COVID-19 Updates

COVID-19 Science Update for March 22nd: Grim Omens in the U.S.

The latest global data for COVID-19—updated with reports received on March 22nd, 2020—have been published at Our World in Data. Here are some of the numbers and trends that I believe deserve special attention, as well as a brief report on notable regional developments and media analyses. Since March 21, these updates have been published at Quillette in our section marked COVID-19 UPDATES. Please report needed corrections or suggestions to jon@quillette.com.

Yesterday’s global tally of total confirmed cases was 305,275. This represents a daily jump of 34,047, up from the previous daily jump of 28,891. This includes:

  • Another 6.5K cases in Italy (a slight increase from the previous daily jump);
  • A worrying 4.9K case jump in Spain (up from the previous daily jump, which was 2.8K);
  • And a big 7.1K increase in the United States, the biggest U.S. jump to date.

These three countries account for more than half of all new cases. If you add in France (1.8K) and Germany (3.3K), you get more than two thirds of global cases.

There were 1,690 new deaths reported globally. This includes the following regional developments:

  • France had 112 new deaths, and Spain had 324. These countries appeared somewhat in lockstep in early March, with both showing roughly similar increases in daily death tallies. But the last few days have been different: While France has had roughly 100 deaths per day for almost a week (much like Iran), Spain doesn’t seem to be plateauing. The numbers suggest it could become the next Italy.
  • Italy itself had 795 new reported deaths, up from 625 the day before, and almost half of the global total. When it comes to the toll this disease has taken, Italy now stands completely apart from other countries—in total deaths (approaching 5,000), known case-fatality rate (an order of magnitude above the level observed in South Korea and, in the latter period, China), and in the sense of chaos and terror inflicted on local residents and health providers (in the Lombardy region, specifically).
  • There were 30 new cases in Belgium. That country’s previous total had been just 38, suggesting a pattern similar to Germany, where mortality has remained very low, but has gone up markedly this week (including 22 newly reported deaths in today’s new German numbers).
  • Switzerland had 13 new deaths, despite very high new-case numbers over the last two weeks, and its pattern might be tracking Germany and Belgium. By comparison, the UK has 233 total deaths (including 56 new ones), compared to Switzerland’s cumulative total of 56, despite both countries’ new-case totals having initially begun to surge around the same time and at the same rate.
  • The United States had 80 new deaths, though for reasons discussed immediately below, that number seems likely to surge in coming weeks.

There are many indicators suggesting that the situation in the United States may get much worse before it gets better. Though media attention has focused on the surreal dysfunctionality that characterizes the U.S. political climate, it’s also clear that there’s been poor long-term planning at all levels, especially in the New York City area, where half of all confirmed U.S. cases have been reported. Attached, by way of example, is a screenshot of a social-media post from Craig R. Smith, Chair of the surgery department at New York-Presbyterian/Columbia University Medical Center. You would expect such facilities to be among the best equipped in the world. Yet Dr. Smith notes that his hospital will likely need 70K masks per day, which is about 0.1 percent of the entire national strategic reserve.

In the short-term, these shortfalls will have a tragic human cost. In the long-term, they may even have a geopolitical cost, as U.S. stature suffers amidst the outbreak. As Steven Erlanger notes, many nations are now looking to China for medical assistance, despite Beijing’s early missteps and cynicism when presented with signs of a pandemic brewing in Wuhan.

Until a month ago, if you would have asked me where I would like to get acute medical care for some hypothetical illness, I might have picked New York City, because of its high concentration of elite teaching hospitals and world-renowned medical experts. But as I’ve noted before, this disease has disproportionately afflicted some of the wealthiest nations on Earth—including, in cases such as Lombardy, Seattle, and New York City, some of the wealthiest areas within those wealthy nations.

