Daily COVID-19 Briefing: 3/18/20

  1. All 50 U.S. states now reporting COVID-19 cases. Big rises in the last two days.
    With West Virginia entering the fray, all U.S. states and D.C. are now reporting at least one case. The epidemic curve as of today (below) shows big case increases on Monday (872) and Tuesday (1,245). Keep in mind that while lab-confirmed cases are increasing very rapidly, we can’t separate how much is due to surges in testing vs. the speed of the epidemic. This curve does put to rest any hope that the epidemic is going to fizzle out and be gone in a couple of weeks (like SARS did in 2003). The Tuesday new case report (1,245) is the largest one-day rise so far, representing a 30% jump in all U.S. cases.
  1. Regional spread, not just individual states.
    The epidemic is moving on a regional basis as it has in Italy and China. Since the weekend, the Northeast has now passed the West as the region with the most cases, due largely to very rapid spread in New York, which reported a 45% one-day increase with 424 new cases. As of today, the Northeast has 40% of all U.S. cases with the West at 34%. As can be seen in the chart below, the Deep South (LA, MS, SC and TN) is clearly a hotspot region. More concerning is the rapid pace of the epidemic in Northeastern states from Maryland to Maine. These numbers show that state-level containment has failed.
  1. WHO recommending patients not use ibuprofen?
    Social media exploded after the French health minister tweeted on Saturday that ibuprofen could worsen COVID-19. Misinformation and controversy followed. On one hand, the French official is technically correct. Fever is the number-one top symptom of COVID-19. A fever is the body’s way of fighting infection because the virus doesn’t survive or spread as well in a hotter internal environment. Medicines like ibuprofen do reduce fever. But is that a good idea? Also, anti-inflammatories like ibuprofen can hamper the body’s immune response. But the story is more complicated. People should not stop taking these medicines if they were already taking them before without talking to their doctor. Doctors are divided about whether taking ibuprofen prolongs infections. The WHO says it is looking further into it but now they recommend paracetamol instead of ibuprofen. In the U.S., we call this acetaminophen (Tylenol). This may at this point be a better option than aspirin, ibuprofen or naproxen until we sort things out. It’s a reminder how hard it is to give good treatment advice when there are so many unknowns.
  2. Imperial College COVID-19 response team in the U.K. issues a paper that everyone is talking about.
    Neil Ferguson, a highly-respected expert in modeling infectious diseases, leads a team in the U.K. who have just put out a paper projecting what is likely to happen if we choose different non-medical tools to “flatten the curve”. In an interview, Dr. Ferguson said, “The world is facing the most serious public health crisis in generations.” A key takeaway of this paper is that we are likely to be dealing with COVID-19 for a longer period than most now realize (“18 months or more”). Current trends and models strongly suggest that the two-weeks or one-month timeframe that many people are still using are no longer realistic.
  3. First clinical trial of vaccine begins.
    Nature (18 March) reports that the first trial to study a potential COVID-19 vaccine has been launched in Seattle, WA. This is good news, but it is vitally important to realize just how long it takes before a vaccine will be ready. Most experts still think we are a year to 18 months away. This first study is in just 45 patients to determine if the vaccine is safe and if it does what scientists think it does. We call this a Phase I trial. It is not a sign that a vaccine is around the corner. 
  4. States have closed schools. It’s not clear that works.
    The Washington Post reports that 30 states have closed schools including New York City, which has the largest school system in the country. However, guidance issued late last week from the CDC calls into question the effectiveness of school closures. This is based on findings from other countries where school closings have not led to clear reductions in the spread of the disease. The role of children in this epidemic has continued to be hotly debated. This is one of the big unknowns. It does appear that children are not having severe symptoms from this disease (which is very good), but whether they get the disease and can pass it remains a subject of hot debate.

Updated 3/18/20 at 4:00 pm EDT.

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