June 30, 2020 Corona Update

Maryland is looking good.  In the face of easing restrictions over the past several weeks, the case numbers, the percent of cases which are positive, hospitalizations, and deaths from Covid-19 have declined.  Less than 5% of coronavirus tests in Maryland have been positive for several weeks, and this is a good indication of an overall low viral load in our state. 

As you have probably heard, some states in the country have not fared as well.  Florida, which looked as if it had dodged a bullet, is now a verifiable mess.  In the last several days it has recorded almost 9000 new cases of Coronavirus per day.  (Rates for the entire country 2 weeks ago were 20,000/day). Arizona is approaching full capacity in their ICU’s in some counties, and Houston, Texas is doing the same.  Los Angeles County in California, which had very low numbers for most of April and May has shown a sudden uptick in cases.  The ill fortune of some cities and states has doubled the national case rate over the last two weeks to 40,000 a day from 20,000/day two weeks ago. 

What are we to make of all this?  This is a difficult analysis, but I would put it together as follows:  Maryland and other states including New York, Connecticut, and New Jersey did not relax restrictions until case rates fell below a certain point.   Epidemiologists use a value called the R number to evaluate whether the virus is increasing or decreasing in severity and communicability.   The formula for the R number for those that are interested is discussed in this article from NIH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190554/

It’s worth clicking on this link just in case you were wondering why you decided not to pursue that mathematics degree.  The calculation of the R number is complex, but its significance is easy to understand: when the R number is under 1, the virus is likely to die out.  As the R number increases above 1 the virus spreads, and at high numbers the virus “explodes” exponentially. 
The governors who were effective at controlling the spread of the virus in their states used this number religiously to determine when to loosen restrictions, and the governors who opted for beach parties because it was Memorial Day, likely disregarded this number and decided to Party-On.  The results of this folly led to the recent explosion of cases in these states.  

But is the increase in cases in these “exploding” states likely to lead to more deaths?  Perhaps not.  Interestingly, the national death rate from Coronavirus has stayed steady in the last three weeks at around 600 per day.  This is down about 75% from the peak death rate of 2500/day in April.  Factors that may keep the death rate at a lower level include:

  1. there is evidence that many of the new cases are in young people, who are not likely to die from the illness 
  2. the older (and wiser) (and more susceptible) folk have tended to lay low, hunkering down in their abodes watching Netflix and drinking Chardonnay
  3. nursing homes where 40% of the deaths in the country have occurred, have enhanced their isolation policies and are doing better at keeping the riff-raff (aka those carrying the virus) out, and
  4. we are getting better at treating Covid-19 (with Remdesivir, dexamethasone, blood thinners, and high flow oxygen) and the death rate is likely lower in critically ill patients than it was 2 months ago. 

So, if you have any summer plans for visitors from Florida, Texas, or Arizona, tell them to stay home, they are like a fungus.  Maryland is likely to fare well if we don’t get an influx of virus from elsewhere.  Likewise, if you have plans to visit these states, cancel them, and go to Ocean City and have some French fries.  Wear a mask if you are inside in a public space and if you are outside and can’t avoid close encounters.  Many public health officials believe that if 60% of us wore masks as recommended, the virus would die off fairly quickly.   We are going to have to deal with this for a few more months, at least.  Maybe Santa Claus will bring us a vaccine for Christmas. If we can keep the numbers low locally, we will be in good shape.

Our office will be closed on Friday for the Holiday.  Have a happy fourth!

Register with our Site!

Severna Park Medical Associates sends out information pertinent to our patients’ health, announcements of closings, and office changes. Our patients can now use email, rather than a phone call, to communicate non-urgent information with us. We can also send lab results and other information to patients directly.