Coronavirus pandemic non-socio-political discussions

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RxCowboy

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Been trying to tell my wife about the benefits of more D. Don't refute the study quite yet.
Didn't refute anything, only pointed out the shortcomings of the data. You absolutely cannot make cause-effect statements on this. As they said in the last line, there needs to be a study where VitD is directly measured.
 
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What did you think about the lack of an N?
That was a concern especially since they seem to be pulling data from so many sources. The actual models, if performed as described, were the legit part. I don't think it will matter a ton because it's going to get killed in peer review at any legit journal, even assuming the N was included in their submitted article.
 

RxCowboy

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Dr. Harris-Fletcher is an OB-GYN at Integris Baptist Medical Center and an Oklahoma State Med grad.

Kim Harris Fletcher is feeling hopeful.

TGIF! It’s data dump time!
Today’s COVID infected Oklahomans (red) rose 2.2% to 4424. The number of cumulative hospitalizations (purple) has increased less than 1%, by 10 patients to 815. **Current hospitalizations** continue the downward trend at 228! The 2.6% increase in recovered patients (green) now out pace the newly diagnosed (2.2%). Unfortunately, we have lost 6 more Sooners to this disease.

Our 3 day rolling average (99 pos/day) and our 7 day rolling average are aligning, with our 7 day rolling average today at 97 pos/day. Our 7 day rolling average continues to fall, which is also good news.

With this marking the 2nd week of our soft reopening, I think we can be encouraged, but NOT cocky. Please mask in public, wash those hands and be socially responsible. This isn’t about you. It’s about all of us. And above all, be kind to each other.
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Didn't refute anything, only pointed out the shortcomings of the data. You absolutely cannot make cause-effect statements on this. As they said in the last line, there needs to be a study where VitD is directly measured.
I wasn't talking about vitamin D. Trying to skip a joke in.
 

RxCowboy

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May 11

Covid-19: Monday update
There is a lot to discuss today so I tried to keep each point short.

1. Since the pandemic began hundreds of products have been falsely marketed to consumers as things that will treat, diagnose or prevent covid. The FDA monitors this and works to get such claims removed. Please do not fall for fake product claims but be aware there are plenty of them.

2. Montana had a case over the weekend - so they are starting their count over. Today will be day 3 in their new count if they make it through the day with 0 new cases. Overall the nation had a good day yesterday with 20k new cases. Hopefully this trend will continue through the week with perhaps a few days dipping below 20. All the states we are monitoring also had a good day with lower numbers, except for Georgia. It was just one day so while we want to keep it in perspective, we also want to celebrate the little victories.

3. Last Tuesday (6 days ago) we looked at total death count for the US compared to the flu. You may remember that we compared the 61k flu deaths over 8 months in 2017 to the 69.9K covid deaths in 5 months. 6 days later we have seen an additional 10k deaths from covid putting us at 80.7k deaths from Covid in the US, in 5 months. That is 20k more than the flu in less time.

4. Vitamin D is good for you but it does not ward off or cure covid. Yes a study was done but it didn't find that vitamin D cured or prevented covid. It wasn't even designed to determine that. Some research tells us that x causes y. Cause is actually pretty complicated to prove and there are very specific criteria for doing so (Bradford-Hill criteria of causation). Some research is designed to give us an indication of IF there could be a connection between two things. The Vitamin D study that is being cited was designed to see if there may be any connection between vitamin D and covid - it was designed to tell us if there was anything worth studying. It is an important first step in the research process but it wasn't designed to answer the question, only to guide the direction of future research. So they looked at countries who have low vitamin D levels in general and compared their case count of covid to countries who have high vitamin D levels. They did not compare actual vitamin D levels of actual people in those countries. So yes, by all means make sure you are getting enough vitamin D - that is a good thing to do always. But don't overdose (and yes, it is toxic if you take too much) and don't have a false sense of security.