To take another example: In Switzerland—which many of us might regard as the very epitome of an efficient, rationally organized, well-resourced society—a government official has warned that, as Reuters reports, the “health care system could collapse by the end of the month if the new coronavirus keeps spreading at current rates.” The problem isn’t just the number of ventilators and ICU beds, but also the limited number of staff who can operate such equipment. (I recall that when my own daughter had breathing problems in a hospital setting, a special team was summoned in case she required emergency interventions—doctors and nurses whose technical training was even more specialized than the specialists in attendance.)

On the issue of testing, here’s an interesting case study from Iceland, reported by Buzzfeed. As with other countries that have been successful in quickly rolling out large-scale COVID-19 testing, the government has enlisted at least one private partner (in this case, a firm called deCode Genetics). This has permitted officials to test even those who have no symptoms, thereby giving us a better look at the true baseline infection rate (and, therefore, mortality rate). Of the asymptomatic group—basically a random, voluntary sample of the population—about 1 percent were infected. (Buzzfeed also reports that similar testing procedures have been implemented on a smaller scale in other countries, including in the Veneto region of Italy, but that national-scale testing of non-symptomatic individuals is, for now, simply impractical in any but the smallest countries.)

One apparent bright spot in last month’s Report of the WHO-China Joint Mission on COVID-19 was that the disease was reported as being difficult to transmit in a hospital or other institutional group setting. But new data suggest that enormous numbers of health-care workers in Spain—3,500 by one estimate—have been infected. Also, today’s New York Times has a definitive piece on the Life Care Center nursing home in Kirkland, Washington (a suburb of Seattle):

Since the first positive tests at Life Care came back on Feb. 28, 129 people there—including 81 residents, about two-thirds of its population—have tested positive for the virus, and 35 people have died. Dozens of its workers have received coronavirus diagnoses, suggesting that the center’s frantic efforts to sanitize the building, quarantine residents and shield staff members with gowns and visors may have come too late.

To put one of those numbers in context—35 deaths—that’s about three times the number of deaths that have been reported in all of Canada.

Another Times article presents lessons from Italy, where swathes of Lombardy became one giant Life Care Center: Lots of people raising the alarm, but no central co-ordinated action till too late. The article also highlights the role of what some call “super-spreaders,” including this person:

When a 38-year-old man went to the emergency room at a hospital in Codogno, a small town in the Lodi province of Lombardy, with severe flu symptoms on Feb. 18, the case did not set off alarms. The patient declined to be hospitalized and went home. He got sicker and returned to the hospital a few hours later and was admitted to a general medicine ward. On Feb. 20, he went into intensive care, where he tested positive for the virus. The man, who became known as Patient One, had had a busy month. He attended at least three dinners, played soccer and ran with a team, all apparently while contagious and without heavy symptoms.

Finally, a lot of us have wondered if the weather will bail us out, just as warmer weather in spring signals an end to the winter flu season. The answer, as Nicholas Kristof reports is, we simply don’t know:

Some respiratory viruses decline in summer from a combination of higher temperatures and people not being huddled together, so it is possible that Northern Hemisphere nations will enjoy a summer break before a second wave in the fall. That’s what happened during the 1918 Spanish flu pandemic: It hit in the spring of 1918, went away but returned worse than ever in the fall. Of the four coronaviruses that cause the common cold, two diminish in warm weather, while two are more variable. SARS and MERS did not have clear seasonal variations, and even seasonal flu is transmitted in the summer, although less than in winter. So while experts hope that hot weather will shortly bring a reprieve from the coronavirus—the flu is already on the retreat — there’s no solid evidence.

 

 

Jonathan Kay is Canadian Editor of Quillette. He Tweets at @jonkayIf you believe this article requires correction, please email jon@quillette.com.

Featured Image: Screenshot from Our World in Data.

Comments

  1. @Robin-Whittle has all of this covered extensively and is my own go to guy for information regarding WuFlu.
    Thx for all your work, Robin.

  2. Seeing articles like hyperbole and selective use of numbers like 2 people died yesterday and today that number has doubled. You can just leave out the figures and just say today the death toll has doubled. You can also do things like quoting 36,000 people die each year of road accidents in the US or you can say this number has decreased from over 50,000 in 1966.

