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    Re: covid-19 Virus Updates and Discussion

    Just now got around to reading WHO's Situation Report for September 17. I don't even know where to start.


    EPI UPDATE The WHO COVID-19 Dashboard reports 30.06 million cases and 943,433 deaths as of 10:00am EDT on September 18. This week appears to be on pace to set a new record for weekly incidence—currently at 315,919 cases. As the cumulative global incidence surpasses 30 million, the following timeline will provide some context for the trajectory of the COVID-19 pandemic:
    1 case to 1 million cases: 90 days
    1 million to 5 million: 48 days
    5 million to 10 million: 38 days
    10 million to 20 million: 44 days
    20 million to 30 million: 37 days

    The global daily incidence is once again increasing, driven largely by increasing incidence in India and multiple countries in Europe. After leveling off at approximately 260,000 new cases per day, the global daily average is now up to 285,000. As expected, the daily incidence in Asia and Europe are increasing, while North and South America appear to have plateaued or started to decline. Africa’s daily incidence peaked in mid-to-late June, and it has steadily decreased since then, now reporting fewer than 7,500 new cases per day for the entire continent. Proportionately, Asia’s and Europe’s contribution to the global daily incidence are increasing, while North and South America’s and Africa’s are decreasing. In fact, Asia currently accounts for more than 40% of the total daily incidence. On a per capita basis, South America still leads all continents at 140 daily cases per million population, followed by North America (84 per million) and Europe (58 per million). The global average is 37 daily cases per million population.

    With respect to deaths, Asia and North and South America are all reporting similar daily mortality (1,350-1,800 deaths per day), and Africa, Europe, and Oceania are all reporting fewer than 500 deaths per day. On a per capita basis, South America (3.4 daily deaths per million population) and North America (2.2 per million) are both reporting higher than the global average (0.7 per million). Europe (0.6 per million) is near the global average, and Africa, Asia, and Oceania are all reporting fewer than 0.4 daily deaths per million population.

    The US represents 22% of the cumulative global cases and 21% of the deaths, despite accounting for 4.25% of the global population.

    The US CDC reported 6.61 million total cases and 196,277 deaths. The US is averaging 38,538 new cases and 859 deaths per day. The average daily incidence has increased by 11% over the last 3 days, and daily mortality has increased by 17% over the last 4 days. It is possible that these increases represent a reversion to the expected average after lower reporting over the Labor Day holiday weekend, but we will continue to monitor the situation to determine if it is the beginning of longer-term trends. If the US continues at its current pace, it could reach 200,000 cumulative COVID-19 deaths by Tuesday’s update.

    In total, 21 states (no change) are reporting more than 100,000 cases, including California with more than 700,000 cases; Florida and Texas with more than 600,000; New York with more than 400,000; and Arizona, Georgia, and Illinois with more than 200,000. The Georgia Department of Health is reporting 300,903 cumulative cases, so we expect this to be reflected in the next CDC update.

    The Johns Hopkins CSSE dashboard reported 6.69 million US cases and 198,055 deaths as of 1:30pm EDT on September 18.

    EUROPE The WHO offered a stark warning for Europe as COVID-19 incidence continues to increase. Last week, incidence in Europe exceeded the continent’s first peak in March, and the epidemic continues to grow. While the resurgence of the virus is spread across the continent, rather than located in a few countries or regions with high transmission, the recent trend is concerning. The rise in European COVID-19 incidence has been driven, in part, by individuals aged 25-49. One potential change that could be affecting this increase is a shift in countries’ approach to containing their respective epidemics. A number of European countries have modified their approach from combatting the virus to coexistence. For example, French President Emmanuel Macron and Italian Minister of Health Roberto Speranza that emphasize that the public needs to learn how to “live with the virus.”

    UNITED KINGDOM The UK continues to struggle with SARS-CoV-2 testing capacity. The national laboratory network was not prepared to handle the surge in testing demand that coincided with children returning to school, and the UK testing program was forced to send tests to France and Germany in order to increase capacity. Following reports of a national backlog of 185,000 tests that is delaying results and hindering the public health response, UK Prime Minister Boris Johnson unveiled a plan dubbed Operation Moonshot, which aims to scale up national testing capacity to 10 million people a day by early 2021. This capacity could effectively allow everyone in the UK to be tested weekly. In light of a series of failures or missteps in the UK testing program—a situation in which the UK is not alone—experts question the feasibility of scaling up testing to this volume. Notably, the kind of rapid tests needed to realize this vision are still not widely available, nor are they approved for use in the UK.

    Like most countries, the UK has felt serious economic consequences from the COVID-19 pandemic and its corresponding impact on routine social and economic activity. The country’s unemployment rate is now the highest it has been in the past 2 years, and the 16-24 age group is facing the most severe decrease in employment. Like many schools in the US and elsewhere, colleges and universities in the UK have resumed fall classes. And like we have reported in the US, some schools are implementing harsh punishments for students who violate COVID-19 policies. For example, Trinity College Cambridge came under some scrutiny after announcing that it would evict students from university housing if they are involved in a COVID-19 outbreak. In addition to the effects on students who may not have alternate housing, this approach disincentivizes reporting by students, which could allow outbreaks to go undetected. If students are afraid to report symptoms or suspected cases, it could facilitate transmission both on campus and in the local community.

    INDIA India reported nearly 100,000 new COVID-19 cases, continuing to set new records for daily incidence, and it is currently reporting more than 1 million active cases nationwide. At this pace, India will soon surpass the US as #1 globally in terms of cumulative COVID-19 incidence. In addition to the national incidence, incidence is also increasing in major cities, including Mumbai and New Delhi, after a temporary plateau. India is testing more than 1 million samples a day. While this is a large number, it is unfortunately low on a per capita and per case basis. There are concerns over whether the country will be able to meaningfully slow the transmission of SARS-CoV-2, and questions about how much of the population may have already had the disease. The Times of India reported that serological studies have identified some communities with high seropositivity, including some greater than 50%. One study estimates that as many as 25% of the population nationwide have been infected. While some health and government officials have estimated that herd immunity could be observed at 60-70% seropositivity, it is unclear how accurate this estimate is. Additionally, there are considerable differences in seropositivity between communities, and the presence of antibodies does not necessarily mean that an individual is immune from infection. Regardless, India’s national trends suggest that its epidemic continues to accelerate.

