6/27/20 AM UPDATE: New numbers, new COVID-19 research, clearing the air

I’ve heard from a handful of people with questions about some of the news that has come out in recent weeks about increased numbers, effectiveness of masks, and what some of the newest research means for the rest of the summer. I wanted to take some time to answer those questions, add some context to all of the numbers and research flying around, and hopefully give some extra background to some of the news stories you are probably seeing on social media and in the news.

Full disclosure: This may get scientific.

Fuller disclosure: This may be not be a quick read.

Fullest disclosure: My goal is to keep everyone better informed about the breadth of the COVID-19 situation.

Before I get started, I have my customary disclaimer that I am not a doctor…. I am not a doctor. The good news is I don’t have to be one in order to look at the science journals and do the mathematics that go into these posts.

New Numbers

WHO Numbers

Total Worldwide Cases: 9,473,214
Total Worldwide Deaths: 177,012

CDC Numbers

Total United States cases: 2,414,870
New Cases: 40,588
Total deaths: 124,385

Johns Hopkins

Total Worldwide Cases: 9,801,572
Total Worldwide Deaths: 494,181
Total Worldwide Recovered: 4,945,589
Total Worldwide ‘status unknown’: 4,855,983

Total US cases: 2,467,837
Total US deaths: 125,039
Total US recovered: 670,809
Total US ‘status unknown’: 1,797,028

Regional Numbers

	Total Cases	Tested	Deaths	%-positive	Mortality Rate
MS	25066	283123	1022	8.85%	4.08%
LA	54769	678006	3077	8.08%	5.62%
AL	33717	377857	887	8.92%	2.63%
TN	39444	741737	577	5.32%	1.46%
AR	18740	N/A	249	N/A	1.33%
Total	171736	2080723	5812	8.25%	3.38%

In Mississippi

Here is a look at the graphs showing numbers since the start of the pandemic

Here is a look at the running averages in cases and deaths

South Mississippi numbers

County	Total Cases	Percent of State	Density (low = good)	Total Deaths	Death Rate
Jones	994	4.1	1460	48	4.83%
Forrest	759	3.1	1013	42	5.53%
Wayne	461	1.9	2284	10	2.17%
Lamar	369	1.5	583	7	1.90%
Covington	263	1.0	1358	5	1.90%
Pearl River	232	0.9	418	32	13.79%
Marion	223	0.9	875	11	4.93%
Jasper	221	0.9	1349	6	2.71%
Smith	199	0.8	1250	11	5.53%
Clarke	193	0.8	1242	22	11.40%
Simpson	187	0.8	701	3	1.60%
Walthall	163	0.7	1141	3	1.84%
Jeff Davis	94	0.4	845	3	3.19%
Greene	75	0.3	552	7	9.33%
George	60	0.2	245	3	5.00%
Perry	56	0.2	468	4	7.14%

Making Estimates from past research

I talked about research from the Cruise Ships that 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.

	Estimated Symptomatic Total	Estimated Asymptomatic Total	Estimated Total
MS	38231	8392	46623
LA	83534	18337	101870
AL	51425	11288	62714
TN	60160	13206	73366
AR	28582	6274	34856
Total	261932	57497	319429

It’s not all bad news

One thing to keep in mind while you look at the numbers continue to rise is the intensity of the infection. So far, with the increased numbers, the number of hospitalizations hasn’t increased in an equal amount.

“We need to change our mindset and focus on severity of illness, rather than just counting the number of new infections. For the vast majority of the people testing positive, their illness is mild or they don’t even have symptoms,” said Dr. Donald Yealy, UPMC’s senior medical director and chair of emergency medicine. “This is why we watch the hospitalization rate and the need for intensive care, and those numbers are down. This indicates that the people in our communities who are most vulnerable to the disease aren’t getting it – and those who are tend to be the least affected.”

Now, before we all throw a party that this thing is over, please know that there is a lag time between people testing positive and people seeking medical attention. A lot like with a cold, a flu, or a broken bone. There is a gap between recognizing the problem and seeking medical attention for that problem.

So, given the recent bloom of higher numbers, the next week will be very telling about how potent this new round of the virus will be.

New Research

CDC identifies more ‘at risk’ groups

Based on the latest from the CDC, here is the list of people who are at an increased risk for “severe” infection from COVID-19.

• chronic kidney disease
• COPD (chronic bronchitis or emphysema)
• Obesity (body mass index [BMI] of 30 or higher)
• Immunocompromised state (weakened immune system) from solid organ transplant
• Serious heart conditions, including coronary artery disease, heart failure, and other diseases of the heart muscle
• Sickle cell disease
• Type 2 diabetes.

