The Potential Impact of COVID-19, AKA: 2019-nCoV, AKA: SARS-CoV-2, AKA: The Novel Coronavirus, on Global Commerce and Food Supply Chains.

Fear of a pandemic / contagion can be far more deadly than the contagion itself!

Note: My intent here is not to incite fear, but to get people thinking and asking questions of their elected leaders. I have no formal medical training or background; so, any opinions I render here in these blog posts are solely a layman’s conjecture based upon my own readings and observations. This is an ongoing blog, updated as needed, on multiple issues pertaining to the Novel Coronavirus.

** July 15, 2020: I believe the blog subscription apps are up and working. 🙂

Chronological / Topical Index

Jul 15, 2020, Moderna’s Phase I vaccine trial results are positive, but don’t get too excited.

Jul 9, 2020, Web resources for International Students navigating recent ICE policy changes regarding online remote learning in the Fall 2020 semester.

Jul 6, 2020, What role does obesity play in your ability to fend off COVID-19?

Jul 2, 2020, CDC mortality statistics indicate risk of death from COVID-19 is highest for those aged 65 and older.

Jun 29, 2020, “We don’t really know what the Earth will do when we start cutting our emissions

Jun 24, 2020, How are climate and geography influencing the spread of the virus

Jun 14, 2020, Are Comorbidities Really A Key Determining Factor In How Susceptible You Are To COVID-19?

Jun 7, 2020, A Gift To The Arts In Challenging Times

May 30, 2020, What is RT-PCR?

May 19, 2020 Plasma Derived B-Cell Monoclonal Antibodies Hold Promise As Effective Therapeutic

May 13, 2020 How Are Factory Farming, Climate Change And Human Encroachment On Nature Contributing To The Likelihood Of Further Pandemics

May 6, 2020 Mysterious Multisystem Inflammatory Syndrome Globally Afflicting Small Numbers Of Children; Potential Association With COVID-19

April 12, 2020    Domesticated Pets As Potential Reservoirs And Transmitters of COVID-19

April 10, 2020    Requesting Mortgage Forbearance Due To COVID-19 Impact

April 09, 2020    Auto Insurance Companies Offering Premium Credits & Discounts Due To COVID-19

April 08, 2020    The Potential Value Of Ivermectin As A Therapeutic Antiviral Against SARS-CoV-2

April 07, 2020    Why Are We Still Eating And Selling Horseshoe Bats, The Originating Host of SARS-CoV-2

April 06, 2020    Large Tech And AI Consortiums Working To Find COVID-19 Vaccines And Therapeutics

April 04, 2020    COVID-19 Economic Impact Payments – What To Expect And When

April 03, 2020    Commentary: The Need To Prioritize Support For Key Industries & Antibody Testing

April 02, 2020    WhatsApp Alert Service On COVID-19 Information

April 01, 2020    A Study On The History And Origin Of Human Coronaviruses (HCOVs)

Mar 31, 2020     Filing Disability & Paid Family Leave Claims In California Due To COVID-19

Mar 30, 2020     Potential To Shed The Virus (Remain Contagious) Up To Five Weeks

Mar 30, 2020    Catching The Virus Through Exposure To Your Eyes

Mar 29, 2020    The Lack Of Preparedness By The UK’s National Health Service

Mar 28, 2020    Federal Law On Implementing Quarantines

Mar 28, 2020    We Must Act Quickly To Protect Our Healthcare Workers and Hospitals

Mar 27, 2020    The Potential Use Of Bi-Pap Machines In The Absence Of Actual Ventilators

Mar 26, 2020    Our (US) Federal Government’s Reluctance To Take a Leading Role In The Fight

Mar 26, 2020    US Feb 12–Mar 16, 2020. MMWR Morbidity Mortality Weekly Report

Mar 25, 2020    NHC As A Potential Antiviral Against SARS-CoV-2

Mar 24, 2020    NY Governor Andrew Cuomo’s 3/24/2020 Daily Press Briefing

Mar 23, 2020    A Rough Translation Of Italy’s Anesthesia Protocols on Triaging COVID-19 Patients

Mar 22, 2020    Is It Time To Activate The US Armed Forces Reserves And Consider Martial Law

Mar 21, 2020    A Simple Request -Please Stop President Trump From Doing The Daily WH Briefings

Mar 21, 2020    Aerosolized and Fomite Transmission Of SARS-CoV-2

Mar 20, 2020    A Counterintuitive Idea To Preventing The Collapse Of Healthcare Systems

Mar 19, 2020    The Dutch Are Exploring COVID-19 Antibody Testing

Mar 19, 2020    The Current Requests For US Blood Donations; No Testing For COVID-19

Mar 18, 2020    Will Frontline Grocery Workers Continue To Show Up For Work?

Mar 18, 2020    A Counterintuitive Idea: Using Cruise Ships As Convalescent COVID-19 Hospitals

Mar 17, 2020    A Call For National Lock Downs

Mar 16, 2020    Is Cremation A Better Option When Dealing With COVID-19 Victims?

Mar 16, 2020    Brainstorming Ideas: Drive-thru Chest CTs & Using Unemployment to Funnel Aid

Mar 15, 2020    The President Is “Very Happy” That The Fed Rate Has Been Cut To Zero – Priorities?

Mar 14, 2020    Personal Mobility Is A Privilege, Not A Right

Mar 13, 2020    CDC Modelling Of Worst-Case Scenarios For Coronavirus Mortality Rates In The US

Mar 13, 2020    CDC: Early Coronavirus Deaths Possibly Categorized As Flu Or Pneumonia

Mar 12, 2020    Sick Healthcare Workers And A Shortage Of Ventilators Will Up Mortality Rates

Mar 09, 2020    Comorbidities Play A Significant Role In Your Ability To Survive COVID-19

Mar 07, 2020    Food Supply Chains Need To Be Maintained!

Mar 06, 2020    The Infection Data Is Easy To Manipulate.

Mar 05, 2020    Beyond The Point Of Containment Of The Virus – Preparing Hospitals

Mar 04, 2020    Slowing The Virus Remains Our Singular Focus

Mar 03, 2020    Mounting Disruption To The Global Supply Of Personal Protective Equipment (PPE)

Mar 01, 2020    Preparing For What’s To Come

Feb 29, 2020     A Review Of The Antiviral Drugs Remdesivir and Chloroquine

Feb 28, 2020     COVID-19’s Potential Impact On The World’s Refugee Population

Feb 27, 2020     COVID-19 Found In Fecal Samples From Recovered Patients

Feb 26, 2020      37 Companies & Academic Groups Pursuing COVID-19 Vaccine Development

Feb 25, 2020     “Supply-Chain Risks From the Coronavirus Demand Immediate Action”

Feb 24, 2020     A Brief History On Cordon Sanitaire (Quarantines) And An Intro To Remdesivir

Feb 23, 2020     “A Preliminary Assessment Of The Clinical Outcomes Of Critically Ill Patients”

Feb 22, 2020     World Health Organization (WHO) COVID-19 infection/mortality statistics

Feb 21, 2020     The Virus’ Emergence In South Korea; And, A Sea Change In Human Social Behavior

Feb 20, 2020     A Conspiracy Theory?:  Coronavirus Is “Partially Synthetic” (Man-Made), Dr. J. Perez

Feb 18, 2020     Who Should Be Tested For COVID-19?

Feb 17, 2020     14 Day Cruise Ship Quarantines Are Simply A Delay Tactic

Feb 16, 2020     The Patient Queue Conundrum And Contingency Planning

Feb 15, 2020     The Virus’ Spread Will Accelerate Quickly Outside The Boundaries Of China

Feb 13, 2020     The Importance Of Oxygen Ventilators In the Coming Storm

Feb 11, 2020     An Isolationist (Delaying) Strategy May Be The Only Viable Strategy Available

Jan 31, 2020      The Initial Blog Post:  Instinctive Human Survival Behavior Scares Me

Latest Update: Jul 15, 2020

Hi, Today I’m introducing the recent New England Journal of Medicine (NEJM) article that discusses the Moderna mRNA 1273 phase I vaccine trial results. In short, I wouldn’t get your hopes up just yet. Yes, it did show positive results toward developing neutralizing antibodies…but it was a really small study…45 people, and the study included only people aged 18 to 55. If you knew that COVID-19 mostly had adverse impacts to people aged 65+ why wouldn’t you conduct a study that included that age group? Also, if I’m reading the abstract correctly, the results had “values generally similar to those in the upper half of the distribution of a panel of control convalescent serum specimens.” If the results were better than the control group they would have stated so! “Generally similar” likely means they weren’t as good as the convalescent serum control group. Lastly, 21% of participants (3 out of 15) who received both doses of the vaccine at the higher dose levels had systemic adverse events. – -“Systemic adverse events were more common after the second vaccination, particularly with the highest dose, and three participants (21%) in the 250-μg dose group reported one or more severe adverse events.” I’m glad they’re making progress; we just shouldn’t get too excited based on these preliminary results (again –my non-medically trained layman’s opinion). The full NEJM article is linked at the end of today’s post.

“An mRNA Vaccine against SARS-CoV-2 — Preliminary Report”, July 14, 2020, DOI: 10.1056/NEJMoa2022483

List of authors: Lisa A. Jackson, M.D., M.P.H., Evan J. Anderson, M.D., Nadine G. Rouphael, M.D., Paul C. Roberts, Ph.D., Mamodikoe Makhene, M.D., M.P.H., Rhea N. Coler, Ph.D., Michele P. McCullough, M.P.H., James D. Chappell, M.D., Ph.D., Mark R. Denison, M.D., Laura J. Stevens, M.S., Andrea J. Pruijssers, Ph.D., Adrian McDermott, Ph.D., et al., for the mRNA-1273 Study Group*

“Abstract”

“BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in late 2019 and spread globally, prompting an international effort to accelerate development of a vaccine. The candidate vaccine mRNA-1273 encodes the stabilized prefusion SARS-CoV-2 spike protein.”

“METHODS: We conducted a phase 1, dose-escalation, open-label trial including 45 healthy adults, 18 to 55 years of age, who received two vaccinations, 28 days apart, with mRNA-1273 in a dose of 25 μg, 100 μg, or 250 μg. There were 15 participants in each dose group.”

“RESULTS After the first vaccination, antibody responses were higher with higher dose (day 29 enzyme-linked immunosorbent assay anti–S-2P antibody geometric mean titer [GMT], 40,227 in the 25-μg group, 109,209 in the 100-μg group, and 213,526 in the 250-μg group). After the second vaccination, the titers increased (day 57 GMT, 299,751, 782,719, and 1,192,154, respectively). After the second vaccination, serum-neutralizing activity was detected by two methods in all participants evaluated, with values generally similar to those in the upper half of the distribution of a panel of control convalescent serum specimens. Solicited adverse events that occurred in more than half the participants included fatigue, chills, headache, myalgia, and pain at the injection site. Systemic adverse events were more common after the second vaccination, particularly with the highest dose, and three participants (21%) in the 250-μg dose group reported one or more severe adverse events.”

“CONCLUSIONS: The mRNA-1273 vaccine induced anti–SARS-CoV-2 immune responses in all participants, and no trial-limiting safety concerns were identified. These findings support further development of this vaccine. (Funded by the National Institute of Allergy and Infectious Diseases and others; mRNA-1273 ClinicalTrials.gov number, NCT04283461. opens in new tab).”

https://www.nejm.org/doi/full/10.1056/NEJMoa2022483

Update: Jul 9, 2020

Hi, Todays’ blog update is simply a resource or reference post to assist International Students studying in the U.S. on student visas.  Recent U.S. ICE guidance advised that international students “attending schools operating entirely online (apparently due to COVID-19) may not take a full online course load and remain in the United States” for the fall 2020 (semester).”

The complexities of the US student visa program bewilder me.  My objective here in posting these article weblinks today is simply to give those impacted students a jumping off point to further research how these recent changes may individually impact them this fall.  Good luck!

(ICE) “Broadcast Message: COVID-19 and Fall 2020 To: All SEVIS Users Date: July 6, 2020 Number: 2007-01

“Temporary Exemptions for the Fall 2020 Semester”

“For the fall 2020 semester, SEVP is modifying these temporary exemptions. In summary, temporary exemptions for the fall 2020 semester provide that:”

“1) Students attending schools operating entirely online may not take a full online course load and remain in the United States. The U.S. Department of State will not issue visas to students enrolled in schools and/or programs that are fully online for the fall semester nor will U.S. Customs and Border Protection permit these students to enter the United States. Active students currently in the United States enrolled in such programs must depart the country or take other measures, such as transferring to a school with in-person instruction to remain in lawful status or potentially face immigration consequences including, but not limited to, the initiation of removal proceedings.”

“2) Students attending schools operating under normal in-person classes are bound by existing federal regulations. Eligible F students may take a maximum of one class or three credit hours online (see 8 CFR 214.2(f)(6)(i)(G)).”

“3) Students attending schools adopting a hybrid model—that is, a mixture of online and in person classes—will be allowed to take more than one class or three credit hours online. These schools must certify to SEVP, through the Form I-20, “Certificate of Eligibility for Nonimmigrant Student Status,” that the program is not entirely online, that the student is not taking an entirely online course load for the fall 2020 semester, and that the student is taking the minimum number of online classes required to make normal progress in their degree program. The above exemptions do not apply to F-1 students in English language training programs or M-1 students, who are not permitted to enroll in any online courses (see 8 CFR 214.2(f)(6)(i)(G) and 8 CFR 214.2(m)(9)(v))). “

https://www.ice.gov/doclib/sevis/pdf/bcm2007-01.pdf

“Updated Visa Guidelines International Students Should Know”, By Anayat Durrani, U.S. News, Published Jul 8, 2020

“Here are four areas enrolled international students and recent graduates should be aware of in light of recent updated guidance from the government:”

— “Requesting a temporary absence”

— “Remote learning in the summer”

— “Taking online classes in the fall”

— “Flexibility with OPT required hours”

https://www.yahoo.com/news/updated-visa-guidelines-international-students-172153277.html?.tsrc=daily_mail&uh_test=1_02

“Frequently Asked Questions for SEVP Stakeholders about COVID-19”, U.S. Customs & Immigration Enforcement, last updated: July 6,2020

“Developing Issues Fall 2020 semester On July 6, 2020, SEVP announced modifications to temporary exemptions for nonimmigrant students taking online classes due to the pandemic for the fall 2020 semester. SEVP is working to answer frequently asked questions from the stakeholders. Responses will be published in a separate document and added to the U.S. Immigration and Customs Enforcement’s (ICE) COVID-19 resource page under the Nonimmigrant Students and SEVP-Certified Schools section when available.”

“Full course of study requirements and online learning”

“Our school has switched to fully online instruction but not all courses will be offered; some courses will be canceled due to inability to deliver via online means. Will students be excused from meeting full course of study requirements if the classes they need are not being offered? “Yes, full course of study requirements can be waived as a direct result of the impact from COVID-19. This information should be reported in a school’s procedural change documents submitted to SEVP, as described in Broadcast Message: COVID19 and Potential Procedural Adaptations for F and M Nonimmigrant Students. If this is a material change to previously submitted documents, schools should resubmit those documents as part of their submission to SEVP.”

https://www.ice.gov/doclib/coronavirus/covid19faq.pdf

Update: Jul 6, 2020

In today’s update I’m highlighting select data from a late April article in BMJ.com titled “A third of covid-19 patients admitted to UK hospitals die”.  Some of you will recognize this article as the one that went viral as a controversial article in which the pre-print study (paper’s) Chief Investigator errantly compared the severity of COVID-19 to Ebola.  My point in referencing the article here today is not to re-hash the grossly misrepresented comparison, but to state that we, the public and the scientific community, should not figuratively throw the baby out with the bathwater.  There appears to be significant scientific data within the study (paper) that still may have potential value in our analysis of COVID-19 (SARS-CoV-2). One subset of data that I’m specifically referring to is the obesity statistical data, relative to mortality risk with COVID-19 patients.  I hope this portion of the paper will still receive further evaluation from the medical-scientific community.  The following are the excerpts in the article relative to obesity; I’m hoping we can hear more about the possible correlation between obesity and “reduced lung function”:    

The study—the largest detailed description of covid-19 in Europe—found that being obese, male, or elderly reduces chance of survival.1  The research was carried out by the ISARIC-4 consortium, a UK wide group of doctors and scientists, who are trying to find out who are the most severely affected by covid-19 and why some people have better outcomes than others. The consortium is funded by a grant from UK Research and innovation.”

“Data was gathered from 166 hospitals in England, Scotland, and Wales between 6 February and 18 April by 2468 research nurses, administrators, and volunteer medical students. It has been published as a preprint and has not yet been through a formal peer review process”

“Many of the findings are consistent with studies carried out in China—such as associations with age, male sex, and comorbidity. A novel finding from this study is that people who are obese do particularly badly from covid-19. Obesity was recognised as a risk factor in 2009 for pandemic A/H1N1 influenza although not in 2016 Middle East respiratory syndrome coronavirus.”

“Although the reasons obese people develop such severe covid-19 are not clear, the researchers believe it could be because they have reduced lung function and possibly more inflammation in adipose tissue which might contribute to an enhanced “cytokine storm”—a potentially life threatening over-reaction of the body’s immune reaction.”

“A third of covid-19 patients admitted to UK hospitals die”, By Jacqui Wise, British Medical Journal (BMJ.Com), Published Apr 30, 2020, BMJ 2020;369:m1794, doi: https://doi.org/10.1136/bmj.m1794

“References”

“Docherty AB, Harrison EM, Green CA, et al. Features of 16 749 hospitalised UK patients with covid-19 using the ISARIC WHO clinical characterisation protocol.” www.medrxiv.org/content/10.1101/2020.04.23.20076042v1.

https://www.bmj.com/content/369/bmj.m1794

https://www.medrxiv.org/content/10.1101/2020.04.23.20076042v1.full.pdf

Update: Jul 2, 2020

In today’s blog update I’m highlighting a recent American Council on Science and Health (ACSH) article that provides graphed COVID-19 U.S. mortality statistics based on CDC data for the period Feb 1 to Jun 17, 2020. Quick note: statistics can be skewed in one direction or another for a multitude of reasons and factors; still, if the data is mostly accurate there is value in what it tells us.  The article’s author, Dr. Alex Berezow, summed up the value of the CDC statistics in this succinct statement: “While coronavirus is obviously concerning and a very real threat to some people (namely, the elderly and immunocompromised), these data also show that the risk for the rest of the population is quite low.”  I included select excerpts from the article below. The key points I took away from the article are:

  1. “More than 80% of deaths occur in people aged 65 and over. That increases to over 92% if the 55-64 age group is included.”
  2. For perspective, “Each year, about 2.8 million Americans pass away” (from diseases, accidents, natural causes, etc.…).
  3. “Thirteen children of primary and middle school age (5-14 years) died from COVID-19, but this represented only 0.7% of all deaths in this age group; 1,742 kids died of other things during this same time period.”
  4. “Blacks constitute about 13% of the U.S. population but suffered 23% of all COVID deaths.” 

The comments section, following the article, contained a wide range of interesting comments from internet readers.  Article commentary sections, in general, frequently are filled with political prattle and statistical comments without any reference to evidentiary sources; still, sometimes the comments contain unique perspectives and raise questions worthy of follow up and further consideration. The commentary which piqued my interest follows. I omitted the authors names (online IDs) for their privacy here; but, if it matters, you can see their online IDs on the ACSH website.  I don’t personally agree with many of these comments, but they do, in my opinion, raise questions worthy of further evaluation and follow-up.  I summed up the selected commentary dialogue into queries preceding each comment or commentary block:

  • What are the lingering effects for COVID-19 contractees/survivors, that are being observed by the medical community?

Commenter#1: “OK, that’s death. Statistically you’re not likely to die of it,
It would be interesting to know more about long term sequelae and lasting damage from Co-Vid infections. That’s more of a concern. (Unless you’re in the small % that dies).”

Alex Berezow: “We don’t know the long-term health effects because the long-term hasn’t happened yet.”

Commenter#1: “Of course…my bad….I used the wrong term. I meant lingering effects (reading about people still ill and weak for weeks after “recovering”.)”

  • Is there a financial incentive, under the CARES Act, for hospitals and/or mortuary services to categorize deaths as COVID-19 deaths vs. other possible contributing causes of death?

Commenter#2: “One thing this article doesn’t distinguish is if these deaths include people dying WITH Covid versus people dying FROM Covid. We’ve seen in many cases people come into hospitals after a massive heart attack or stroke who eventually succumb to the incident, and who also happen to also have COVID. In these cases, COVID is identified as a contributing factor on the death certificate. The death is then factored into the overall statistics and when they are reported the numbers are not broken down to show that many of the deaths are not directly from COVID but usually something else.”

Commenter#3: “I suspect that is why the US has a much higher death rate than other countries.”  “Also, there is a financial incentive to classify a death as due to Covid-19 as the CARES bill made the provision that all Covid-19 treatments were covered by Medicare rates if the patient was uninsured. Most were over 65 under Medicare anyway, but was the 80/20 copay applied?”

  • What are the obesity statistics for COVID-19 mortality victims?

Commenter#4: “Most Covid deaths in people <65 years have occurred among the obese. And yet, I’m not aware of any efforts by CDC, NIH, state or local health agencies to encourage weight loss among the obese, healthy diets and/or increased exercise during the past four months.”

  • Is Herd Immunity possible with highly mutative Corona viruses?

Commenter#5: “No herd immunity for carona (Corona) type viruses mainly due to the mutation rate. If herd immunity truly existed, then we would have been immune to the common corona flu decades ago. Herd immunity would probably last less than 6 months if at all.”

  • No query here, I agree with commenter#6; we have a moral obligation to protect the vulnerable amongst us.  Shutting down global and national economies is not the solution; but we can all still pursue many other less drastic, common sense social preventative measures.

Commenter#6: “Although young people are much less likely to have a serious illness when infected by Covid19, the problem is that they are more active and more interactive than people over 65 and thus probably contribute significantly to the spread of the illness to the older and/or high risk cohort. This message seems not to be getting through and people are dying as a result of more social interaction and less mask wearing. Anything that suggests that Covid19 is not a serious threat to the public at large may encourage people to ignore the simple steps they can take to help save the lives of their fellow citizens.”

“Coronavirus: COVID Deaths in U.S. by Age, Race”, By Alex Berezow, PhD, Published By the American Council on Science and Health (ACSH), Jun 23, 2020

U.S. Coronavirus Deaths by Age

“As shown, deaths in young people (from babies to college students) are almost non-existent. The first age group to provide a substantial contribution to the death toll is 45-54 years, who contribute nearly 5% of all coronavirus deaths. More than 80% of deaths occur in people aged 65 and over. That increases to over 92% if the 55-64 age group is included.

One thing that is often forgotten is that people of all ages are dying all the time. Each year, about 2.8 million Americans pass away. The following chart shows the percentage of deaths in each age group that were due to coronavirus:”

“Of the roughly 1.2 million American deaths that occurred between February 1 and June 17, almost 9% were due (attributed) to coronavirus. The proportion of deaths due to coronavirus were about the same for each age group above 45 years. Below that, the proportion of deaths due to coronavirus fell dramatically. Thirteen children of primary and middle school age (5-14 years) died from COVID-19, but this represented only 0.7% of all deaths in this age group; 1,742 kids died of other things during this same time period.”

“U.S. Coronavirus Deaths by Race”

“The number that stands out here is the percentage of COVID deaths that occurred among Black Americans. Blacks constitute about 13% of the U.S. population but suffered 23% of all COVID deaths.” 

https://www.acsh.org/news/2020/06/23/coronavirus-covid-deaths-us-age-race-14863

“CDC Data Sources (Accessed on 23-June-2020)”

(1) https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-by-Sex-Age-and-S/9bhg-hcku

(2) https://data.cdc.gov/NCHS/Provisional-Death-Counts-for-Coronavirus-Disease-C/pj7m-y5uh

Update: Jun 29, 2020

Today’s blog update highlights some highly informative and interesting data disclosed in a recent Earth Institute – Columbia University article by Renee Cho, on COVID-19 and Climate. I’m essentially re-stating Cho’s article here in full, but with my own highlights (bold & italics) on what I’ve interpreted, from my own individual perspective, as the key or valued points of the article.  Whether you read my take, or the original article is irrelevant to me; the main thing is you should read one of them and come away enlightened for it.

The core theme of the article to me was this paragraph:

COVID-19 may result in an approximately five to eight percent reduction in average global emissions for the year, and while this is a small amount in the context of the whole system, it offers a rare opportunity to see how Earth responds to cuts on carbon emissions. “All of our observations of the Earth system have been made under a situation where atmospheric CO2 is going up exponentially every year,” said McKinley. “We don’t really know what the Earth will do when we start cutting our emissions, but this is what we want and need to do under the Paris accord. That is one reason why this is a valuable opportunity to tease out any signals of what we can expect the Earth system to do in response to cutting emissions.”

“COVID-19’s Long-Term Effects on Climate Change—For Better or Worse”, By Renee Cho, Published Online at Earth institute- Columbia University, 25 Jun 2020.

“As a result of the lockdowns around the world to control COVID-19, huge decreases in transportation and industrial activity resulted in a drop in daily global carbon emissions of 17 percent in April. Nonetheless, CO2 levels in the atmosphere reached their highest monthly average ever recorded in May — 417.1 parts per million. This is because the carbon dioxide humans have already emitted can remain in the atmosphere for a hundred years; some of it could last tens of thousands of years.”

“Beyond carbon emissions, however, COVID-19 is resulting in changes in individual behavior and social attitudes, and in responses by governments that will have impacts on the environment and on our ability to combat climate change. Many of these will make matters worse, while others could make them better. While it’s unclear how these factors will balance out in the end, one thing is certain: more large-scale actions will be essential to avoid the worst impacts of climate change.

“For worse”

“Delay of COP26”

“The Paris climate accord of 2015, adopted by every country, all of which pledged to take action to keep global average temperatures from rising less than 2° C beyond preindustrial levels, was set to reconvene in November this year at COP26. The countries were to announce plans to ratchet up climate actions, since the plans they submitted in 2015 could still allow global temperatures to rise by a potentially catastrophic 3°C. Now COP26 has been delayed a year. If the conference occurred this fall, countries would likely be more compelled to introduce economic recovery plans for COVID-19 that also further their climate change goals. The delay, however, could enable countries to enact stimulus plans that do not incorporate climate change strategies.”

“International negotiations delayed”

“A variety of international negotiations to protect the environment have also been delayed. The World Conservation Congress to evaluate global conservation measures has been postponed to January 2021. The Convention on Biological Diversity, which would have established new global rules to protect wildlife and plants from climate change and other threats, has been postponed until next year. The 2020 U.N. Ocean Conference scheduled for June to plan for sustainable solutions to manage the oceans has been delayed but no new date has been set. And a meeting to finalize the High Seas Treaty to establish agreements for conservation and sustainable development for ocean biodiversity in international waters — a meeting that took years of negotiations to arrange— has been pushed to 2021. These delays could allow some countries to shift their priorities away from the environment.”

“Deforestation in the Amazon”

“Brazilian president Jair Bolsonaro has been calling for more commercial development in the Amazon rainforest, which absorbs two billion tons of CO2 from the atmosphere a year.”

“Now as Brazil, hard hit by COVID-19, is focused on controlling the virus, illegal loggers and miners are taking advantage of the situation to cut down large swaths of the Amazon. Between January and April, 464 square miles of the rainforest were razed, 55 percent more area than was destroyed in the same period in 2019. The cleared area will be burned to make it suitable for cattle grazing, which could increase the chance of wildfires; wildfires burning out of control in 2019 destroyed an estimated 3,500 square miles of rainforest.”

“Weakening of climate policies”

“Some countries and private companies may delay or cancel investments in renewable energy or climate action policies if their finances have been impacted by the pandemic. For example, airlines, responsible for two to three percent of global carbon emissions, have been hard hit financially by the cessation of travel. They are clamoring to defer impending carbon taxes for flights within Europe. And after years of negotiation, a global plan to reduce aviation emissions, set to go into effect in 2021, would compel airlines to improve their international flights’ fuel economy by capping emissions at a 2020 baseline; any increase in future emissions would need to be offset by carbon reduction projects. But because a 2020 baseline would be relatively low, if air travel returns to its “normal” levels, they would be counted as growth and increase the burden on airlines; the United Nations’ International Civil Aviation Organization is considering making 2019 the baseline.”

“Rollback of U.S. environmental measures”

“President Trump signed an executive order that enables federal agencies to waive environmental review for infrastructure projects such as highways and pipelines to speed the economic recovery. It weakens the National Environmental Policy Act (NEPA) that requires government agencies to conduct a review of potential environmental and public health impacts before a project is approved and enables local communities to weigh in. The executive order gives NEPA “flexibility” in emergency situations and allows agencies to put aside normal environmental reviews and make alternative plans.”

“The EPA has announced that it will temporarily “exercise enforcement discretion” with regard to violations of environmental laws as a result of COVID-19. New guidelines enable companies to monitor themselves to determine if they are violating air and water quality regulations. In other words, entities unable to comply with regulations due to social distancing or shortage of workers will not be penalized. States and environmental groups are suing the EPA for abdicating its duty. Gina McCarthy, head of the EPA under the Obama administration, now president of the Natural Resources Defense Council, called it “an open license to pollute.”

“One result of the EPA’s action is that manufacturing or energy production facilities, coal mines, industrial waste landfills and others can delay reporting of their greenhouse gas emissions. This emissions data is necessary to help the EPA assess its existing greenhouse gas regulations and determine if additional ones are necessary.”

“Using the pandemic as cover, President Trump is continuing his efforts to weaken environmental regulations. The EPA has proposed a new rule that would alter the cost-benefit formulas used in Clean Air Act regulations. “Co-benefits” such as improvements in public health from reducing pollution, will no longer be given as much weight in justifying regulations.”

‘In addition, Trump signed another executive order opening up a marine conservation area off New England to commercial fishing. The Northeast Canyons and Seamounts Marine National Monument established by President Obama is a haven for endangered right whales and other vulnerable marine creatures.”

“The Pipeline and Hazardous Materials Safety Administration declared that it would exercise discretion in enforcing natural gas pipeline safety regulations during the pandemic. This could result in more methane (a greenhouse gas with 80 times more global warming potential than CO2 over a 20-year span) being emitted from leaking pipelines. The EPA estimates that the natural gas pipeline system was responsible for almost 13 percent of national methane emissions in 2018.”

“Less money for climate resilience and renewable energy”

The need for more emergency services coupled with a reduction in tax revenue has taken an economic toll on cities and states. As a result, some have had to delay and divert funding away from climate resilience projects and renewable energy. Miami, which began elevating its flood-prone roads in 2015, had only completed about 20 percent of the work when COVID-19 struck and cut tourism income. The city has lost about one quarter of its total revenue, which will make finishing the job more challenging.”

“The Obama administration’s $1 billion National Disaster Resilience Competition set aside $1 billion in funding for innovative projects that make cities and states more resilient to climate change, but the funds must be spent by fall 2022. