June 17, 2020 Corona Update

Trying to figure out the current state of the Covid-19 infection reminds us of the parable, “The Blind Men and the Elephant.”  Three blind men are placed at different parts of an elephant, the tusk, the tail, and the leg and are asked to describe what they observe.  An argument ensues as each describes a completely different sensory experience.  
In one day on the News, in regard to the Pandemic, I have heard everything from the worst is over to doomsday is coming. The facts are becoming more difficult to discern as different statistics are used to support a variety of narratives, often to support political agendas and not necessarily public health.   So, what should you believe?  

Here are a few immutable facts:

  1. Caseloads in the United States have been rising by about 20,000 per day. This has been constant for the last two weeks. In mid-April at the peak of the US pandemic, this number was at 30,000 per day.  The ongoing rise in cases in somewhat attributable to the increased availability of testing.  We do not know how many asymptomatic people choose to get tested vs those who have symptoms.  So, the case load number tells us that disease is still active, it does not tell us much about the severity of these cases.  
  2. The percentage of Coronavirus tests that are positive in the United States has fallen from about 20% in early April, (the peak) to less than 5% now.  This number has decreased consistently over the last month.  This is one indication that things are improving nationwide. 
  3. Individual states are having vastly different experiences, as in the elephant example above. Arizona’s + case load has increased from 7% 2 months ago to 17% percent now.  Florida 2.4% positive case rate in May, 7% now.  New York had a 45% + case rate in early April, and it is now at 1.2%!  Maryland had a peak + rate of 26% in April and we are now at 6.9%.  You can see all of these statistics for each state here: https://coronavirus.jhu.edu/testing/individual-states/new-york
  4. The number of deaths from the Covid-19 infection have been decreasing consistently in the United States from about 2500 per day at a peak two months ago to less than 700 per day now. This is likely a good indicator of slowing disease rates, as the percentage of the population that gets severely ill may be a constant fraction of total cases.  This could also be a sign that we are getting better at treating severely ill patients:  the death rate may be decreasing on this basis as well.  
  5. Individual states, Arizona, Florida, the Carolinas, Texas, and others have seen increases in cases, deaths, and hospitalizations.  It is not known exactly why. Possible contributors are increased social interactions with relaxing of quarantine measures, the fact that these states are delayed on the disease curve because they had few infections early on, or possibly travel to these states by infected individuals.  

So the overall message is the country as a whole is improving in terms of caseloads and deaths, and Maryland in particular is doing extremely well, seeing a marked decrease in cases and deaths over the last two weeks. 

Public Health experts are hoping to see the current numbers of cases fall to a much lower level before the weather changes in the fall when the virus potentially becomes more active.  If new cases were to get to very low numbers, say in the single or double digits per day, it would be possible to trace contacts of these patients and ask them to quarantine,  thus avoiding another explosion of cases for your Christmas present. 

On to updates on the hydroxychloroquine saga:  The FDA has withdrawn emergency approval for use of Hydroxychloroquine for Covid -19 on the basis of lack of evidence of efficacy.  A New England Journal of Medicine trial published this week showed that prophylactic use of Hydroxychloroquine to prevent infection after exposure to the disease was also ineffective.  In light of issues with previous trials, we need to consider these results in the context of more data as it emerges.   

And finally, I have tried to restrain myself from political commentary unless the actions of our political leaders lop over into the medical field, which I figure is in my wheelhouse.  So, if I were advising the President (which is admittedly very unlikely to happen) I would suggest that he rethink his planned indoor rally in Tulsa, Oklahoma with 19,000 people this Saturday.  For starters, Tulsa is a city that has already experienced a sudden uptick in cases, in the last two weeks.   Trump rallies generally do not resemble a night at the symphony:  there is generally a good deal of shouting and high fiving and some people have even been known to share their half-eaten Hostess Twinkie with others.   I am betting that the percentage of people wearing masks will be about the same percentage as the people drinking white wine, but I may be wrong. 

 So when you combine the outcome of this rally in terms of the spread of the virus with the President’s aversion to mail in voting,  he may be inadvertently contributing to his election loss in November:  As he holds rallies all over the country and sickens his voters,  they may be too ill to get to the polls and have to mail in their ballot,  which by November may be illegal. 

Just thinking ahead.  

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