Conditions that might increase risk of severe COVID-19 illness include:

• Moderate to severe asthma
• Cerebrovascular disease
• Cystic fibrosis
• High blood pressure
• Weakened immune response due to blood or bone marrow transplant,
• Immune deficiencies (HIV or AIDS), use of corticosteroids, or use of other immune-weakening medications
• Conditions or treatments that weakens the immune response (cancer, cancer treatment, organ or bone marrow transplant, immunosuppressant medications, HIV or AIDS)
• Neurologic conditions, such as dementia
• Liver disease
• Pregnancy
• Pulmonary fibrosis (damaged or scarred lung tissue)
• Smoking
• Thalassemia (a blood disorder)
• Type 1 diabetes.

COVID-19 “Negative” tests may not tell the whole story

A new paper published in the Annals of Internal Medicine titled, “SARS-CoV-2–Positive Sputum and Feces After Conversion of Pharyngeal Samples in Patients With COVID-19” investigated the people who were infected with COVID-19 and given a clean bill of health, so to speak, after testing negatively on the nasal swabs, but still carried a viral load in their lungs or stool.

From the authors:

Pharyngeal swabs are widely used to determine the appropriateness of a patient’s discharge from the hospital and whether isolation continues to be required. We observed 22 patients who had positive RT-qPCR results for SARS-CoV-2 in the sputum or feces after pharyngeal swabs became negative. These findings raise concern about whether patients with negative pharyngeal swabs are truly virus-free, or sampling of additional body sites is needed. It is important to emphasize, however, that it is not known whether the positive RT-qPCR results for SARS-CoV-2 observed here indicate that a patient continues to pose a risk for infection to others. Related, positive throat samples (after negative samples) after hospital discharge have been reported.

The authors admitted that the study was not a “perfect” scientific study since it was a small sample size and it was a “convenience” study. But they did note that “These results warrant further study, including the systematic and simultaneous collection of samples from multiple body sites and evaluation of infectious risk.”

A lot like the study we discussed back in March about the one child that was found to be “COVID-free” yet carried the virus in his digestive tract, this may be a similar situation for some people.

re-infection may be a real threat down the line

From a new paper titled, “Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections” there is a lot to unpack. But give give the below snippet a quick read, and then swipe down…

The strength and duration of immunity after infection are key issues for ‘shield immunity’18 and for informing decisions on how and when to ease physical distancing restrictions19,20. Previous studies have shown that circulating antibodies against SARS-CoV or MERS-CoV last for at least 1 year. Sustained IgG levels were maintained for more than 2 years after SARS-CoV infection.

Antibody responses in individuals with laboratory-confirmed MERS-CoV infection lasted for at least 34 months after the outbreak25. Recently, several studies characterizing adaptive immune responses to SARS-CoV-2 infection have reported that most COVID-19 convalescent individuals have detectable neutralizing antibodies, which correlate with the numbers of virus-specific T cells26–29.

In this study, we observed that IgG levels and neutralizing antibodies in a high proportion of individuals who recovered from SARS-CoV-2 infection start to decrease within 2–3 months after infection. In another analysis of the dynamics of neutralizing antibody titers in eight convalescent patients with COVID-19, four patients showed decreased neutralizing antibodies approximately 6–7 weeks after illness onset.

One mathematical model also suggests a short duration of immunity after SARS-CoV-2 infection31. Together, these data might indicate the risks of using COVID-19 ‘immunity passports’ and support the prolongation of public health interventions, including social distancing, hygiene, isolation of high-risk groups and widespread testing. Additional longitudinal serological studies profiling more symptomatic and asymptomatic individuals are urgently needed to determine the duration of antibody-mediated immunity. In addition, low levels of anti-viral IgG in asymptomatic patients, who might be more likely to become seronegative, further support the need for timely serosurvey to study the true infection rate.

In short, the bodies immune response to COVID-19 may only linger for a few months after the body fights it off. That means that if you are infected, and survive, the antibodies responsible for fighting off the virus may not be there a few months later and thus you can be re-infected.

New Symptoms

The CDC has added to the list of potential symptoms for those infected with COVID-19.

The CDC and the medical community continue to note that the incubation period for COVID-19 is about 2-14 days. With most people developing symtpoms between Day 2 and Day 9. The average amongst researched “infected individuals” is 5.1 days.

In other words, on average, it takes about five days to develop symptoms.

From Harvard Medical:

What treatments are available to treat coronavirus?
Currently there is no specific antiviral treatment for COVID-19. However, similar to treatment of any viral infection, these measures can help:

While you don’t need to stay in bed, you should get plenty of rest.
Stay well hydrated.
To reduce fever and ease aches and pains, take acetaminophen. Be sure to follow directions. If you are taking any combination cold or flu medicine, keep track of all the ingredients and the doses. For acetaminophen, the total daily dose from all products should not exceed 3,000 milligrams.

If you develop symptoms, the CDC recommends staying home, except to visit a medical facility for testing or treatment.

