Daily COVID-19 Briefing: 3/24/20

  1. If you are wearing gloves, masks or scarves and aren’t sick, please think again!
    I see lots of folks in the community wearing masks and gloves or scarves to protect themselves. If you are not sick, please reconsider. It is vitally important to remember how this virus is spreading. Here are the details and why this matters:
  • The virus is not generally airborne, it does not float in the air, so a mask won’t stop it.
  • The virus is transmitted because respiratory droplets from coughs and sneezes land on surfaces, we touch those surfaces, then touch our faces, allowing the virus to enter our airway.
  • Wearing a mask or scarf will cause you to touch your face more. It’s very hard to keep from doing this. Every time you adjust your mask, you are risking infection.
  • Wearing gloves can be worse than not wearing them because we tend not to wash or disinfect gloves. Gloves give a false sense of security.
  • The moment you put on a glove and touch a surface, the glove is contaminated. The point is to keep the virus from getting to our airway, not to keep it off our hands.
  • Masks should be warn by those who are sick so that they don’t cough or sneeze more virus.
  • If you have masks or gloves, save them for when you must care for a sick loved one in your home. Then, discard or disinfect them after every contact.
  1. U.S. cases and deaths continue to rise rapidly, doubling in about 3 days
    On Monday, there were new 8,608 cases reported in the U.S., while deaths jumped from 64 on Sunday to 109. Both new cases and deaths are doubling about every three days now, indicating the epidemic continues to move rapidly. Substantial 1-day rises were seen in Alaska (+73%), Indiana (+60%), Missouri (+45%), South Dakota (+50%), Kentucky (+83%), Mississippi (+76%), West Virginia (+45%), Connecticut (+47%), and New York (+46%). In New York, 4,812 new cases were reported in just one day, bringing the total number of confirmed cases in that state to over 15,000. Deaths also rose by 54, an increase of nearly 90%. New York’s governor Andrew Cuomo has demanded the federal government send thousands of stockpiled ventilators to his state. He said his state will need 30,000 more ventilators than the 7,000 it has.
  1. What are the symptoms of COVID-19?
    If you have read my blog, you have heard me talk about the importance of clearly defining a case as job #1 in any outbreak investigation. Currently, the CDC lists only these three symptoms: fever, cough and shortness of breath. The WHO, on the other hand lists fever, tiredness and dry cough (in that order). Why are these lists different? And where did this even come from? The answer is that 2 papers were published very early in China based on 99 and 41 patients hospitalized in Wuhan province. Since then, we have much better, larger studies that show this early case definition wasn’t very good. Despite this, we have been stuck on this definition, including the CDC. Bigger studies showed that while fever is still the top symptom, there are about 10% of patients who don’t have even that. Plus, there is no consistency in what people think of as a fever. Many COVID-19 patients don’t have a noticeable fever (>101 degrees). Shortness of breath should not be a top symptom any longer. A report by WHO on 55,000 patients showed that SOB was only found in 19% of cases. I combined all the available information I could find and determined that fever, dry cough, fatigue/tiredness, coughing up phlegm, shortness of breath, and muscle and body aches are all important to consider. Please see my symptom checklist, which can help you keep track of your symptoms and help you better communicate with health care providers.
    Why does this matter? As I have said here before, this epidemic is being driven by the large number of covert cases (about half of all infections). The disease is spreading like wildfire because of people who have no symptoms or mild symptoms. People who don’t have fever, cough and shortness of breath are assuming they do not have COVID-19, but have something else. The symptom profiles are much more inconsistent than we first thought. We need a better case definition because too many people have the disease and are spreading it without knowing they are.
    Bottom line: Don’t rely on the outmoded 3-symptom list. It has outlasted its usefulness. If you have any combination of these top symptoms, assume you are a presumptive case (might have COVID-19) and stay home.
  2. There are no proven treatments for COVID-19 as of yet
    The news and social media are full of reports of patients asking for (or taking on their own) a host of drugs already approved for malaria, HIV, diabetes, lupus etc. People are dying of the side effects of these powerful drugs. As Anthoni Fauci and others have repeatedly said, we currently have no evidence that any of these medicine are effective against SARS-CoV-2. The New England Journal of Medicine just reported that a study of two HIV anti-viral medicines had to be stopped because it showed there was no benefit for patients who were very sick.
    What does this mean? Wishful thinking and common sense are very bad reasons to start taking a drug that has not been proven to work. Let the experts do their studies. The good news as reported by the New York Times, is a new study suggesting that there are about 70 existing drugs that MIGHT be effective and should be studied. We will find effective treatments when careful research is done to determine what works. That research is being done as fast as possible as we speak and is a top priority. Until then, taking so-called “off-label” medicines based on a hunch can be a waste of time or deadly. And, diverting these medicines away from the people that really need them will cause unnecessary suffering.
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