5. There is a 5G rumor going around, most likely you have heard this. The theory goes that 5G allows the germs to communicate via electromagnetic signals. This is based off a paper that was published in 2011 and this topic is hotly disputed in the scientific world. However, we need not debate the paper or overall theory because there are some simple facts that can help us rule this out as a factor with covid. 1)the paper was written specifically about bacteria and covid is a virus. They are very different. 2)There are places with 5G that got a lot fewer cases than would be expected if this theory were applicable to viruses, such as Beijing. 3)There are places with very little 5G that got cases. So for now we can cross this off the list of things to worry about in connection to covid.

6. The Pediatric multi-system inflammatory syndrome is something to keep an eye on. Currently we do not know if it is related to covid (i.e. triggered by exposure even if the child doesn't necessarily develop covid symptoms) or if it is it's own new thing. The current theory is that it is a response to covid exposure and can develop in asymptomatic children, meaning the child doesn't develop covid but does develop this as a result of being exposed to covid. It is still rare, but it is something for parents and clinicians to watch.

7. Rashes are emerging as a new symptom, or at least we are noticing them more now that we are looking for it. From what we can tell they are typically seen in milder cases but just be aware of it. The rashes are quite varied ranging from a hive like rash to a chicken pox like rash. People with the rash describe it as feeling like they have too much icy hot on the skin or a burning sensation.

FINAL THOUGHTS: We are starting a new week and we are still in quarantine. Hopefully you gave yourself a break over the weekend and you are rested and ready to tackle the week. We are together in it, experiencing it differently, battling different things, and socially distanced, but together none the less. One day we will look back and tell stories of where we were during the Quarantine of 2020. Aim for your story to be one of inspiration and hope. You got this.
 

Bowers2

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5. There is a 5G rumor going around, most likely you have heard this. The theory goes that 5G allows the germs to communicate via electromagnetic signals. This is based off a paper that was published in 2011 and this topic is hotly disputed in the scientific world.
 

RxCowboy

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May 12

Covid19: Tuesday Update
This has been a very busy news week and I have gotten a few requests so I apologize in advance for the length of the post and for the things I didn't get to today-they are on the list for tomorrow. I tried to keep things short where I could so feel free to ask questions if you need additional context or more explanation on something.

1. A study came out of Canada (this is a preprint study not yet peer reviewed) that found temperature and/or latitude had no impact on the virus but humidity did seem to have a small impact. The applicability of this is that most likely the disease isn't seasonal like the flu so it won't just fizzle out over summer. However, the researchers suggested that a humidifier in your home may help. Note the "may" in that statement.

2. Traces of the virus have been found in semen. Thus far they do not believe it is enough to spread the disease and further research is needed but it is something to know. Additionally, in a case study (so a study of only one person) they also found the virus in the kidneys. As you know some covid patients need kidney replacement therapy (dialysis) so this may explain why. And another study found that 20% of patients in the study had brain changes/abnormalities as a result of the disease. More research is needed in each of these areas to have solid information but evidence is suggesting that the virus can have widespread impact in the body.

3. As testing increases but test shortages persist, some public health professionals are suggesting a one test per household approach. Because the virus spreads so easily among people in close proximity the idea is if one member of the family has it all members would, so there is only a need to test one. This is a viable approach and would conserve tests while still accomplishing widespread testing. The test is not pleasant.

4. The US was not the only country without enough PPE. We weren't even the only ones who didn't restock our Strategic National Stockpile (SNS) after SARS. Specifically, our northern neighbor is facing similar criticism. But in reality, even if the SNS had been fully stocked we would have seen shortages, not to the same extent, but shortages none the less.