Steps to help prevent the spread of COVID-19 if you are sick
If you are sick with COVID-19 or think you might have COVID-19, follow the steps below to care for yourself and to help protect other people in your home and community.

Stay home except to get medical care
— Stay home. Most people with COVID-19 have mild illness and can recover at home without medical care. Do not leave your home, except to get medical care. Do not visit public areas.
— Take care of yourself. Get rest and stay hydrated. Take over-the-counter medicines, such as acetaminophen, to help you feel better.
— Stay in touch with your doctor. Call before you get medical care. Be sure to get care if you have trouble breathing, or have any other emergency warning signs, or if you think it is an emergency.
— Avoid public transportation, ride-sharing, or taxis.

Separate yourself from other people
— As much as possible, stay in a specific room and away from other people and pets in your home.
— If possible, you should use a separate bathroom.
— If you need to be around other people or animals in or outside of the home, wear a cloth face covering.

When to Seek Emergency Medical Attention
Look for emergency warning signs for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately

— Trouble breathing
— Persistent pain or pressure in the chest
— New confusion
— Inability to wake or stay awake
— Bluish lips or face

Call 911 or call ahead to your local emergency facility: Notify the operator that you are seeking care for someone who has or may have COVID-19.

Grocery shopping tips from Harvard Medical

I’ve heard from a lot of people about going to the store to pick up food and how they can protect themselves. Since the coronavirus that causes COVID-19 is primarily transmitted through droplets containing virus, or through viral particles that float in the air, a lot of people are concerned about navigating the aisles between other people. Rightfully so! If you walk by someone who has just coughed or sneezed, the virus may floating around in the air, free to be breathed in by you, directly. Or indirectly when that person ‘s droplets land on the packaging for a loaf of bread of box of cereal – and then you reach of that item.

Harvard Medical says safety “maintain at least six feet of distance between yourself and other shoppers. Wipe frequently touched surfaces like grocery carts or basket handles with disinfectant wipes. Avoid touching your face. Wearing a cloth mask helps remind you not to touch your face and can further help reduce spread of the virus. Use hand sanitizer before leaving the store. Wash your hands as soon as you get home.”

Harvard notes that if you are older than 65, or at increased risk for any reason, limiting the trips you take – in general – is a good starting point. Ask a neighbor or friend to pick up groceries and leave them outside your house. See if your grocery store offers special hours for older adults or those with underlying conditions. Or have groceries delivered to your home.

Once the groceries are at your house, though, the work isn’t done. Harvard notes:

Recent studies have shown that the COVID-19 virus may remain on surfaces or objects for up to 72 hours. This means virus on the surface of groceries will become inactivated over time after groceries are put away. If you need to use the products before 72 hours, consider washing the outside surfaces or wiping them with disinfectant. The contents of sealed containers won’t be contaminated.

After unpacking your groceries, wash your hands with soap and water for at least 20 seconds. Wipe surfaces on which you placed groceries while unpacking them with household disinfectants.

Thoroughly rinse fruits and vegetables with water before consuming. And wash your hands before consuming any foods that you’ve recently brought home from the grocery store.

So make sure you are taking the time to protect yourself, and your family. These quick tips could go a long way toward keeping you healthy.

Wear a mask

In the paper, “The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2” authors looked at a small population of mask-wearing people versus non-mask-wearing people and found a reduction in transmission of 73-percent.

From the paper:

Within first 100 days (31 December 2019 to 8 April 2020), 961 COVID-19 patients were diagnosed in Hong Kong Special Administrative Region (HKSAR). The COVID-19 incidence in HKSAR (129.0 per million population) was significantly lower (p<0.001) than that of Spain (2983.2), Italy (2250.8), Germany (1241.5), France (1151.6), U.S. (1102.8), U.K. (831.5), Singapore (259.8), and South Korea (200.5). The compliance of face mask usage by HKSAR general public was 96.6% (range: 95.7% to 97.2%). We observed 11 COVID-19 clusters in recreational ‘mask-off’ settings compared to only 3 in workplace ‘mask-on’ settings (p = 0.036 by Chi square test of goodness-of-fit).

The Bottom Line

Do what you can to protect yourself from getting this virus. The more we learn about this thing, the more it is apparent that even if you aren’t visibly, physically ill, there may be other issues you have to face. Between new research showing lung damage occurring in asymptomatic patients, or the ‘viral shedding’ of asymptomatic people lasting – up to – twice as long as symptomatic people.

So, yes, you may not “feel” sick. But this virus can still cause lung damage while you pass it along to other people for up to three weeks while you “feel fine” and walk around without wearing a mask.

And a brief reminder that the term “mild” COVID-19 does not mean a simple cough and a fever for a few days, it simply mens you aren’t in a hospital bed. Nor are you in the ICU. You can still be sick as a dog, have a high fever, and not be able to breathe.

So, please, do what you can to avoid becoming sick.