May 7, 2020 Corona Update

As of yesterday, Marylanders can play golf and tennis, and most importantly go out on their boats.  This would seem to be a positive development, but the Maryland numbers for hospitalizations and deaths remain relatively flat over the last 2 weeks. (Total case numbers are becoming a less reliable way of gauging the severity of the disease as more tests are being performed nationwide.  Hospitalizations and deaths from Covid-19 are now a better measure of the state of the pandemic) In our state, roughly 540 Covid patients reside in ICU beds each day (+/-3%) since April 22nd.  Deaths from Covid in Maryland show a slight decline but are averaging around 45 per day. 

Maryland was one of the few states to release numbers relating to the level of disease in nursing homes, last week.  These numbers are shocking:  59.2% (793 of 1338) of deaths in Maryland as of yesterday were in nursing facilities.  This number is higher (71%) in Anne Arundel County.  

Other Data from the Maryland Department of public health website reveals:

Percentage of all state deaths in those under 40:       0.27%

Percentage of all state deaths in those ages 40-69:    48.9%

Percentage of all state deaths in those ages 70-79:    12.8%

Percentage of all state deaths in those ages 80-89:   25.8%

The high death rate in nursing homes is a countrywide phenomenon.  With corrective measures, including carefully testing all staff that enter the nursing home, separating infected patients, and strict use of personal protective equipment, most public health experts expect this trend to change dramatically in the future.   

Experts also expect that the use of Remdesivir, an antiviral that I have mentioned previously, to decrease the death rate of hospitalized patients.  Remdesivir was FDA approved last week under an emergency use provision.  The manufacturer, Gilead pharmaceuticals, donated 1.5million doses to be distributed to hospitals around the country.  The drug, like Clorox, is given intravenously and appears to work better when given earlier in the course of the disease before patients require ventilators.

Though we have all been locked up and wearing masks, the USA is not doing all that well relative to other advanced countries in terms of death rate from Covid.  The USA currently has a death rate of 226/ per 1 million population.  This compares to 28/million for Israel, 87/million in Germany, and 139/million in Hong Kong.  Spain 558/million and Italy 491/million have much higher Covid death rates than the USA.   A chart listing interesting statistics for all major countries in the world is available here:

The most surprising aspect of this pandemic in the last 2 weeks is its persistence.  Most public health experts expected a decline in the rate of hospitalizations and deaths by now, but in fact nationwide we are seeing an increase in both in rural areas. (It is decreasing in the New York Metro area) There is a possibility that the disease will not decline at all and stay with us like a bad house guest who won’t leave, until a vaccine or treatment is available. What a happy thought.   This persistence is more likely as we open in the economy over the next few months. 

There is agreement that keeping the world locked down indefinitely could result in worse outcomes than the virus itself because of widespread poverty and economic collapse.  The way we proceed forward will determine the success of both our public health efforts and the success of restoring the economy.  I think this is one and the same:  The public must feel confident in their safety before they venture out to buy a new pair of underwear on their way to have a beer at the country club.  An organized effort by our leadership to restore confidence in venturing out to spend money will involve a comprehensive plan of protecting the elderly, testing at risk populations and workers frequently, transparency in statistics, and investments in vaccines and therapy.  For now, just use the Clorox in the laundry until more reliable data are available. 

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