5. Social circles - Each state is approaching reopening differently so the rules look different from place to place. But something that is being attempted in some areas is the creation of social circles. The idea is that if you are in quarantine and have been adhering to social distancing protocols, you shouldn't have the disease because we have been at this a while. If you have friends or family nearby that have also been quarantined and adhering to the protocols - they too can be assumed safe. Therefore, you can visit with them and feel safe in doing so. This protocol is considered safe for up to 10 people. However, and this is a big however, everyone in the social circle has to have been adhering to the protocols and has to continue to do so. Even then, it shouldn't be considered 100% safe. Every time you leave the house and go into a public place you have a risk of contracting the disease, even when taking precautions because little fails happen even if you don't realize it. So in areas where this is being implemented, you may want to take additional precautions after a member of the group has been out in public or avoid it altogether if members of your circle are high risk.

6. Viral load can last anywhere 15.6 days in mild cases to 49.4 days in severe cases - so you can be contagious to others for quite a while.

7. There's an app for that. There are apps to help you know what to do if you think you have symptoms. Now there is a research study being conducted that also uses an app. People are asked to enter how they are feeling in the app each day. It takes less than one minute and the researchers are hoping you will use it. The app is available for free via both Apple and Android and is called C-19 COVID Symptom Study if you are interested in participating.

FINAL THOUGHTS: Motivation is a global issue right now. People are finding motivation more difficult to find than toilet paper. Pay attention to your mental health and give yourself breaks. Turn off the news. Shut down social media. Take breaks. Go for a walk. Shower more. Push yourself when you must but then listen when your body or mind says, "no more." Sometimes just taking a break will help you muster up the motivation to finish that task.
 

RxCowboy

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Kim Harris Fletcher is feeling hopeful.

Hope everyone enjoyed the weekend! Here’s your Monday data dump! The number of COVID infected Oklahomans (red) increased by 24 cases state wide (+0.5%) to 4613. The cumulative hospitalizations (purple) increased statewide by 2 patients to 828. The number •current inpatients• due to COVID is 177, our lowest number yet! Now, to be fair, this number has not been updated for today but is the census from 5/8. Since we’ve only increased the cumulative rate by 6 people over the entire weekend, I expect tomorrow’s update to be encouraging on that front. Our 3241 recovered patients (green) once again outpace the newly diagnosed, also another good sign. Thankfully the number of those who never recover is slowing and we stand at 274 today.

I’ve kept track of our 3 and 7 day rolling averages over the weekend. And our 7 day has declined to 81.2 cases/day. (From 104 just 6 days ago) The 3 day average today looks abnormally low at 63 cases/day, because of the low number of positives reported on Mondays. I’ll plan to put up a graph of those later today.

As is the usual on Monday, it is a report of Sat/Sunday numbers and is usually pretty low. Tomorrow will show what really happened over the weekend and today. Our R(t) is staying consistently under 1.0, which is important as we continue to open the state. Continue to wash and mask as you go about, and keep a safe distance. Above all, love your neighbor, and be kind. See ya tomorrow for the Tuesday bump!
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RxCowboy

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May 12
Kim Harris Fletcher

Hello all, as expected, a mixed bag on Tuesday! The COVID infected Oklahomans (red) has increased 2.6% today by 119 patients to 4732. We are also over 106K tested, by the way! So, with increased testing, one can certainly expect finding more positive cases ???????! The cumulative hospitalizations (purple) have increased 1.4% from 828 to 840. The patients currently hospitalized continues to stay under 200 at 190 today! The number of recovered patients now ar 3423 (+5.6%) is sharply increasing (noted on the green line), a very good trend, indeed! Again, the number of patients that did not recover (yellow) is slowing, and 4 more have been added to that list, unfortunately.

The rolling 3 day average today is 81 cases/day and the 7 day rolling average is 86 cases/day. This has significantly improved over last weeks numbers.