    It’s called spin and the media created it as editors struggled for circulation and journalist (?) were and continue to be taught this method of gaining attention by the assumption that nobody looks at the detail. The detail requires effort which is an anathema to most people.

    A couple of points , let’s not condemn any country as I’m sure China did not intend to create this situation however their social structure is definitely not conducive to freedom of information and I can definitely see this problem being repeated again and again due to their health infrastructure and a myriad of other basic problems.

    The WHO conflicted position by being a mouthpiece for China due to some questionable funding and the structure of the 35 member board is well known. Perhaps ignoring WHO and looking for more independent country advice is better in the future.

    Italy and China have been best of friends for years in the “rag trade” with numerous clothing factories in and around the Lombardy region and the flow of workers has been happening uncontrolled for years. Hence the easy spread of the virus considering the hygiene in these premises and elsewhere in Italy. Take a walk around Roma Termini!

    Latest research is the following:

    -The virus can remain active in the air for about 3 hours so it must be contained in mucus (droplets). So clearly coughing in front of people as expected is not a good thing.

    • The virus can be active on fomite (material) up to 3 days however its dependent on the material and its virulence has declined rapidly during that time. Plastic and stainless steel seems to provide longer life whilst porous substances much shorter time.

    Back to figures and number of people tested positive:

    Italy 0.0097% of population, Australia 0.0053%, Germany 0.022%, UK 0.009%, Finland 0.0011%

    The virus will hibernate and people will recover…the world economy and the damage done by this ridiculous panic fuelled by social media and our marvellous advances in technology …that’s another question.

  3. Thanks @Sawfile. I have no medical training, but I am an electronic technician and computer programmer, so I spend a lot of my time solving problems - including those where the problem is not at all clearly defined, and in the absence of schematics etc.

    I have a public page with medical advice which I think should come from doctors, nurses and health authorities:

    http://aminotheory.com/cv19/

    since, to the extent that it is good advice, people should be getting it from healthcare professionals rather than me. Please consider the arguments and cited research there. The fact that I currently think these are good ideas shouldn’t figure at all in your reckoning. In summary:

    • There are arguments against taking ibuprofen, aspirin, paracetamol/acetaminophen etc. to lower fever, except perhaps if it becomes debilitating.
    • There are particular, well researched, arguments for not using aspirin at all - since aspirin contributed significantly to the death toll of the Spanish Flu, especially among young adults: https://academic.oup.com/cid/article/49/9/1405/301441 . “early deaths exhibited extremely ‘wet’, sometimes hemorrhagic lungs”. Now read a despairing report of COVID-19 patients in New Orleans (link at the end of this message) where the same red frothy symptoms appear, including in people in their 30s and 40s.
    • France has banned the use of ibuprofen, apparently due to a report of four young people with severe symptoms which seem to have resulted from their early use of and NSAID - and ibuprofen and aspirin are the most commonly used NSAIDs. (Paracetamol/acetaminophen is not usually considered and NSAID.
    • So the WHO and other health authorities urgently need to provide advice on which, if any, of these drugs to take. I am also concerned with liver toxicity from paracetamol (I am sick of typing the other word!) due to people self-dosing at home while the virus damages their liver’s capacity to break it down by the first pathway, leaving the second pathway to produce permanent protein damage from NAPQI.
    • Pneumonia and death and disability due to lung, heart, liver and kidney failure (and the risk of later bacterial infection) are all driven by sepsis, which results from the body’s overly-aggressive, inflammatory, immune response to viral infection.
    • There are several readily available nutrients which are known to reduce this excessive inflammatory response: vitamin D, boron (borax is on supermarket shelves, in the laundry department), omega 3 (fish) oil, vitamin C and zinc. Most people are highly deficient in these, especially the first three. Boron is not even considered an essential nutrient, despite decades of research showing that it is.
    • I believe that if people took all these, including ~12mg boron a day, that their risk of COVID-19-induced sepsis harming or killing them would be greatly reduced. However, I am just an electronic technician - and people should only act on advice (unless they make their own personal judgements about it) when it comes from clinicians. In other words, I view the looming massive toll of disability and death as being caused primarily by easily avoided, very common, nutritional deficiencies, plus of course the impact of smoking, alcohol-induced damage and other conditions. Type 2 diabetes is partly or largely caused by excessive inflammation. This is well established. What is not so clearly known by clinicians is that nutritional deficiencies contribute enormously to this inflammation.
    • There is unresolved controversy about the impact of blood pressure drugs on COVID-19 patients. High blood pressure, cardiovascular disease and stroke are all strongly driven, to the point of being caused, by a low potassium to sodium (as salt) ratio in the diet. Most people, including especially doctors - who are frequently overly influenced by drug companies and outdated guidelines, rather than being guided by research into nutrition - do not know that potassium supplementation is possible. It is certainly desirable, since, with some salt avoidance, it solves the cause, rather than mucks around with the mechanisms with drugs. All these drugs have side effects, and some may include increased COVID-19 disability and death. Potassium tablets don’t work, since we need 2 or 3 grams a day. Solutions are thought not to work, because almost everyone thinks that potassium salts have a very strong taste. What almost no-one knows is that potassium gluconate has a very mild taste in solution. 4.5kg a year per adult gives about 2.4 grams potassium a day, typically doubling the potassium to sodium ratio. This would be more effective than these drugs - and have no ill effects.

