Tag: Face Mask

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COVID-19

State of The Disunion

A look today at how we’re doing with COVID-19. First let’s look at my home region, Riverside County. Like much of the country Riverside is seeing significant increases in new daily cases. Over the last week or so we’ve been seeing over 500 new cases each day on most days. Yesterday, Riverside saw its highest daily increase yet with 631 new cases in 24 hours. That compares to fewer than 100 cases per day on most days in mid-April after the initial surge and when social distancing orders were in place. Other metrics are moving in the wrong direction as well: hospitalizations and ICU admits are up but still manageable, the percent-positive rate is up, and doubling-time (time it takes for cases to double) is down. The doubling time maxed out at around 33 days in Riverside a few weeks ago but has now slipped to around 28 days. This is perhaps the most worrisome signal that we’re losing control of the virus in this region. If this trend continues we’ll edge closer and closer to the risk of exponential growth we faced at the beginning of the pandemic. A discussion of exponential growth is beyond the scope of today’s post but at the bottom I’ll post a video of an excellent and understandable explanation of exponential growth and why it isn’t intuitive for most people. The percent-positive rate (rate at which Riverside County’s COVID-19 tests are coming back positive) is at 10%. This is up from a low of around 5 in early May. What this indicates is that our increase in cases is not merely due to increased testing as some political leaders suggest but in fact a true representation of increased prevalence of the virus in the community. Hospitalization rates are an important factor to watch. Daily new cases can be affected by testing rate and the reporting of daily new cases often lags behind as reporting may be slower from sone agencies. Rising hospitalizations show in real-time how a region is doing because it’s a measure of how many people are quite sick, now. Keep an eye on hospitalizations. More people don’t get sick enough to be hospitalized because we test more, more people get really sick because there’s more infection out there.

RUHS Coronavirus/https://www.rivcoph.org/coronavirus
RUHS Coronavirus/https://www.rivcoph.org/coronavirus

What about the rest of the country? We’re seeing increasing cases in a number of hotspots around the country. The New York Times tracks where the virus is increasing and we’re seeing significant increases in several hotspots around the country.

NY Times map showing areas with increasing numbers of cases of COVID-19

The South was the first region to begin reopening after stay-at-home orders and they’re now the region with some of the most noticeable growth in the last two weeks with 10 states in the region on an increasing trajectory including Texas, Florida, Georgia, North Carolina, Louisiana, Tennessee, Alabama, South Carolina, Mississippi, Arkansas and Oklahoma. Overall, the most concerning regions in the country right now are Florida (reopening began May 4), Arizona (reopening began May 8), Texas (reopening began April 30) and Oklahoma (reopening began April 24). Florida had an 86% increase in new cases over one week and a doubling of their percent-positive rate to 11% in recent days. According to the Sun Sentinel, 75% of adult ICU beds in South Florida are now occupied. The state has had to walk back some of its reopening to address the rising cases there. Arizona has seen their percent-positive rate leap to 20% with an increase in new cases of 90% in a one week period. Oklahoma saw the biggest one week increase with a jump of 111% in new cases. Texas has seen similar increases in percent-positive rate (now at 10%) and new cases (up 86% in a week). More worrisomely, Texas has seen a 60% increase in new hospitalizations. NPR reports that Texas Children’s Hospital in Houston is now admitting adults with COVID-19 to help with the surge, this in spite of the fact that Houston is home to Texas Medical Center, the largest hospital in the world. The growth of the virus in Texas has led some regions within the state to begin mandating facial coverings and Governor Greg Abbot to implore the state’s residents to do so to help keep business open.

“Wearing a mask will help us to keep Texas open.”

Texas Governor Greg Abbott

States that reopened early are not the only states of concern right now and certainly other factors contribute to surges in a region like the recent protests and outbreaks at inpatient institutions. But there are some simple facts that seem to be lost on a significant percentage of Americans: SARS-CoV-2 is here, it’s a dangerous virus that can spread exponentially through an almost completely vulnerable population and no amount of hiding our collective heads in the sand about these previous two facts is going to make it go away. Perhaps the simplest and most effective thing Americans could do to prevent the spread would be to wear a mask when in indoor public spaces and outdoors when social distancing isn’t possible. If the majority of Americans wore a face covering under these circumstances, the spread of SARS-CoV-2 would be significantly limited and businesses would be much less at risk of new closures. As I discussed in a previous post, wearing a mask isn’t for your own protection. The science on masks shows us that if the majority of a population wears face coverings, we, the wearers, spread the virus to fewer people. Wearing a mask protects your neighbor, particularly the most vulnerable, it isn’t to protect you. Your neighbor wears a mask to protect you. If more of us do it, we protect more people. So let’s be neighborly and wear a mask to keep the economy open by stopping the exponential spread of COVID-19, which is starting to happen…again.

Here’s the video that nicely and understandably explains the math of exponential growth.