With us well into the “soft reopening” of our state, these trends look promising. I pay more attention to wed-Sat numbers as I feel those are a more accurate representation of daily activity, so we’ll see what those hold for us this week. Be smart as you go about, mask and wash those hands. Stay safe, and be kind.
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sc5mu93

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2. Traces of the virus have been found in semen. Thus far they do not believe it is enough to spread the disease and further research is needed but it is something to know. Additionally, in a case study (so a study of only one person) they also found the virus in the kidneys. As you know some covid patients need kidney replacement therapy (dialysis) so this may explain why. And another study found that 20% of patients in the study had brain changes/abnormalities as a result of the disease. More research is needed in each of these areas to have solid information but evidence is suggesting that the virus can have widespread impact in the body.
.
Hadn't heard this one. Do you have anymore info? Wife has only one kidney from a live donation a couple of years ago - so this is of interest.
 

RxCowboy

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May 13
Covid19: Wednesday Update

1. Don't drink hand sanitizer, it won't prevent covid. There are a rising number of people seeking medical treatment after regularly dosing with hand sanitizer as a way to reduce their risk of getting the disease. Let's just review that the virus burrows into your cells, hand sanitizer can't get to it. I have also heard people say the pool will kill it. This may be true on your skin, but it won't kill the virus from inside your body. This issue has become so pervasive that the WHO had to issue a public statement about it. Please don't do shots of hand sanitizer.

2. There have been lots of conversations regarding access to care and I have seen some misunderstandings regarding what this term means so I thought I would take some time to explain it. Access to care is more than if there is a hospital or healthcare facility near you or that if you show up they will treat you. Those are certainly elements of it, but they are only a piece. And if you live somewhere where there are healthcare facilities nearby it is easy to forget that some people live hours from the closest doctor. But access to care also includes things like the physical ability to get to the doctor - i.e. transportation (is it on a bus line, do you have a car, are you able to drive, do you have gas money or cab fare or bus passes etc., is there a transportation service available (such as those who will transport the elderly or handicapped, etc.). It also includes things like, can the person take off work to go to the doctor, will they lose wages for doing so, will the medical bill sink them financially, are there language barriers, do they even have a doctor to go to, can they get in for an appointment or is the doctor booked. The list goes on. There are many factors that impact someones access to care. In a recent gallop poll they found 1 out of 7 Americans said they would hesitate to seek care for Covid because of concerns over cost. At a time when many are losing their jobs and possibly their health insurance you can see where this might be an issue. Hourly workers and those on a fixed income, are less likely to seek care because they lose pay when doing so. They are also more likely to go to work sick for the same reason. So when public health people use that term it encompasses more than simply having a doctor near by and/or having insurance and often involves making difficult decisions.

3. We are learning more about the virus everyday and know that those over 75 are more likely to have severe illness, as are men. It also appears that black people are at high risk for developing complications. This trend is true across multiple nations, (including nations with universal health coverage such as Canada and Europe) not just in the United States. As in every case we have to explore possible reasons for this. Working theories include two primary factors: a) they are more likely to have jobs that are deemed essential and therefore less likely to be able to shelter in place, this increases their exposure and therefore their risk, the virus is somewhat "dose dependent" meaning the more exposure you have the more likely you are to develop a severe case, b) they are at higher risk for high blood pressure which is the leading risk factor for developing severe complications. We haven't necessarily been tracking race as part of the numbers so we have incomplete data but places are now doing so to get a more complete picture so we can determine the exact cause.

4. Smokers are back in the news. Varying research studies have been finding varying things regarding the risk for smokers. Some studies have found that smokers are less likely to develop Covid - significantly less likely, implying smoking is actually a protective factor (please don't take up smoking or doing hand sanitizer shots!) Other studies have said they are far more likely to develop serious complications if they do get it. Both could be true or neither could be, we still don't really know enough to say for sure.

5. In places monitoring wastewater for covid they have found they can detect it in the wastewater nearly 2 weeks prior to symptom onset in a community. This continues to look like a promising tool for monitoring community level cases.

FINAL THOUGHTS: No matter what you are facing today, let's all resolve that we are going to rock it. Today we are not just going to survive. Today we are not just going to make it through and rush to the part where we get to go back to bed. Today we are going to savor life, savor each experience that comes our way, sing in the shower, and do amazing things. Tackle each task with purpose, make it your goal to shine brightly, show kindness, go the extra mile and eat dessert.
 