    These points are a summary of the abovementioned page, which itself is a summary of what would ideally be a much longer exposition. Please read the page, with its references and especially the disclaimer that you shouldn’t act on medical advice from an electronic technician unless you take full responsibility for your decision, and have researched the arguments to your satisfaction, and have read and ideally consulted very widely indeed.

    The Quillette Circle thread I started in late January:

    is now a very long chronicle of the developing pandemic, complete with people arguing that I was being over-dramatic fearing what is actually happening now. To view the entire discussion as a single conventional web page (rather than the piecemeal way this Discourse software normally presents it), so you can search, save and print it, make the URL end with: 5026/print .

    From New Orleans:

  4. I’ve seen you often state this disclaimer. That’s proper.
    I suppose that I should have been more precise: “… go to guy for citations, source material and general information regarding WuFlu.”
    :grinning:

  5. Yes, the whole community has benefited from @Robin-Whittle’s work on this. Can we issue honours or awards or something?

  6. I found this very, very helpful. It describes a path forward:

    R0 below 1. Should take about 5 weeks with extreme social distancing, and a massive buildup of testing and public health isolation and tracking. At that point, most things can return to normal.

  7. I have just grown so weary of these panic updates and I have no idea what they achieve as its almost like the days of the Colosseum. By the way the recovery curve has turned in Italy and 12 % have fully recovered and 79 % are under treatment or isolation. Yes…thats 79%!.

    Doesn’t make for good headlines does it?? Jonathan, Your March 23 update doesn’t allow criticism so just try to shake that well worn coat of journalism off your shoulders. As to the Boron comment well …some things are best left unsaid.

  8. @Sasha, if you have anything specific to say about boron as an essential nutrient, please go ahead. Likewise any specific critiques of what I wrote above or at the page I link to there.

    I suggest you first read a review article such as (2015) Nothing Boring about Boron: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712861/ .

    Please also peruse decades of research by Forrest Nielsen, US Department of Agriculture: https://scholar.google.com/scholar?q=Forrest+Nielsen+boron .

    It is a mistake that boron is not regarded as an essential nutrient for humans. The fact that it is a good ant and cockroach poison needs to be considered in light of the mass they consume, relative to their tiny body mass. I couldn’t easily find any figures on this.

    The tolerable upper limit for boron (above which it may not be safe) for adult humans is 20mg / day = 0.286 parts per million body weight. I take 12mg a day.