    INDONESIA Indonesia’s COVID-19 epidemic has surged over the past several weeks, with daily incidence increasing more than 80% since August 25. In order to address the growing epidemic, some Indonesian officials are using unique approaches to increase adherence to policies, including mask use. In the Cerme district in East Java, the local government reportedly forced 8 individuals to dig graves for COVID-19 victims as punishment for violating the local mask mandate. The district is experiencing a shortage of grave diggers, and the district’s leadership believed that the punishment could both fill that role temporarily and serve as a deterrent to others. Notably, the individuals did not participate in any burial services and did not have contact with the bodies of any COVID-19 victim. And in Jakarta, the local government reportedly ”paraded” coffins containing dummies wearing masks through the city and displayed them in various public locations to serve as a stark reminder to wear a mask. The effort was met with considerable criticism and opposition by the public, some of whom cited the government’s failure to effectively implement social distancing and quarantine policies and delays in distributing economic and social assistance to the public.

    VACCINE ESPIONAGE As governments and countries press ahead with efforts to develop their own SARS-CoV-2 vaccine—as opposed to large, collaborative, multilateral efforts—”vaccine nationalism” not only creates challenges for the equitable global availability of a future vaccine, it also provides incentive for increased foreign intrusion and “espionage targeting vaccine research and development.” According to analysis published by the Council on Foreign Relations, espionage (including cyber espionage) is not technically prohibited under international law; however, it would violate international law if it were to result in “significant adverse or harmful consequences.” The analysis highlights the “ubiquity of cyber espionage” on SAR-CoV-2 vaccine efforts and the difficulty in “defending against or deterring” it.

    A previous report by The New York Times indicates that Chinese intelligence operatives conducted cyber espionage on academic research institutions working on SARS-CoV-2 vaccines, rather than pharmaceutical companies, and leveraged information from the WHO to direct their activities. Additionally, Russian and Iranian intelligence organizations “targeted vaccine research networks” in multiple countries, including in Canada, the UK, and the US. In July, the US Department of Justice charged 2 Chinese nationals with spying on multiple US entities conducting SARS-CoV-2 vaccine research—including Moderna Therapeutics, which is currently conducting late-stage clinical trials for its vaccine candidate—and entities in multiple other countries.

    DOWNSTREAM IMPACTS: GLOBAL HEALTH The Bill and Melinda Gates Foundation released a report that assesses the progress made and outstanding gaps in terms of achieving the Sustainable Development Goals (SDGs). The SDGs were established in 2015 as a follow-on to the Millennium Development Goals, with the goal of ending poverty, reducing inequality, and stopping climate change by 2030. The Gates Foundation report notes that, while progress has been made each year since the establishment of the SDGs, that progress largely stopped in 2020, primarily as a direct result of the COVID-19 pandemic. Additionally, the report notes that efforts to establish strong vaccine coverage have been severely affected, commenting that vaccination has been “set back about 25 years in about 25 weeks.” The severe global recession has driven much of the regression in 2020, particularly in lower-income countries that are largely reliant on informal economies. Women are especially affected. Additionally, the pandemic response has reduced the amount of funding available from governments, both for domestic populations and international aid, which further limits aid available to the public. The report indicates that 68 million people in lower-middle-income countries have been forced into poverty as a result of the pandemic and that an additional 37 million people have been forced into extreme poverty worldwide.

    VIRTUAL UN GENERAL ASSEMBLY In July, the UN announced that the 75th UN General Assembly would largely be held virtually, with Member States and others participating remotely via videoconference and pre-recorded video statements. UN Secretary-General Antonia Guterres acknowledged that the virtual solution is far from ideal, and he expects a “huge loss in the efficiency of diplomacy” resulting from the virtual format. As with many international and diplomatic fora, much of the important and interesting work at the General Assembly occurs outside of formal meetings, which is considerably more difficult if relevant parties are unable to have face-to-face conversations. Notably, the option to deliver statements via video has resulted in increased participation by heads of state, particularly by those who do not typically attend the General Assembly in New York. The annual meeting commenced earlier this week, and is scheduled to continue through October 2. In addition to a virtual General Debate, other high-profile events—including on Sustainable Development Goals, biodiversity, women’s rights, and the commemoration of the UN’s 75th anniversary—will also be held virtually.

    PREGNANT WOMEN MORBIDITY & MORTALITY Researchers from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) published findings from a study on COVID-19 in pregnant women. The study, published in the US CDC’s MMWR, involved 598 hospitalized pregnant women with confirmed SARS-CoV-2 infection. The patients included women in all 3 trimesters of pregnancy, but 87.4% were hospitalized during the third trimester. Notably, 81.9% of those admitted during the third trimester were hospitalized for “obstetric indications” (eg, labor and delivery).

    Among 458 women who had completed pregnancy at the time of their discharge, 97.8% resulted in a live birth. Pregnancy losses occurred in both symptomatic and asymptomatic patients. Among live births, 12.6% were pre-term, including 23.1% of live births among symptomatic patients and 8.0% among asymptomatic patients. The overall prevalence of pre-term births in 2010 was 10%, which suggests that pregnant COVID-19 patients could potentially be at elevated risk for pre-term birth. Additionally, 2 live births died shortly after delivery, and both were born to symptomatic patients who required mechanical ventilation. From March-August, an estimated 25% of hospitalized women aged 15-49 with confirmed SARS-CoV-2 infection were pregnant, compared to an estimated 5% in the general population. The study was not designed to determine the significance of these findings, but the results indicate that pregnant women could be at elevated risk for SARS-CoV-2-related complications and that additional research should be conducted to better characterize the effects of SARS-CoV-2 infection in pregnant women.

