April 16, 2020 Corona Update

On a nationwide basis, the number of Corona Virus cases tallied per day is peaking and beginning to decline.  This is largely because of New York City and New Jersey, which have likely reached peak occurrence rate and make up about 40% of the cases in the United States.  In rural areas, most caseloads remain fairly low and are not expected to peak for 2-4 more weeks.  Exceptions in rural America include Sioux Falls, South Dakota, where an infection among workers in the Smithfield pork production plant resulted in over 600 cases (and counting) Smithfield has closed this plant and two others around the country so …. better get your bacon now before it’s all gone.  

The Smithfield experience contrasted with the California experience, illustrate the effectiveness of social distancing in controlling disease rates.  The San Francisco area followed the distancing guidelines compulsively and essentially had no peak in cases. (A flattened curve) Smithfield shows what happens in a free for all.  (Almost everyone gets sick)  

Important medical literature on Corona Virus has emerged in the last week including:

  1. Remdesivir, an intravenous antiviral given in a small study in multiple US hospitals, seems to have decreased the rate of death in critically ill patients on ventilators.  Death rate was 13% on Remdesivir patients compared with an observed rate of 60-70% of patients not given the drug.  Printed in the New England Journal of Medicine, the findings of this study are not conclusive, given the obvious limits on the investigators under the current circumstances
  2. Multiple centers have identified a known condition called Disseminated Intravascular Coagulation (DIC), an explosive activation of the body’s clotting system, associated with severe Covid 19 infection. Improvement has been observed in critically ill patients who have been treated with various forms of anticoagulants.  The most effective protocol of treatment is still being worked out but offers hope in reducing mortality rates
  3. Intense activation of the immune system  referred to as a “cytokine storm”  has been observed in severe cases of Covid -19 and has been treated with  tocilizumab, prescribed under the brand name Actemra to quiet the immune system in patients with rheumatoid arthritis.  This also has shown promise in reducing mortality.  

To get our lives back on some normal footing, which everyone craves,  we will need the ability to test large swaths of the population and keep the individuals who are still shedding virus out of the mix until they are no longer infectious.   Also, contacts of these individuals will be sought out and tested as well, and the effected ones must stay home and watch The Price is Right for 2 weeks until they are clear. 

Pretty much everyone agrees that this method will work, the problem is that we do not have the testing capability to make this happen.  One would think, in a country capable of designing and producing over 200 million I-phones in a year, that we could come up with a couple of hundred million q-tips and testing reagents kits as well.     As Winston Churchill once said, “You can always count on the Americans to do the right thing after they have tried everything else first.”

So, until we figure it out, stay safe.  We believe we will be able to return to regular appointments sometime next month.   We will remain in the office and are available by phone and email as well. 

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