New York posted its largest gain in confirmed cases ever (10,000) yesterday.

The United Kingdom – As expected, deaths have shot up rapidly in the U.K. The deaths now are occurring to those at risk who caught the virus 2 or 3 weeks ago. With the expected peak, ironically on the day, Easter Sunday, Donald Trump once predicted the U.S. to be back in business, the country may see rising deaths over the next month.

The country is expected to remain in an intense lockdown until the end of May. The Imperial College Modeling team reported a couple of weeks ago that with the social distancing practices put into place, the British medical system should be able to withstand the peak.

Italy – The virus has been churning through Italy for 6-8 weeks and the country has been in lockdown for almost a month. The percentage daily growth rate of new cases has decreased and deaths have stabilized. Still, Italy is adding over 4,000 new confirmed cases a day. Thus far, Italy has been in more of plateau than a peak.

Seattle – Seattle is interesting because it was an early hot spot. Projections now indicate that the peak will hit over the next week. A recent report suggests that the R0 for the virus – the number of people that each infected person is likely to infect – is down significantly from over 2.7 to 1.4.

Others

The predictions for the not-so-hot spots suggest that the peak in most cities will follow the peak in the hot spots by a couple of weeks; California (and Philadelphia) appear to be exceptions. California’s institution of more rigorous social distancing measures earlier may have allowed it to push back the peak to mid-May and blunt it. (Every model shows that pushing back the peak also blunts it and results in fewer deaths.)

Some more peaks predicted: Miami – end of April; Boston – April 10-20th; Philadelphia – mid-May; Phoenix – late April; Chicago – later half of April; Minneapolis – early May.

Is It in the Air?

Coronavirus aerosolization

Is the coronavirus in the air? (Image by mohamed Hassan from Pixabay)

Is the virus spreading through the air? There’s no doubt that if someone sneezes or coughs on you or next to you, you can get it that way, but could somebody sneeze, cough or simply breathe, and thirty minutes later infect you if you walk through the air they were in? Staying aloft that long would require that the virus be present in aerosolized particles (as opposed to droplets) smaller than 5 micrometres (.0002 inches) in diameter. These tiny aerosolized particles can be passed simply by talking and breathing.

You’d think this would be worked out by now but it hasn’t been. On March 27th, the World Health Organization stated that “there is not sufficient evidence to suggest that SARS-CoV-2 is airborne.”

Nature reported, though, that experts on airborne infections assume the virus is airborne but that it will take time – too much time – to gather the evidence that it is. Aerosol scientist Lidia Morawska, of the Queensland University of Technology in Brisbane, Australia, said:

“In the mind of scientists working on this, there’s absolutely no doubt that the virus spreads in the air. This is a no-brainer.”

A Chinese researcher found evidence that viral transmission through the air can occur and “impact people both near and far from the source”. He recommended that the public wear masks. Two other studies, however, did not find airborne coronavirus, and one that did so didn’t find any infective particles. One study attempted but failed to find RNA from the virus in air collected  just 10 centimeters in front of an infected person who was breathing, speaking and coughing,

The sole study, amazingly enough to test the aerosol idea out, demonstrated that the virus can be found for up to three hours in the air under laboratory conditions which involved using a nebulizer to feed viral particles into a special drum. The study found that the viral infectivity half-life – that is, the amount of time that half the virus was still able to infect a culture – was just over an hour.  One of the co-authors noted that the conditions were “highly artificial”, but that there is probably “a non-zero risk of longer-range spread through the air”.

Another question involves whether enough virus is present in the air to infect someone. Quickly passing through an airspace where someone was breathing or emitting virus is one thing – standing next to someone who’s been hacking away for 30 minutes is quite another.

The consensus right now appears to be that when the virus is being transmitted, it’s usually being transmitted by picking it up on our hands and transferring it to our mouth, nose and eyes. When respiratory transmission occurs, it probably most commonly occurs via large droplets passed by coughing or sneezing which quickly fall to the ground after travelling usually a couple of feet – but possibly 25 feet.

STAT News reported that microbiologist and physician Stanley Perlman of the University of Iowa stated:

“I think the answer will be, aerosolization occurs rarely but not never. You have to distinguish between what’s possible and what’s actually happening.”

Some epidemiologists believe that we would see far higher rates of transmission, particularly among people who don’t know each other, than we are seeing thus far if the virus was strongly aerosolized. Earlier this month, CDC reported that 10.5% of household members are getting the virus, but only 0.45% of close contacts. That figure suggests that aerosolization of the virus is not a major source of infection as well.

Aerosolized transmission may be occurring but it’s not now believed to be a major source of infection. It should be noted that the danger of picking up an aerosolized form of the infection is worse in poorly ventilated areas.

Intensive Care Unit Doctor in New York City Shares About His Experience with COVID-19

“What I want you to know is that every single day we’re learning more…I’m not scared anymore.” Dr. Mark Price

Dr. Mark Price

Dr. Mark Price, an ICU doctor in the thick of it in New York City, urges people to be careful and not to be scared.

Check out a hopeful commentary on COVID-19 from an intensive care doctor on the front lines of the pandemic in New York City. His ICU unit is only caring for COVID-19 patients at this point.