Categories
COVID-19

Thoughts on COVID-19 June 15, 2020

  • It’s been a time of great unrest in the Unites States and around the world after the death of George Floyd in Minneapolis at the hands of several police officers there. Demonstrations continue to occur around the country. Unquestionably we’ll see some disease surges in cities where protests occurred. Some factors that could lead to a greater surge include the use of tear gas and pepper spray which induce violent coughing, a significant driver of disease spread. Additionally, pepper spray and tear gas cause respiratory epithelial damage which could make protesters more susceptible. We know from sporting events like the UEFA Champion’s League match in Milan on February 19 between between Atalanta and Valencia that the gathering of thousands of screaming people can lead to devastating super-spreading events. Two days after that match Italy had its first case and epidemiologists feel that the match likely played a part in the region’s massive outbreak. Similarly, the protests saw much yelling likely introducing more virus into the air and onto surfaces. A mitigating factor of course, is that almost all protests occurred outdoors where dissipation of virus containing droplets occurs much faster than the still air inside buildings. We’ll likely start to see increasing cases in the next week as spikes generally occur 2-3 weeks after spreading events. Admittedly though, since there’s already a significant increase occurring in many localities due to reopening measures it may be hard to tease out causative factors.
  • There’s a bit of a notion that COVID-19 is merely a disease of the very old. While this disease unquestionably hits older ages disproportionately, the death toll for people pre-retirement age and younger is not insignificant. In the US, 19% of all deaths have occurred in ages 64 and below for a total of 36,906 deaths at the time of this writing. COVID-19’s disease burden is not limited to retirees and the risk to older, pre-retirement workers is substantial. This has impacts beyond death rates. The disease often leads to a long period of illness and potentially long hospitalizations. Having a significant number of employed individuals hospitalized and/or sick for extended periods of time has a measurable effect on the economy. Dismissing this disease as merely a disease of the very old is not just statistically wrong, it’s unwise on many levels for the wellbeing of the nation.
CDC Data for US COVID-19 Deaths by Age/CDC
  • A MMRW Early Release publication looked at how the US Air Force managed over 10,000 trainees and limited total COVID-19 cases to 5 with only 3 transmissions. Their success is no surprise to public health experts as it followed well established non-pharmaceutical interventions. Trainees were kept healthy utilizing arrival quarantine, social distancing, mandatory face coverings and rapid identification of exposed/infected individuals through rapid testing and contact tracing. As the disease grew around the country, recruits from heavily infected areas were not permitted onto the base for training. The success there indicates clearly that well-established public health interventions like those described above can very successfully prevent viral spread and can allow for business almost as usual. Just because it can’t be said too much–wear a face covering!!
  • The FDA rescinded its Emergency Use Authorization for hydroxychloroquine today after reviewing the growing data demonstrating that the medication is ineffective in the treatment of COVID-19 and carries significant cardiac risk. There are still a few large trials underway examining the medication’s usefulness and safety but the FDA’s action means the medication now should not be used outside of those trials.
  • There are over 135 vaccines in development for COVID-19. The most advanced trial (Phase III) is the Oxford University vaccine which is a viral vector vaccine–the spike protein from SARS-CoV-2 is delivered with a safe virus in order to generate an immune response. In the case of the Oxford vaccine that virus is an adenovirus which causes the common cold. Early data indicates that the Oxford vaccine may not prevent SARS-CoV-2 infection but it may prevent fatal illness. Even that would make the vaccine a significant step forward against COVID-19. Right on Oxford’s heels is the Moderna vaccine which is a genetic vaccine (the mechanism was discussed in an earlier post). Moderna expects to have a large scale Phase III trial underway in July. If these vaccines make it through their trials and demonstrate efficacy and safety, it’s possible that emergency use for front-line healthcare workers, first responders and highest risk individuals may be possible in late 2020. So much has to line up for that to be a reality I hesitate to mention it for fear of raising hopes too much. But it’s always nice to end on an optimistic note so here’s to hope!
Categories
COVID-19

Thoughts on COVID-19 May 26, 2020

Mother and child during COVID-19 crisis/https://www.vperemen.com/Wikimedia Commons

Last week I was on call for public health and wasn’t able to post much. This long weekend was about recovering from call. Hopefully I’ll get back into a more regular schedule this week.

  • The Basic Reproduction Number (R0/R-naught) for the US looks like it has crossed back above 1 for the whole country. The R0 is important if you remember because it describes how many people on average are infected by one person. As long as that number is below 1, COVID-19 cases will drop. Once it goes above one as it has now (estimated by Youyang Gu on his site) we’ll start to see overall increases in new cases of the virus nationwide.
  • Imperial College’s new study (not yet peer reviewed) reveals that 24 states have COVID-19 reproduction numbers that are above 1 (one) and therefore have growth of the virus. Their model which incorporates changing mobility of the population further reveals that only 15.7% of US states have truly credible reproduction numbers below 1 (one).
  • An article in Pediatrics examined the role children play in spreading COVID-19. Swiss researchers looked at family clusters of infected individuals and found that child to adult spread occurred in only 8% of cases. It was far more common for adults to spread the virus to their children. If this is true and validated by other studies it could have significant implications for the reopening of schools. It’s important to remember that children may still be important vectors for the disease since they have have a higher likelihood of having few or no symptoms even if they don’t spread the virus as commonly as adults do.
  • There were 675 new cases of COVID-19 in Riverside County over the Memorial Day weekend from Friday to Tuesday. This is a significant bump with an average of 168 cases per day over the four days. A few weeks ago, the county had been averaging under 100 cases per day. This increase is worrisome and very likely due to several factors including spread during Mother’s Day gatherings 2 weeks ago. Citizens of Riverside County have been much more mobile in recent weeks and now have a failing grade with Unacast Social Distancing Scorecard. It’s also likely that social distancing is less rigorous in general as quarantine fatigue has fully set in. Additionally, face coverings are no longer mandatory in Riverside county, an order rescinded by the Board of Supervisors–this factor alone may play the largest role in increasing numbers now and in future weeks. One might suggest that increased testing is responsible for the bump but testing is actually down in Riverside County so in all likelihood, we’re seeing higher numbers because the virus is spreading more. This is what viruses do when given the chance. As the county opens up under the Governor’s new criteria and people feel more comfortable congregating in churches, at the beach, in restaurants and in stores, look for the daily new cases to climb further.