Daily COVID-19 Briefing: 3/11/20

Today has been very eventful and important. There are several key inflection points occurring now. I will try to briefly present some of them.

  1. At a press briefing, the WHO joins other agencies and declares a global pandemic. Debate will continue about whether they waited too long. The WHO stresses this does not indicate that countries should abandon epidemic control measures in favor of mitigating the impact of the epidemic. While the term ‘global pandemic’ remains somewhat loosely defined, the declaration does authorize additional public health tools. A global pandemic refers to “an outbreak of a new infectious illness characterized by ‘sustained transmission’ across multiple national borders and continents.” ‘Pandemic’ refers to the spread and distribution of a disease, not its severity. Thus, while both the Spanish flu of 1918–1920 and COVID-19 are both pandemics, there is no firm basis for assuming that this will be as devastating as Spanish flu. For example, the H1N1 flu of 2009 was declared a pandemic but caused only 150,000–575,000 deaths globally.
  2. Global laboratory-confirmed cases now exceed 126,000 with >4,600 deaths. That does not represent the true prevalence of cases (what proportion of a population has been infected). Because so few people have been tested in most countries, the true prevalence cannot currently be calculated. The epidemic curve is now approaching vertical in the linear scale, indicating, in my opinion, that a third wave of sustained transmission is in full bloom. This indicates significant community spread outside of China and points to limitations in current control measures.
  3. Politico reports U.S. facing significant shortages of testing supplies that threaten to slow the pace of testing. The shortages are related to precursor materials used for RNA extraction and not the actual testing kits. Having said that, the supply of test kits is not yet meeting the rising demand. The WHO declaration as well as the President’s upcoming press conference will no doubt increase demand for testing, which will put further pressure on supply chains. Awareness is now growing that testing is the most important containment tool.
  4. Lab-confirmed cases in the U.S. now exceed 1,300, rising today by 308 cases (or 31%). The dramatic rise in cases day-over-day reflects two factors: ongoing sustained disease transmission and the upsurge in testing. The U.S. now ranks 8th among 123 countries and territories impacted by the pandemic. Again, people should not assume that the number of people testing positive represents the total burden of disease. It is highly likely that the true number of infections in the U.S. is in the range of 50,000 to 1,000,000.
  5. Today, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases and the most experienced and qualified federal official in public view, told members of the House Oversight Committee that “we will see more cases, and things will get worse.” This represents a significant shift in tone from national health experts.
  6. The case fatality rate (CFR, the percent of infected persons who die) remains unknown. However, today Dr. Fauci told lawmakers that the CFR is at least ten times more lethal than the seasonal flu (which is thought to have a CFR of about 0.1%). The current CFR estimate from WHO is 3.4%, but that is based on a dramatic under-count of persons with no or mild symptoms. If, however, the overall CFR is around 1%, this would be ten times higher than flu and would mean millions of deaths worldwide.
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