RxCowboy

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Hadn't heard this one. Do you have anymore info? Wife has only one kidney from a live donation a couple of years ago - so this is of interest.
From the National Kidney Foundation:
Are transplant recipients at higher risk of getting COVID-19?
Because transplant recipients take immunosuppressive drugs, they have a higher risk of infection from viruses such as cold or flu. To lower the chance of getting the coronavirus that causes COVID-19, transplant patients should follow the CDC’s guidance on how to avoid catching or spreading germs, and contact their health care professional if they develop symptoms of COVID-19.

Statement from the American Society of Transplantation (AST):
We do not have specific information on whether COVID-19 infection will be more severe in transplant recipients compared to healthy people; however, other viruses often cause more severe disease in people whose immune system is low, such as transplant recipients.

Should transplant recipients be worried about living with loved ones who go out in public or work outside the home? Updated May 12, 2020

A person who is living with a loved one who has contracted COVID-19 is at risk of also becoming infected. This is especially true for posttransplant patients.

Therefore, it is important for anyone to limit going into the public, especially if there is an active and expanding outbreak in their area, or if local and state authorities recommend remaining in place in an effort to maintain social distancing to help control the spread of the virus.

If people need to go into public, then they should take certain precautions, including limiting the time spent outside as much as possible, avoiding large crowds, and maintaining social distances (at least 6 feet). People with a kidney transplant should also consult with their healthcare team to find out what precautions should be taken by them and their caregivers. This might include additional hand washing/sanitizing, face coverings, or other measures.

How can COVID-19 affect transplant surgeries?
Statement from the American Society of Transplantation: The risk of acquiring COVID-19 from organ donation is low. Donors are screened for COVID-19 symptoms and exposure history. Living donors who have been to high-risk areas or exposed to someone diagnosed or being evaluated for COVID-19 infection are generally being asked to postpone donation for 14 to 28 days after returning. Some organ procurement organizations are testing some or all donors for COVID-19. The Center for Disease Control (CDC) made recommendations about elective surgeries and non-essential procedures that include transplantation. Transplants should not be postponed in “high acuity/unhealthy patients.” Some centers may still need to look at temporarily putting elective living donor transplantation or non-urgent deceased donor transplants on hold. Transplant centers will base these decisions on issues such as the level of circulating COVID-19 infection in their areas and/or operational issues (such as testing availability, bed space, availability of basic supplies and equipment, including personal protective equipment).

Also, living donors are being asked to not travel to high-risk areas for at least 14 days before donation and monitor for symptoms. Information about recent travel and possible exposure is also asked about deceased donors to help determine if it is safe to use them for organ and tissue donation.

The Center for Disease Control (CDC) made recommendations about elective surgeries and non-essential procedures that include transplantation. Transplants should not be postponed in “high acuity/unhealthy patients.” Some centers may still need to look at temporarily putting elective living donor transplantation or non-urgent deceased donor transplants on hold. Transplant centers will base these decisions on issues such as the level of circulating COVID-19 infection in their areas and/or operational issues (such as testing availability, bed space, availability of basic supplies and equipment, including personal protective equipment).
 

SLVRBK

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May 13


4. Smokers are back in the news. Varying research studies have been finding varying things regarding the risk for smokers. Some studies have found that smokers are less likely to develop Covid - significantly less likely, implying smoking is actually a protective factor (please don't take up smoking or doing hand sanitizer shots!) Other studies have said they are far more likely to develop serious complications if they do get it. Both could be true or neither could be, we still don't really know enough to say for sure.
In short...if you smoke it's hard to catch the bug...if the bug battles it's way through your nicotine defense system you're screwed.
 