Staying Safe

The virus goes throughout the entire body. About 80% of people just don’t feel good. The disease typically lasts between 5-14 days. People who get short of breath usually do so about day 3-5.

The overarching theme is sustained contact with someone who has the disease or someone who is about to get it. It’s almost exclusively from your hands to your face (eyes, nose, mouth). In order for an aerosolized infection to occur, they believe you need to be in sustained contact in infected air for 15-30 minutes.

COVID-19 is in your community – wherever you are – it is in the community. That is not to scare you.

Become a “hand-Nazi”. Know where your hands are and keep them clean all the time. He walks around with Purell. Every time he touches something, he Purells his hands.

It is not a disease that is primarily being transmitted by someone with the disease touching something and then passing it on. It’s overwhelmingly driven by being in sustained contact with someone.

Out of an abundance of caution, we make sure that after you touch something, you clean your hands. Always know where your hands are.

Be aware of when you touch your face. Wearing a mask stops you from touching your face. So, wear a mask. Washing your hands and wearing a mask (not touching your face) will stop, he believes 99% of the cases.

A medical mask is not necessary. The general community has zero need for N-95 masks. the mask is there to train people. Nurses and doctor’s in his hospital only wear an N95 mask when they’re doing something to a COVID-19 patient which will make them spit or cause aerosolization of the virus.

The health-care workers getting sick now have been in: (a) sustained contact with COVID-19 patients; and (b) were not protecting themselves properly earlier in the epidemic. He said now that they are protecting themselves properly, they are not getting sick.

In other words, so long as you keep your contacts short, you don’t have to be scared of your neighbor or the outside world. Throughout the world, the vast amount of transmission is via family and close friends not through casual contacts.

(But what is sustained contact? One epidemiologist stated it was having a face-to-face discussion with someone who is infected. Note that a small German study suggested that people infected with the virus are most contagious before they develop symptoms. Viral shedding dropped by day five in the mildly affected patients and continued to be high for ten days in two patients with pneumonia.

 

That may mean that while this doctor is surrounded by seriously ill COVID-19 patients, he may not regularly be in contact with the most contagious patients – the asymptomatic ones. It’s remarkable how few studies have examined patterns of viral shedding thus far.)

The doctor recommended that we shrink our social circle dramatically, but continue to go out for short walks.

  • Staying Safe – Check out Health Rising’s Staying Safe page including including hand washing, nasal irrigation, disinfecting, making a mask, plus – is the virus being aerosolized? How long the virus is alive on different surfaces, and does the amount of virus present matter?

Staying Safe Page: Practices to Keep You Safe from the Coronavirus

If You Get Sick

What to do if you get sick? You will probably get a fever (90% get fever), body aches, etc., and be sick for a week or more. Isolate yourself from your family. (Avoid sustained contact…) Have the sick person in a separate room/bathroom if possible. If you have to be in contact with them – wash your hands, put on a mask, wash everything you touch. Don’t take their temperature constantly.

If you live with someone who is vulnerable, they need to be completely isolated from you.

The current indication from the CDC is that when you start feeling better, you can return to work with a mask.

Going to the Hospital

“Going to the hospital is not a death sentence. The hospital is a safe place to be.” Dr. David Price

When should you go to the hospital? When you’re feeling short of breath. Not if you have a fever or have body aches, etc.

People feeling short of breath are short of breath for 5-7 days and then can go home. About 10% people with COVID-19 get short of breath and need to go to the hospital (10% of all infected). Of those who need to be in a hospital, 1-3% end up on a ventilator. When people get so short of breath that they can’t get to the bathroom, we put them on the ventilator. Of those, the overwhelming majority come off the ventilator 7-10 days later.

(The early studies are not so promising – thanks Richard. Price did say they are learning more and more all the time and are presumably getting better at keeping people alive. On the ICU subject the CDC recently reported that 78 percent of patients in the ICU had a pre-existing condition such as heart or lung disease or diabetes.)

With regard to younger people getting sick. Except for people 0-14, younger people are getting sick, are going to the hospital, and are being put on ventilators as well. Price said

“We (in the ICU) see a bit more older people, but we get a ton of 35-year olds. We see young people who get really sick and we see older people who do just fine.”

His hospital is not using ibuprofen – it’s using acetaminophen.

 Laura Hillenbrand’s Probable COVID-19 Experience

Laura Hillenbrand

Laura Hillenbrand ended up in the hospital with breathing issues and flu symptoms.

Laura Hillenbrand, the author of Seabiscuit and Unbroken, both of which were made into films, vividly (of course) describes her harrowing descent into coronavirus hell on a Facebook post.  She describes feeling short of breath and flu-like symptoms first, having the shortness of breath resolve temporarily, and then come roaring back:

“It began with a strange shortness of breath. I couldn’t seem to get a full breath of air, and found myself panting. I had a constant urge to cough. Friends commented on the odd hiss in my breathing, and the brevity of each breath I took. I was winded just having a casual conversation. My throat was raw…My muscles ached and I was perpetually chilled, sometimes shaking. My lymph nodes were swollen and painful. I had no congestion, yet my chest felt as if it were wrapped in duct tape, and I was breathing through gauze. This was nothing like the flu, or anything else I’d ever had.”

One takeaway is that Laura didn’t know how dangerously ill she was until a pulse oximeter reading indicated the oxygen saturation of her blood was 89 – way below the cutoff point – 92 – for getting checked out in the hospital. That morning, she was lightheaded and was “gasping wheezily” to get air, and was then directed to go straight to the emergency room. After testing negative for the virus (very likely a false negative) she was given a breathing medication and returned home. As of a couple of days ago, she was doing better but was still sick.

She didn’t mention ME/CFS in her post. To my knowledge, she hasn’t referred to it much for years, and it wasn’t clear if she still has it or not.  She said she was not in a high risk group, doesn’t have a compromised immune system and called herself “fit”.  Perhaps she’s recovered.

Still, she provided a cautionary tale for everyone – and a good reason to possibly get a pulse oximeter. (Note that they may not be completely accurate.)

One doctor advised that if you’re taking 12-18 breaths per minute, or if you can speak in full sentences and are not feeling short of breath, you probably have enough oxygen in your blood.

Treatment Updates

No study results are in, but the news – the really big news – is the enormous number of studies underway. Clinicaltrials.gov lists over 230 trials (50 in the last day!) involving dozens of substances that are underway or about to get underway.  In just a couple of days, the number of hydroxychloroquine and IV plasma studies, for instance, jumped into the high teens.

Check out Health Rising’s new Coronavirus Treatment Page For More.

Coronavirus Diagnostics and Treatments

Two Very Different Treatment Approaches from ME/CFS/FM Practitioners

(Please note that Health Rising does not endorse any treatment approaches and simply presents them for your information.)

Dr. Ian Hyams

Dr. Ian Hyms is the medical director of the Pain and Fatigue Clinic in West Vancouver, BC., and is the Interim Lead of the Complex Chronic Diseases Program at BC Women’s Hospital + Health Centre in British Columbia. He’s also a clinical instructor at the University of British Columbia. He provides an hour-long plus take on COVID-19, ME/CFS, FM and Lyme disease.

Courtney Craig – Nutritionist / Recovered ME/CFS Patient

Courtney Craig doesn’t think any supplement is up to battling the coronavirus.

Courtney Craig was able to use integrative and traditional medicine to recover from ME/CFS, but COVID-19 – that’s an entirely different ballgame. She doesn’t recommend any supplements

“There is NO evidence that any herbal or vitamin product, or dietary measure can prevent or treat this particular corona virus.”

and recommends not taking on a new supplement regimen now.

“Now is not the time to change your routines. Do not attempt a new ME/CFS-specific supplement, dietary plan, or fasting protocol. Keep your condition as stable as possible. Avoid activities that may trigger post-exertional malaise.”

Instead, focus on being as safe and as healthy as possible. Check out her “Chronic fatigue syndrome in the Time of COVID-19” post.

Health Rising’s ME/CFS/FM Doctors Resource Page

Check Health Rising’s ME/CFS/FM Doctors and Researchers Resource page on how to stay safe and support your health.

ME/CFS and Fibromyalgia Doctors’ and Researchers’ Report

Say What? A COVID-19 Voice Detector  (??)

It sounds space-agey, comes with a bunch of provisos, and is decidedly preliminary but then again, the people who created this app aren’t exactly guys in a diner, either. Researchers from Carnegie Mellon University and other institutions are creating an app they hope will be able to determine if you have COVID-19 just by analyzing your voice. The idea is to determine if signatures in your voice are similar to those found in COVID-19 patients.

Not approved by the FDA or CDC, definitely not a substitute for a medical test – and not available yet – but symptom tracking apps that can show outbreaks in real time are. Check them out on HR’s Coronavirus Apps page.

The Coronavirus App Page

Jarred Younger Seeking Info on COVID-19 Patients and LDN

From Jarred Younger:

“I am interested to hear of anyone’s experience with COVID-19 while taking LDN. If you were taking LDN and had/have a confirmed or suspected case of COVID-19, let me know how severe your symptoms have been and how long they lasted. You can email me at the address below (please use the email instead of facebook discussion). I don’t know if I will have a chance to respond to everyone, but I will definitely read everything sent. Please forward this on to anyone who might have information to share. Thank you!”

Please email Jarred at youngerlab@uab.edu.

Coronavirus Central – Resources From Health Rising

  • Tracking – check out the multiplicity of ways the virus is being tracked: its spread, its infectious rate, the deaths it’s causing, efforts to model its effects.
  • Advice From ME/CFS/FM Doctors and Researchers – ME/CFS/FM doctors and researchers give advice.
  • Staying Safe – how to stay safe: including hand washing, nasal irrigation, disinfecting, making a mask, plus – is the virus being aerosolized? How long is the virus alive on different surfaces, and does the amount of virus present matter?
  • Treatments – Check out the astonishing number of COVID-19 treatment trials underway.
  • Apps – be part of the solution; use apps that help us understand the spread of the virus; plus, use apps that can warn you if you’ve been in contact with someone who is infected.

The Coronavirus Series From Health Rising

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