    4000IU vitamin D3 a day for adults might seem like a scarily high amount, but it is only 0.1mg = 1.43 parts per billion body weight. So at this rate, we would use a gram every 27 years. Supplementation is better than relying on sunlight, since the UVB (290 to 315nm) light is hard to come by, and damages the skin in general and DNA in particular, leading to higher risk of skin cancer.

    7-dehydrocholesterol bound in the lipid bilayer of skin cells is converted to vitamin D3 by UVB at a rate depending on skin pigment, clothing, intensity of the sunlight, azimuth of illumination etc. As we age, the level of 7-dehydrocholesterol in our skin drops. ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897598/ ) “. . . exposing 20% of the body surface to an amount of sunlight equal to 0.5 MED is equivalent to ingesting approximately 1400–2000 IUs of vitamin D3.”

    A minimal erythemal dose (MED) of UV is 200 joules per square metre (a joule is a watt for a second), which is the amount "required to produce a barely perceptible erythema [redness of the skin] in people with skin type 1. ( https://www.who.int/uv/health/solaruvradfull_180706.pdf)

    We all agree that vitamin D is vital for health. Thousands of research articles attest to this.

    Vitamin D3 - tactfully under its chemical name cholecalciferol - is widely used as a mouse and rat poison. https://en.wikipedia.org/wiki/Rodenticide#Hypercalcemia https://crop-solutions.basf.com.au/preview/f/files/5a977a5ff7d0020192aad5cd/Tech%20.pdf states that the lethal oral dose (50% threshold) for rats is 41mg/kg = 41 parts per million body weight. This is 29,000 times the healthy dose of 4000IU for adult humans.

    Vitamin D3 is an essential nutrient for humans. Most people are deficient in it and this deficiency drives, amongst other things, immune system dysregulation leading to the overly-aggressive inflammatory response which is the cause of sepsis - and it is sepsis which does most of the harm and killing of a significant fraction of the people who contract COVID-19 (which I think will be most of us in the months to come.)

    Boron is an essential human nutrient, but is not yet recognised as such. The second sentence of the previous paragraph applies identically to boron.

    Vitamin D3 is a widely used rat poison.

    Boron is a widely used ant and cockroach poison.

    Your objection to boron is?

  9. Hello Robin

    Lack of vitamins or various chemicals within our body is due to disease or poor physical health. I am not surprised at all about the massive time spent investigating various substances and the huge industry that has grown from this.

    Just simply that they are not needed if you live a healthy common sense life style. I am totally aware that when I go to shops that a huge number of people are now obese. At first I couldn’t believe the growth in obesity and generally found it hard to believe that people could actually eat so much food that they almost find it impossible to walk.

    Many supplements just pass through our metabolism with very little benefit. Ten minutes in the Sun is fine for Vitamin D. I don’t intend to compete with your knowledge on many bottles of tablets in the health stores.

    I can give you two simple rules in the current climate wash your hands regularly and in any climate exercise and eat fruit, vegetables and as little processed food as possible. Also please give up the tattoos and enjoy life.

  10. Probably one of the most impressive things I’ve seen in my 2-3 years of reading/commenting at Quillette. If he doesn’t work at WHO, someone needs to get that man an application.

    Much appreciated, @Robin-Whittle :clap::clap::clap:

  11. Thanks @DB_Cooper, @Sawfile and @Stephanie!

    I did get my ideas to a WHO secretariat, but everyone is really busy. Doctors tend to think little about nutrition, and I am an outsider.

    If you think that the nutritional supplements I am suggesting at http://aminotheory.com/cv19/ are potentially important in reducing the toll of suffering, disability and death in the next few months, then you can help by finding doctors and nurses who work in ICU with COVID-19 patients, and emailing them suggesting they take a look. You can do this via finding news reports and social media posts quoting these people and then Googling to find their email addresses. Likewise anyone who researches or treats sepsis patients - any pulmonologist.

    It would be easy for such clinicians to give these patients vitamin D and fish oil capsules (at least before they are on ventilators) and with a bit of gumption they might even give them some borax and oral or IV vitamin C. If they found that any or all of this helps, it would be an important discovery and they would then probably communicate it among their colleagues, or discuss it on some forum or blog site such as: https://emcrit.org/ .