RxCowboy

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From The Lancet:

Considering BCG vaccination to reduce the impact of COVID-19
Nigel Curtis, Annie Sparrow, Tedros A Ghebreyesus, Mihai G Netea
Published:April 30, 2020 DOI:https://doi.org/10.1016/S0140-6736(20)31025-4

In addition to its specific effect against tuberculosis, the BCG vaccine has beneficial nonspecific (off-target) effects on the immune system that protect against a wide range of other infections and are used routinely to treat bladder cancer.1, 2 This has led to the suggestion that vaccination with BCG might have a role in protecting health-care workers and other vulnerable individuals against severe coronavirus disease 2019 (COVID-19).

Randomised controlled trials have provided evidence that the BCG vaccine's immunomodulatory properties can protect against respiratory infections. In Guinea-Bissau, a high-mortality setting, BCG-Danish reduced all-cause neonatal mortality by 38% (95% CI 17–54), mainly because there were fewer deaths from pneumonia and sepsis.3 In South Africa, BCG-Danish reduced respiratory tract infections by 73% (95% CI 39–88) in adolescents.4

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a single-stranded positive-sense RNA virus, and the BCG vaccine has been shown to reduce the severity of infections by other viruses with that structure in controlled trials. For example, the BCG vaccine reduced yellow fever vaccine viraemia by 71% (95% CI 6–91) in volunteers in the Netherlands,5 and it markedly reduced the severity of mengovirus (encephalomyocarditis virus) infection in two studies in mice.6, 7

Many of the mechanisms underlying the beneficial off-target effects of the BCG vaccine are now understood. The BCG vaccine and some other live vaccines induce metabolic and epigenetic changes that enhance the innate immune response to subsequent infections, a process termed trained immunity.8 The BCG vaccine might therefore reduce viraemia after SARS-COV-2 exposure, with consequent less severe COVID-19 and more rapid recovery.

Randomised controlled trials are underway in the Netherlands and Australia to assess whether BCG-Danish reduces the incidence and severity of COVID-19 in health-care workers, and the effect this has on time away from work (NCT04327206, NCT04328441). It is possible that BCG-Tokyo would be preferable to BCG-Danish.9

Until these trials are complete, there are four main reasons why it is very important to adhere to WHO's recommendation that the BCG vaccine is used for COVID-19 only in randomised controlled trials.10 First, the BCG vaccine is already in short supply, and indiscriminate use could jeopardise the supply needed to protect children against tuberculosis in high-risk areas. Second, whether BCG will be effective remains unknown: findings from the ecological studies suggesting less COVID-19 in countries with routine BCG immunisation are weak evidence because they are based on population rather than individual data and are prone to confounding.11 Also, it is unlikely that a BCG vaccine given decades ago in childhood will ameliorate COVID-19 now. One reason for this is that the beneficial off-target effects of the BCG vaccine might be altered by subsequent administration of a different vaccine.1 Third, if the BCG vaccine is not effective against COVID-19, BCG vaccination could engender a false sense of security. Fourth, careful safety monitoring in randomised trials is needed to guard against the remote possibility that up-regulation of immunity by BCG will exacerbate COVID-19 in a minority of patients with severe disease.
If the BCG vaccine or another inducer of trained immunity provides non-specific protection to bridge the gap before a disease-specific vaccine is developed, this would be an important tool in the response to COVID-19 and future pandemics.

NC is the lead investigator of the BRACE trial (NCT04327206), and MGN is one of the lead investigators of the BCG-CORONA trial (NCT04328441). TAG is Director General of WHO. AS declares no competing interests.
 

RxCowboy

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Addendum to this am data:
Two **very important** things to know.
1. 83 out of the 120 cases reported today were in Texas (Guymon) and Comanche (Lawton) county. 50 of those are from Guymon and related to the meat processing plant.

2. We processed 3300 COVID tests in 24 hours. Of 3300 tests, 120 of those were positive. That is 3.6% of the tests run. This is the •lowest• percent of positive tests we’ve had to date. When we started testing 11% of the tests we did were positives, and it’s fallen daily. It was at 5% on Friday.