    **While the following topics are largely US issues and guidance, they are emerging storylines that we feel are important to cover as they unfold instead of waiting until next week.**

    US CDC SCHOOL & CHILDCARE GUIDANCE The US CDC published a set of indicators to assist school officials and state and local governments in making dynamic decisions regarding how to operate schools in the midst of the US COVID-19 epidemic. The indicators include specific thresholds for estimating the risk of SARS-CoV-2 transmission in schools. The Core Indicators include per capita COVID-19 incidence and test positivity in the community over the past 2 weeks as well as the school’s ability to implement 5 recommended risk mitigation strategies: mask use, social distancing, enhanced hygiene and respiratory etiquette, enhanced cleaning and disinfection, and contact tracing. An additional list of Secondary Indicators address relative change in incidence, hospital bed and ICU capacity, and the existence of local COVID-19 outbreaks. Each indicator is divided into 5 risk categories to aid school and government officials in their risk assessments.

    The guidance suggests that schools with higher assessed risk “could consider alternative learning models,” such as virtual or hybrid classes, to mitigate the risk. The guidance does not instruct school and government officials how exactly to factor these indicators into their risk assessment, but these metrics and key recommended strategies do provide additional information to inform school decision-making.

    The timing of the guidance has raised criticism of the CDC for not distributing it sooner, in time to inform school planning and preparedness efforts. Notably, many schools have been in session for weeks already, and this kind of guidance would have been more helpful as schools were developing their plans, particularly those that aimed to resume in-person classes. Analysis by Dr. Ashish Jha, Director of the Harvard Global Health Institute, found that 56% of US counties fall into the “highest” risk category and 31% in the “higher” risk category (the two highest categories), based on local COVID-19 incidence and test positivity, which accounts for nearly 90% of the US population.

    CDC Director Dr. Robert Redfield also indicated that the CDC is developing guidance regarding asymptomatic or presymptomatic testing to screen for SARS-CoV-2 infections, including at schools, businesses, and other locations. As effective rapid tests become available, screening could provide important information to help school and health officials more quickly identify and respond to emerging outbreaks. That guidance is expected to be published in the near future.

    US VACCINE DISTRIBUTION PLAN On September 16, the US CDC released guidance for jurisdictions to prepare operationally for SARS-CoV-2 mass vaccination. The document states that pandemic influenza planning activities and routine immunization preparedness efforts can serve as a foundation for SARS-CoV-2 vaccination planning; however, additional planning is necessary to undertake vaccination on scale necessary to combat the pandemic. Jurisdictions are required to submit their plans by October 16 in order to receive federal funding support. The document advises jurisdictions to test their plans and establish timelines for their preparedness efforts.

    The document describes 3 main phases to support SARS-CoV-2 mass vaccination planning efforts. Phase 1 is expected to involve an initial limited supply of vaccine, which will focus primarily on critical high-priority populations. Vaccination during Phase 1 will occur predominantly in closed points of dispensing (PODs; ie, limited to specific eligible groups). Phase 1A will prioritize healthcare workers, and Phase 1B will expand to other essential workers and individuals at high risk for severe disease and death. In Phase 2, it is expected that the available supply will be sufficient to start vaccinating the general population. The venues for vaccination would need to expand to include clinical settings, pharmacies, and public health mass vaccination clinics (eg, open PODS) and other settings. Phase 3 consists of continued vaccination and a shift to routine immunization strategies for SARS-CoV-2.

    The guidance notes that a surge in vaccine demand may be possible by Phase 2, and a broad vaccine administration network could be needed to support surge capacity. The guidance document notes several key challenges, including ensuring equitable allocation and distribution of the vaccines. Additionally, the guidance also highlights the potential that the vaccine could require an ultra-cold chain (-60 to -80°C). Ancillary kits containing some of the key supplies needed to conduct vaccination, including syringes and alcohol pads, will be sent to jurisdictions. The vaccine itself may be distributed centrally by the federal government or potentially directly from the manufacturer—such as early in the vaccination effort for vaccines requiring ultra-cold chain.

    Considerable uncertainty remains regarding the timeline for vaccine availability, so the document does not include specific timelines for each mass vaccination phase. CDC Director Dr. Robert Redfield recently stated in testimony to the US Senate that a vaccine would likely not be available for large-scale general public rollout until spring or summer of 2021. President Donald Trump directly contradicted Dr. Redfield at a press conference later that day, stating that distribution would be “rapid,” possibly starting in October, and that the military would be involved in mass vaccination efforts. The role of the military in distributing the vaccine is unclear, and some experts have raised concerns that the inclusion of military assets in vaccination could exacerbate mistrust in the federal government among certain populations, particularly communities of color. An additional concern is the lack of funding that state and local jurisdictions have to support large-scale mass vaccination, particularly considering the chronic underfunding of public health infrastructure. Dr. Redfield stated that it could take up to US$6 billion to distribute the vaccine; however, the CDC currently has approximately US$600 million to support COVID-19 relief efforts. The funding needed to support vaccine distribution efforts have reportedly been stalled as Congress has been unable to finalize another COVID-19 relief package.

    US CDC TESTING GUIDANCE Following up on an emerging storyline regarding the potential influence of political appointees in CDC reporting and guidance, The New York Times reports that controversial SARS-CoV-2 testing guidance published on the US CDC website was not drafted by CDC experts. The guidance in question stated that individuals with known exposure to COVID-19 cases but who are not exhibiting symptoms “do not necessarily need” to be tested. Following the update, multiple media outlets reported that the changes were influenced by pressure from White House officials, including reports that Dr. Anthony Fauci did not sign off on the changes before they were published. The new New York Times report indicates that the update was drafted by officials at the Department of Health and Human Services and the White House Coronavirus Task Force and posted to the CDC website without going through the CDC’s traditional scientific review process. According to the report, additional changes to the testing guidance are expected to be posted today; however, these changes may also be circumventing the CDC review process.
    Winston, a.k.a. Alvena Rae Risley Hiatt (1944-2019), RIP

  2. #3692

    Re: covid-19 Virus Updates and Discussion

    Quote Originally Posted by suliso View Post
    The numbers are deaths per 1 million inhabitants as officially reported

    Peru 922
    Belgium 855
    Spain 636
    Chile 619
    Bolivia 619
    Brazil 613
    Ecuador 612
    UK 612
    USA 596
    Italy 589
    Sweden 578
    Mexico 543
    Panama 494
    France 473
    Colombia 442