    That site hosts a very comprehensive guide for ICU clinicians: https://emcrit.org/ibcc/covid19/ which includes Paul Marik’s COVID-19 Treatment Strategy: https://emcrit.org/wp-content/uploads/2020/03/PMarik3182.pdf For mildly symptomatic patients, this begins with 500mg vitamin C 2x or 3x per day, and 220mg zinc (which is a lot - ordinary zinc supplement tablets provide 25mg and the supposed RDA is even less than this).

    Patients with breathing difficulties go to ICU and have intravenous vitamin C and vitamin B1 (thiamine), with antibacterials and possibly corticosteroids.

    To me, it is not too much of a step to go from oral and IV micronutrients upon admission to hospital to seeing the value of the general public taking proper doses of micronutrients, as I describe, to reduce the rate at which sepsis may impede their breathing or worse.

    If 30% of the population are actively infected at the same time, and a third of these have sepsis to the point of breathing difficulties (pneumonia), then most of those are not going to fit in a hospital anyway.

    Also, everyone needs to be advised whether or not to take fever-reducing drugs at all, and if so which ones, how much and for what temperatures.

  12. So batteries go flat when the devices they are in stop working?

    In electronics, a circuit won’t work properly if its power supply voltage is outside some specified range, or noisy, fluctuating or whatever. So this is the first thing to check.

    If a car engine is running roughly, after checking a few easy things, the next question is whether the fuel is contaminated.

    With humans it is the same thing - are we getting proper levels of dozens of nutrients. With a little research you can see that most of us do not get what we need for quite a number of nutrients in a normal diet, without the use of supplements. This is normal, but it is not healthy.

    To achieve health we need proper levels of nutrients.

    Doctors prescribing drugs for high blood pressure makes no sense when they could have the person completely fix the problem with a few drinks of potassium gluconate solution a day. This is not a drug. It has no side effects. Potassium is the nutrient whose lack is causing the high blood pressure, along with excessive salt.

    However, the doctors - and a lot of their patients - think drugs, surgery etc. are the way forward. Its a mistake whenever the problem is inadequate nutrition - and it is now clear from research into excessive inflammation that inadequate nutrition, including for boron, is the primary easily correctable cause of a long list of diseases, not least Alzheimers etc. diabetes, sepsis etc.

  13. While I’m not in a position to have a strong opinion on the importance of the “nutritional supplements [you] are suggesting”, I am persuaded to think, given your assiduous treatment of the issue, the odds against chance of the supplements being important is in your favor.

    As it happens, I’m in regular contact with a number of physicians, PCPs and specialty physicians alike. Just to be clear, I’ll need a day or two to look over your blog with some discernment just to make sure there’s enough meat there before I pitch it. That’s not a slight against you or the work you’ve done.

    While your posts on the forum have been first class, at present moment, I’ve only glanced (briefly) at the amino theory blog. The blog (and the info therein) doesn’t need to be perfect (perfection is the stuff of wedding days, pin-up girls, and other such ideals of disappointment), but as rule (or at least one of my rules), no one bats 1000%. As I’m sure you know, in order for these docs to bite, the blog will need to provide clear/concise/logical chains of evidence and be generally free of grammatical errors.

    In any case, I look forward to taking a closer look at it. Thanks again for all the work. I’ll get back to you (hopefully) by weeks end.

  14. I’ll leave you head down your path and I’ll keep to my healthy lifestyle. The obesity epidemic or maybe a pandemic is what will kill most people also next time you see these huge people can you tell them that leotards just don’t seem to improve their appearance! Keep up the panic.

  15. Thanks @DB_Cooper. I improved the formatting and added a table of contents in the section intended for clinicians and researchers. My email address is on the page if you want to send me corrections and improvements.

    @Sasha, deficiencies of the micronutrients I write about contribute to the pro-inflammatory immune response which is recognised as an important contributing cause of type 2 diabetes and other diseases.

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