I’m not saying we are out of the woods, but high positive numbers by themselves are not necessarily bad. It’s very important to evaluate what they mean. Stay safe, friends.

This is the cases/100,000 people by state, as of today.
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RxCowboy

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May 14
Covid-19 Update: Thursday

1. I wanted to start today with a quick review of Covid cases because it can be easy to get lose track of where we are. 80% of all cases are mild or asymptomatic. 15% are severe or require medical intervention, most often seen as oxygen. 5% are critical and require a ventilator.

2. Covid19 has now killed more people in 5 months (January - May) in the United States than Diabetes does in a year. (based on 2017 mortality data, the last year for which data is currently available). Covid 85K, Diabetes 83K. This moves Covid into position as the 7th leading cause of death in America. IF we continue at this pace, and that is an "IF" by October it would be the 3rd leading cause of death in America. The good news is that the US numbers have been looking better over the week. Our new "target" is 20k. So watch for numbers to stay under 20K (good day) over is a not as good a day, but still better than last week (as long as it is under 30K). Of course, remember that improvements in the overall number don't mean improvements in your particular area. So you want to monitor that too.

3. A CRISPR based test has been approved by the FDA. The test can provide results in 1 hour and they are very hopeful it will help reduce the backlog and get our testing on track.

4. We have been discussing the wastewater monitoring. Well now a study out of the UK suggests that the virus may be able to spread through the wastewater. We know the virus is found in feces for up to 33 days after a person tests negative for the disease. They don't yet know if it is contagious through the fecal route in general, but the UK study suggests there is enough in wastewater to be.

5. Lots of people have been comparing Covid to SARS so I would like to mention there have been no human to human SARS cases since 2004 and only 4 cases world-wide since then. Three were lab accidents and 1 animal-human transmission. So let's hope this goes the way of SARS.

6. Seventeen states have now identified cases of the Pediatric Multi-system Inflammatory Syndrome (PMIS as I am calling it). 3-5 children have died from it in the US (I am seeing two different reports, one for 3 one for 5 so it would seem either one is behind or one is confused. I will continue to monitor that). The majority of known cases in the US are in NY, NJ and Boston. The CDC is expected to make a special statement on it in the next day or so. The disease is not COVID - that much they know. But it appears to be a result of being exposed to COVID. It is still considered uncommon and there is exploration of if it could be tied to having long term exposure because most cases are showing up 4-6wks after an outbreak. It is being seen around the world in places that have had longer outbreaks (i.e. not in places where the outbreak is just starting). The good news is there are known treatments that are effective.

FINAL THOUGHTS: Yesterday lots of news reports and studies came out that people are mentally over this. In fact, many people have reached the, "I'll just take my chances" mindset or the "only 85k people have died, what's the big deal" mindset. Clearly we haven't eaten enough dessert, danced enough jigs, watched enough funny movies that make us pee our pants just a little, or gone for enough long walks. Things are going to get better. States are reopening. Sure, the outbreak is going to be with us for a while - but there is light in the tunnel and things are getting better. Sure you will most likely have to stand 6 feet from the next person and wear a mask which will make you feel like a Ninja robber, but hey, you get to be a Ninja robber! (ok, maybe without the actual robbing part - no, not maybe. totally without that part). And for all the conspiracy theorist out there- wearing a mask will conceal you from facial recognition, so that's a win! So get your shades to protect your eyes from all that sunshine and make sure your car is all gassed up because your favorite place is preparing for you.
 

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4. We have been discussing the wastewater monitoring. Well now a study out of the UK suggests that the virus may be able to spread through the wastewater. We know the virus is found in feces for up to 33 days after a person tests negative for the disease. They don't yet know if it is contagious through the fecal route in general, but the UK study suggests there is enough in wastewater to be.
Food supply concerns here from imported fruits, vegetables and farm raised fish?