    There has been some serious adjustment in several South American countries if you compare those two lists. Situation is bad there still, but not so bad that so many people would die in just two weeks. It's clearly from earlier and probably believable considering stories from Peru and Ecuador earlier in the year. Elsewhere USA has overtaken Italy and Sweden and will certainly zoom past UK soon, maybe Spain too albeit there the second wave is raging and fatalities might be increasing rapidly soon.
    Update a week later

    Peru 949
    Belgium 857
    Spain 652
    Bolivia 648
    Brazil 641
    Chile 640
    Ecuador 626
    USA 615
    UK 614
    Italy 591
    Sweden 580
    Mexico 567
    Panama 519
    France 479
    Colombia 471

    Not that much change in rankings this week except for USA officially passing UK. Situation is worsening in Europe again so perhaps Spain, France and UK will feature prominently again... There is nobody closely following Colombia, though (Netherlands 366)
    Roger forever

  3. #3693

    Re: covid-19 Virus Updates and Discussion

    Quote Originally Posted by suliso View Post
    Below is European map and table too weeks later. One doesn't need to be Einstein to see that the situation is stable or improving in only handful of countries (Germany, Sweden, Finland, Poland, Serbia, Bulgaria, Cyprus, Iceland and Latvia) and rapidly deteriorating elsewhere. Particularly concerning is situation in Spain and France.

    Again the table and the map is self explanatory... It's getting worse almost everywhere. Including very rapidly in formerly safe islands like Hungary or Georgia.

    Roger forever

  4. #3694

    Re: covid-19 Virus Updates and Discussion

    Another interesting graph of pandemic long development in select European countries

    Roger forever

  5. #3695

    Re: covid-19 Virus Updates and Discussion

    Quote Originally Posted by suliso View Post
    The ten worst and the ten least affected US States at the moment. Daily new cases per 100k inhabitants (moving 7 day average). Data Source: Harvard Global Health Institute

    North Dakota 34.6
    South Dakota 25.4
    Iowa 22.9
    Missouri 21.6
    Oklahoma 21.0
    Arkansas 20.7
    Tennessee 19.4
    Kansas 18.7
    Alabama 18.0
    Georgia 17.1
    Oregon 4.7
    Colorado 4.7
    New Mexico 4.5
    Massachusetts 4.0
    New Jersey 3.9
    New York 3.6
    Connecticut 3.1
    New Hampshire 2.4
    Maine 2.3
    Vermont 0.5

    As expected the worst states are no longer in the deep South, but rather further north in the Great Plains. Overall situation is steadily improving since the new hot spots are much thinner populated. The bottom of the list has become slight worse, we'll see in few weeks whether that is a cause for concern or not.
    Here is an update a week later

    North Dakota 47.7
    Wisconsin 41.5
    South Dakota 31.6
    Arkansas 30.3
    Missouri 25.5
    Oklahoma 25.1
    Iowa 24.9
    Utah 23.0
    Tennessee 22.4
    South Carolina 22.0
    New Mexico 5.4
    Oregon 5.0
    Massachusetts 5.0
    Washington 4.9
    Connecticut 4.9
    New Jersey 4.8
    New York 3.9
    New Hampshire 2.6
    Maine 2.2
    Vermont 0.9

    The pandemic continues to rage in Dakotas but the big surprise is a huge outbreak in Wisconsin which has shot up from outside the top 10 to almost the worst in the nation and it's not a tiny state either. After reaching a recent nationwide low about 10 days ago the infection rate is steadily raising in US again (compare average for the 10 worst and 10 best from now and a week before).

    Attached is also a US map on county level so you can see where it's red and where it's green. Green and yellow is somewhat under control, orange and red certainly not.

    USA September 20th.JPG
    Roger forever

  6. #3696

    Re: covid-19 Virus Updates and Discussion

    Quote Originally Posted by suliso View Post
    Here is a weekly update to the global list now with numbers directly comparable with those of US states (daily infections per 100k inhabitants as a moving 7 day average)

    Bahrain 40.1
    Montenegro 25.2
    Israel 24.0
    Argentina 23.1
    Costa Rica 22.2
    Kuwait 18.2
    Peru 17.0
    Panama 16.4
    Maldives 16.4
    Spain 16.1
    Colombia 15.0
    Brazil 13.4
    France 11.3
    USA 10.8
    Chile 9.1
    India 6.5
    Hungary 4.8
    Switzerland 4.1
    Mexico 4.0
    Denmark 3.8
    UK 3.7
    Italy 2.4
    Turkey 1.9
    Sweden 1.7
    Canada 1.7
    Germany 1.6
    Finland 0.7
    Latvia 0.3
    Australia 0.3

    As you can see the center of the pandemic is slowly pivoting back to Europe although of course situation in South America still dire. I guess we see now why Argentina has decided on another lockdown. The strange story is the consistently poor performance of Israel. In most places the infections peak and then decline somewhat, but not there...
    Update a week later

    Bahrain 42.3
    Israel 38.5
    Montenegro 25.5
    Argentina 24.5
    Costa Rica 23.2
    Spain 18.6
    Peru 17.3
    Kuwait 16.9
    Czechia 16.5
    Puerto Rico 15.5
    Brazil 14.6
    Colombia 13.8
    France 13.8
    USA 12.4 (recent low was 10.6)
    Chile 9.2
    Hungary 8.9 (used to be <2 three weeks ago)
    Netherlands 8.5
    India 6.7
    Denmark 6.5
    Belgium 6.5
    UK 5.1
    Switzerland 5.0
    Mexico 3.5
    Italy 2.4
    Canada 2.2
    Germany 2.0
    Sweden 2.0
    Finland 0.9
    Uruguay 0.5 (how can they do that next to Brazil and Argentina?)
    Japan 0.4
    Latvia 0.3
    Australia 0.2

    Well, the second wave is clearly upon most countries...
    Roger forever

  7. #3697

    Re: covid-19 Virus Updates and Discussion

    Quote Originally Posted by suliso View Post

    And another type of European man a week later

    Roger forever

  8. #3698

    Re: covid-19 Virus Updates and Discussion

    Second wave indeed, Suliso. Wonder if there will be a THIRD, as I believe cold temperatures have not really reached Europe.
    Thanks for the graphs.
    Face it. It's the apocalypse.

  9. #3699

    Re: covid-19 Virus Updates and Discussion

    I look forward to seeing these graphs suliso. Thanks for posting them for us.
    “No matter how cynical I get, I just can't keep up.” – Lily Tomlin.

  10. #3700

    Re: covid-19 Virus Updates and Discussion

    U.S. Covid-19 death toll surpasses 200,000
    A prediction made in March — unfathomable at the time — has come to pass.

    Sept. 19, 2020, 11:38 AM EDT / Updated Sept. 19, 2020, 12:07 PM EDT
    By Erika Edwards and Denise Chow

    In the predawn hours of March 30, Dr. Deborah Birx stepped in front of the camera on the White House lawn and made an alarming prediction about the coronavirus, which had, by then, killed fewer than 3,000 people in the United States.

    "If we do things together, well, almost perfectly, we can get in the range of 100,000 to 200,000 fatalities," Birx, coordinator of the White House coronavirus task force, told Savannah Guthrie of NBC News' "Today" show.

    "We don't even want to see that," she added, before Guthrie cut her off.

    "I know, but you kind of take my breath away with that," Guthrie said. "Because what I hear you saying is that's sort of the best-case scenario."

    "The best-case scenario," Birx replied, "would be 100 percent of Americans doing precisely what is required."

    On Saturday, Birx's prediction came true, as the number of lives lost to Covid-19 in the U.S. topped 200,000.

    Experts like Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention, said it didn't have to be this way.

    "Tens of thousands of people would not have died if the U.S. response had been more effective," said Frieden, now president of Resolve to Save Lives, a global public health initiative.

    Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said Birx's prediction in late March was "very sobering." That was the time, he said, to develop and implement a plan to stop or at least slow the spread of the virus.

    That didn't happen then, and it hasn't happened since. "Where is our national plan?" Osterholm asked. "How are we this far along and we don't have one?"

    "We have a long way to go," he added.

    Indeed, the country still faces many challenges in overcoming the pandemic, including agreeing on even the most basic facts. Americans are still fighting over whether to wear masks, whether the virus is serious and to what extent it's safe to reopen certain businesses and to resume certain activities.

    In short, 100 percent of Americans — government officials included — still aren't doing precisely what is required.

    Another ominous prediction

    Now, many experts are making another ominous prediction: A surge in the number of new infections in the fall and winter, combined with growing fatigue over social distancing and other public health measures, could result in more than 415,000 deaths in the U.S. by January, according to the Institute for Health Metrics and Evaluation, or IHME, at the University of Washington.

    The prediction comes even as doctors are growing more adept at treating patients and clinical trials are finding that treatments like remdesivir and dexamethasone can help. And as the pandemic has spread, it has moved into younger, healthier populations, who are less likely to die from Covid-19.

    A woman passes a fence outside Green-Wood Cemetery, adorned with tributes to victims of Covid-19, in Brooklyn, N.Y., on May 28. The memorial is part of the Naming the Lost project, which seeks to humanize victims who are often simply listed as statistics.Mark Lennihan / AP file

    The IHME's projections are by no means set in stone. Changes in human behavior, such as increased adherence to wearing masks, can bring the number down considerably, said the director of the IHME, Dr. Christopher Murray, a professor of health metrics sciences at the University of Washington. But the experiences of other countries have shown that, as the pandemic wears on, public complacency is a real concern.

    "We're seeing it in a very big way in parts of Europe, for example, where lack of vigilance is leading already to a big uptick," Murray said.

    The IHME model is one of several that the CDC uses to track the evolution of the pandemic, but it has faced its share of skepticism. The model often includes high degrees of uncertainty, and it was criticized early on for underestimating the number of deaths nationwide. In April, for example, the IHME model projected that the death toll in the U.S. through August could be 60,415, although the prediction included a wide range to account for uncertainties early in the pandemic.

    Murray said that the model is constantly being refined to provide more accurate scenarios but that most researchers in the modeling community had been warning for months that the pandemic could have a serious death toll. It's the type of insight, Murray said, that makes the 200,000-death milestone all the more frustrating.

    "There is obviously something pretty depressing about the whole drama as it unfolds," he said. "It's sort of like a train wreck that we know is unfolding and people keep grasping for some idea that it's not that bad."

    200,000 who didn't expect to die

    For those whose loved ones have died, such complacency is "like a daily kick in the teeth."

    Nicole Hutcherson, of Goodlettsville, Tennessee, lost her father, Frank M. Carter, 82, to Covid-19 in April. Hutcherson said that since then, people around her have questioned whether the pandemic is real (it is) or have suggested that her father was already frail or sick before he became infected with the virus (he wasn't).

    "My dad could outwork most any 30-year-old," Hutcherson said. "People are just not grasping that this is a big deal."

    Dr. E. Wesley Ely, a professor of medicine and critical care at Vanderbilt University Medical Center in Nashville, Tennessee, called the 200,000 deaths a "benchmark of sadness."

    "This is 200,000 people who didn't think they were going to die this year," Ely said.

    Covid-19 has killed people of all ages, all races and all political affiliations. They include a veteran emergency medical technician with the New York Fire Department. A pastor in Texas. A nurse in South Carolina. Children who have succumbed to a rare inflammatory complication of the disease called MIS-C.

    States currently logging the biggest numbers of daily Covid-19 deaths are California, Florida and Texas. By far, the state with the most deaths total is New York, with just over 33,900 as of Saturday.

    A Covid-19 'tsunami'

    Dr. Hugh Cassiere felt he was facing a "tsunami" of gravely ill Covid-19 patients when New York was at its peak of cases in March and April. He led a Covid-19 intensive care unit at North Shore University Hospital, part of Northwell Health, on Long Island.

    The coronavirus presented new challenges even for veteran ICU physicians.

    "There were a multitude of deaths every single day no matter the best that you could possibly do," Cassiere said. "It was overwhelming professionally and emotionally."

    But not all patients made it to the ICU.

    Joyce Brown Wigfall, a labor and delivery nurse in Forest Hills, New York, started feeling sick on March 30 — the day Birx mentioned 200,000 deaths.

    Wigfall, 67, felt weak and had trouble catching her breath walking up stairs — unusual symptoms for a woman who raised five sons, loved Zumba exercise classes and had just completed a master's degree in nursing with an emphasis in leadership, and had begun to pursue a doctorate.

    "I was so proud of her," said Wigfall's son, Erik Brown, 33.

    Within a week of falling ill, Wigfall was diagnosed with Covid-19, but she felt well enough to recover at home. Brown said his mother remained engaged with her co-workers from afar, and on April 12, said she was ready to go back to work.

    On April 13, Wigfall's health deteriorated rapidly. She died within hours. Her passing left an immeasurable void.

    "She was the center of the family. She was the rock," Brown said.

    "I'm angry at the fact that we still don't have any sort of concrete plan to get the country back to 'normal,' whatever that is," Brown said. "There is still no way that we can go back to the life that I had prior to March 30."

    An unpredictable path

    Much remains unknown about how the virus could progress in the fall and winter, particularly with regard to whether the changing seasons will affect how it spreads within communities, as cold weather draws people indoors. But experts stressed that maintaining vigilance will be one of the most effective ways to contain it and prevent runaway outbreaks.

    A team at Northeastern University in Boston created a model that provides state and nationwide projections for up to four weeks in the future — akin to a weather forecast. Beyond four weeks, too many unknown factors can dilute the model's accuracy, said Alessandro Vespignani, director of Northeastern's Network Science Institute.

    Numbers aside, Vespignani was adamant that certain proven strategies, when followed, would reduce the number of future cases and deaths.

    Mexican Consul General Jorge Islas Lopez leads people carrying cremated remains after a prayer service at Saint Patrick's Cathedral in New York on July 11. The service was held to bless the ashes of Mexicans who died during the coronavirus pandemic but could not have funeral Masses or burials.Andrew Kelly / Reuters file

    "A storm will do what it's supposed to do. You can't do anything about it," Vespignani said. "With an epidemic, we can change the trajectory."

    Many of the ways to do that aren't new, including wearing masks, practicing good hygiene by washing hands frequently and getting a flu shot, he said.

    Managing the factors that can be controlled will be crucial in the months ahead, especially because most scientists are anticipating a new wave of infections in the fall and winter, coinciding with flu season.

    "There's winter coming, and there might be another wave of transmission ahead, so we still need to have a plan to deal with that," said Sen Pei, an associate research scientist at Columbia University, who has done extensive Covid-19 modeling work. "Otherwise, we will still see people dying."

    The IHME model's prediction that the U.S. will double its number of Covid-19 deaths by January, to 415,000, is not unrealistic, experts said.

    Cassiere, of Northwell Health, said, "I think we're going to easily hit 400,000."
    “No matter how cynical I get, I just can't keep up.” – Lily Tomlin.

  11. #3701

    Re: covid-19 Virus Updates and Discussion

    Forgot to post yesterday this Swiss made map below. Numbers differ slightly due to different sources and time cut off points, but the general story is the same.

    Roger forever

  12. #3702

    Re: covid-19 Virus Updates and Discussion

    There are large regional differences here in Switzerland. About 1/3 of all infections are from Lausanne area (ca 10% of the population).
    Roger forever

  13. #3703

    Re: covid-19 Virus Updates and Discussion

    Colombia: ICU occupancy rate stands at 58%, from a high of almost 90%. So the opening continues, despite the numbers being high. Some more measures are being relaxed.
    You tell me when you figure out how this virus works.
    Face it. It's the apocalypse.

  14. #3704
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    Re: covid-19 Virus Updates and Discussion

    WHO's Situation Report for September 20, 2020. Full text from the enewsletter below.


    EPI UPDATE The WHO COVID-19 Dashboard reports 30.95 million cases and 959,116 deaths as of 10:30am EDT on September 21. Last week, the WHO reported more than 2 million new cases, a new weekly record and an increase of 6.5% from the previous week.

    Total Daily Incidence (change in average incidence; change in rank, if applicable)
    1. India: 91,593 new cases per day (-94)
    2. USA: 40,691 (+5,897)
    3. Brazil: 30,596 (+3,034)
    4. Argentina: 10,922 (+254)
    5. Spain: 10,531* (+790)
    6. France: 10,381 (+2,336)
    7. Colombia: 6,965 (-149)
    8. Russia: 5,798 (+469; ↑ 1)
    9. Peru: 5,611 (-52; ↓ 1)
    10. Israel: 4,547 (+840; new)

    Per Capita Daily Incidence (change in average incidence; change in rank, if applicable)
    1. Israel: 676 daily cases per million population (+97)
    2. Montenegro: 432 (+169; ↑ 1)
    3. Bahrain: 412 (+8; ↓ 1)
    4. Andorra: 407 (+168; ↑ 1)
    5. Argentina: 242 (+6; ↑ 1)
    6. Costa Rica: 232 (-8; ↓ 2)
    7. Spain: 225* (+17)
    8. Czech Republic: 174 (+67 ; new)
    9. Peru: 170 (-2)
    10. Bahamas: 161 (+22 ; new)
    *Spain’s average daily incidence is not reported for today; these values correspond to the previous day’s averages.

    India appears to have passed a peak in terms of daily incidence, reporting more than 93,000 new cases each on September 17 and 18 before decreasing for 3 consecutive days. Mexico fell out of the top 10 in terms of total daily incidence, and it was replaced by Israel. Kuwait and Panama fell out of the top 10 in terms of per capita daily incidence, and they were replaced by the Czech Republic and the Bahamas. Additionally, the Occupied Palestinian Territory is reporting 166 daily cases per million population, which would be #10 in terms of per capita daily incidence if it were a WHO Member State.

    The US CDC reported 6.75 million total cases and 198,754 deaths. The US is averaging 40,207 new cases and 794 deaths per day. In total, 22 states (increase of 1) are reporting more than 100,000 cases, including California with more than 700,000 cases; Florida and Texas with more than 600,000; New York with more than 400,000; Georgia with more than 300,000; and Arizona and Illinois with more than 200,000.

    The Johns Hopkins CSSE dashboard reported 6.82 million US cases and 199,636 deaths as of 12:30pm EDT on September 21.

    US CDC TESTING GUIDANCE Several weeks ago, the US CDC published controversial SARS-CoV-2 testing guidance indicating that individuals with known exposure to COVID-19 cases “do not necessarily need” to be tested. Since then, information has emerged in various media reports that the guidance was drafted by officials at the Department of Health and Human Services (HHS) and the White House Coronavirus Task Force and did not undergo the traditional CDC review process before being posted to the CDC website. On Friday, the CDC published another update that now recommends testing for all individuals with known exposure to COVID-19 cases. The update is very clear regarding individuals who have been within 6 feet of someone with known SARS-CoV-2 infection for at least 15 minutes: “You need a test.” Additionally, the update recommends that individuals with known exposure self-quarantine/isolate for 14 days, regardless of whether their test result is positive or negative.

    In the weeks since the previous update, a number of experts have called for this kind change to the testing guidance, particularly in light of the current understanding of the role of asymptomatic and presymptomatic transmission in the pandemic. Notably, we are not aware of any new studies or information since the previous change that significantly affects our understanding of asymptomatic or presymptomatic transmission, so it appears that the most recent update is a correction to the previous guidance.

    VACCINE SAFETY Vaccine safety continues to be an object of concern among the public. A poll conducted by the Pew Research Center found that only 51% of US adults would definitely or probably get a SARS-CoV-2 vaccine if it were available, a substantial decrease from 72% in late April and early May. Additionally, 77% of respondents indicated that they expect a vaccine to be approved before its safety and efficacy is fully studied, and 78% indicated that a rushed approval process is their greatest concern regarding the vaccine. More than 90 health organizations issued an open letter to the US FDA to address these fears, encouraging the FDA to complete Phase 3 clinical trials and utilize existing regulatory processes to fully evaluate and authorize a vaccine for public use.

    A group of Black physicians from the National Medical Association created an independent expert panel to review data on candidate vaccines and therapeutics with the aim of increasing confidence and uptake of effective medical countermeasures among Black communities who have been disproportionately affected by COVID-19. The National Medical Association was founded in 1895, at a time when Black doctors were excluded from other medical associations, and it aims to eliminate health disparities affecting Black patients. In addition to safety and efficacy data from clinical trials, the panel will also review study design to evaluate the extent to which racial and ethnic minorities are included. The panel hopes its review and recommendation will ensure the appropriate evaluation of candidate vaccines and help improve uptake of safe and efficacious vaccines among Black and other racial and ethnic minorities.

    After pressure from health experts to increase transparency regarding their vaccine clinical trials, AstraZeneca, Moderna Therapeutics, and Pfizer disclosed their Phase 3 clinical trial protocols. Study protocols for clinical trials have historically not been made public until after the trial is completed. The study protocols describe how the 3 companies intend to analyze the trial data, including outcomes of interest and conditions that would result in early termination. The studies also describe the points at which preliminary data will be analyzed and the conditions for applying for an Emergency Use Authorization prior to the completion of the trial. AstraZeneca’s protocol is of particular interest after the Phase 3 trials were suspended as a result of a serious adverse event in one of the participants. The trials were resumed in the UK following an independent safety review, but the company has released only minimal information about the event and related data.

    AIRBORNE/AEROSOL TRANSMISSION On Friday, the US CDC updated its guidance regarding SARS-CoV-2 transmission, in particular with respect to droplet and airborne/aerosol transmission routes. The update emphasized the role of airborne/aerosol transmission, noting that aerosols are believed to “be the main way the virus spreads” and that “airborne particles” can remain suspended in the air for prolonged periods of time and travel distances beyond 6 feet. This represented a major shift in how the CDC communicated regarding respiratory transmission of SARS-CoV-2, which previously focused on “droplet” transmission (ie, via larger respiratory particles). This morning, the CDC issued a statement that the information updated on Friday was a draft version of guidance that was published prematurely. The website was updated again today to revert to the previous iteration of the guidance (ie, that emphasizes droplet transmission as the primary route).* The current website on SARS-CoV-2 transmission notes that the CDC is in the process of updating its guidance and that new language will be published “once [the] review process has been completed.” If the CDC shifts its focus to airborne/aerosol transmission as the primary concern for SARS-CoV-2, it is unclear if associated recommendations regarding mask use (which are less or minimally effective at reducing aerosols compared to larger droplets), physical distancing, face shields or other solid barriers, or other mitigation measures will change as well.
    *We have been unable to identify an archived version of the changes from Friday, so we are unable to confirm the content of the changes beyond what is reported in the media.

    BRADYKININ STORM Bradykinin is a peptide commonly found in the human body that is involved in a myriad of biological functions—including lowering blood pressure, contracting smooth muscle in the lungs and gut, assisting kidney diuresis, creating pain sensation, and triggering inflammation—and new analysis suggests that it could potentially account for certain unexplained facets of COVID-19 disease. Researchers at the Oak Ridge National Laboratory and several US universities found that an enzyme known as DABK accumulates as a result of SARS-CoV-2 binding to ACE2 receptors, which then triggers an increase in bradykinin in the body. This increased level of the peptide could explain clotting issues in COVID-19 patients that can cause serious effects such as heart attacks or strokes as well “COVID toes.” Increased bradykinin could also cause lungs to become more watery or release blood and immune cells to their interior, which could cause respiratory distress and breathing issues in patients. The myriad of functions of bradykinin could also potentially be linked to thyroid and neurological symptoms in COVID-19 patients. The bradykinin hypothesis could also potentially explain increased disease severity in male COVID-19 patients compared to females, as females typically produce twice as much of a specific protein that protects against certain effects of bradykinin over-accumulation. Bradykinin could also factor into the effects of vitamin D deficiency and corticosteroids in COVID-19 disease progression and severity. Scientists are currently pursuing treatment options that may address the role of bradykinin in COVID-19 patients, such as repurposing the drug icatibant and beginning clinical trials for new treatments. Further research is required to better characterize any direct or indirect effects of bradykinin in COVID-19 patients.

    HUMAN/PET TRANSMISSION A study published in the US CDC’s Emerging Infectious Diseases journal provides further evidence that SARS-CoV-2 can be transmitted between animals and humans, potentially including pets. The study tested 50 cats for COVID-19 in Hong Kong and identified 6 SARS-CoV-2 infections. Based on findings during the 2003 SARS epidemic, Hong Kong initiated a policy of quarantining mammalian pets belonging to humans with confirmed SARS-CoV-2 infection. While the researchers identified 6 feline infections, they were not able to definitively identify specific instances of human-to-animal or animal-to-human transmission.

    LONG-TERM CARE FACILITIES Nursing homes and other long-term care facilities provide ideal conditions for the spread of SARS-CoV-2, including prolonged indoor contact and residents at elevated risk for infection and severe disease, and nursing homes account for a disproportionately high fraction of US COVID-19 cases and deaths. Last week, the Centers for Medicare and Medicaid Services (CMS) unveiled the report by an expert panel convened to provide additional recommendations for improving safety at long-term care facilities in the midst of the US epidemic. The expert panel cited increased testing, PPE availability, and increased training and pay for nursing staff as key factors in mitigating the risk. Some patient care advocates have criticized the report for not holding the facilities themselves more accountable for patient safety. In fact, one of the panel members reportedly refused to endorse the report over these concerns.

    Researchers at the CDC and the West Virginia Bureau for Public Health published a study in the US CDC’s MMWR that analyzed the odds of a COVID-19 outbreak based on CMS ratings at long-term care facilities in West Virginia. The ratings are based on health inspections, staffing ratios, and 15 “physical and clinical measures,” and each facility is assigned a rating of 1 (lowest) to 5 (highest) stars. In West Virginia COVID-19 outbreaks were reported in 14 of 123 total facilities. The researchers found that the odds of a COVID-19 outbreak in West Virginia facilities rated as 4 or 5 stars were 94% lower than in 1-star facilities, and the odds in 2- and 3-star facilities were 87% lower than in 1-star facilities. Of the 14 outbreaks in long-term care facilities in West Virginia, 7 were 1-star facilities, compared to 5 outbreaks in 3-star facilities and 1 in a 4-star facility*. Statewide, 12% of long-term care facilities were rated as 1 star, but 1-star facilities accounted for 50% of the outbreaks in long-term care facilities.
    *One (1) facility had no star rating due to “a history of serious quality issues;” there were no outbreaks documented in 2- or 5-star facilities.

    EYEGLASSES Researchers from China published findings from study investigating whether the use of eyeglasses provides protection against SARS-CoV-2 transmission. The study, published in JAMA: Ophthalmology, included a cohort of 276 hospitalized COVID-19 patients in Hubei Province in January-March. Among these patients, 5.8% routinely wore eyeglasses—defined as more than 8 hours per day—compared to an estimated 31.5% among the general public. The researchers hypothesize that wearing glasses could reduce the amount that people touch their eyes, which could reduce SARS-CoV-2 transmission. While protective eyewear is recommended for healthcare professionals, peer-reviewed evidence is limited regarding any potential protective effect for the general public. Further research is necessary to better characterize any effect of eyeglasses on mitigating SARS-CoV-2 transmission risk outside the context of the healthcare setting.

    SPORTS As countries attempt to relax social distancing measures and resume some measure of normal social activity, sporting events seem to remain among the top priorities in many parts of the world. Sports and leagues have taken a variety of approaches to resuming play, and some have faced additional challenges as a result of surging COVID-19 incidence. The French Open (tennis) is scheduled to start later this week, but several players have been forced to withdraw due to positive SARS-CoV-2 tests, including several who had close contact with a coach who tested positive. The tournament will permit 5,000 spectators per day, despite increasing COVID-19 incidence in France, including the Paris area, although this is still much fewer than the 20-30,000 anticipated previously. All spectators will be required to wear a mask. Players will participate in a “bubble,” with dedicated housing and periodic testing throughout the tournament. Following the report of positive tests among players and coaches, some players have expressed concern about how tournament officials are managing the player’s bubble.

    College football has resumed in many parts of the US, and more conferences are planning to resume play in the near future. The start of the season has not been without setbacks, however, with multiple games being postponed or possibly cancelled due to COVID-19. The opening game between the University of Virginia and Virginia Tech was postponed after positive SARS-CoV-2 tests at Virginia Tech did not leave enough players to play the game. Similarly, the game between the University of Houston and Baylor University was postponed due to Baylor not having enough players. The head coach for Louisiana State University (LSU) recently reported that “most of [the] players have caught it [COVID-19].” It is unclear exactly how many players have tested positive, at LSU or any other school, but these cases do not appear to be affecting conference plans to continue the season. As we have covered previously, the risk of longer-term health effects remains uncertain; however, evidence continues to emerge of COVID-19 patients experiencing long-term issues, younger and healthier adults that exhibit mild symptoms during the acute phase of their disease.

    Despite these events, the Big Ten Conference announced last week that it intends to resume play on October 23-24. Notably, a number of states in the Midwest (where most Big Ten schools are located) are reporting concerning COVID-19 trends, including on college campuses. In fact, several days before the announcement, health officials in Ingham County, Michigan (home to Michigan State University), asked all students to “self-quarantine” for 2 weeks due to a recent increase in local COVID-19 incidence. Interestingly, the guidance recommends that students remain at home except for in-person classes, sports practices, their jobs, medical care, or shopping, which does not sound much like quarantine.

    Ten (10) people have been ordered to quarantine following the NFL game between the Houston Texans and the Kansas City Chiefs. The Kansas City Chiefs permitted a limited number of spectators into the stadium for the game, and one subsequently test positive for SARS-CoV-2. The team coordinated with local health officials to conduct contact tracing efforts in order to identify those who may have been exposed.
    Winston, a.k.a. Alvena Rae Risley Hiatt (1944-2019), RIP

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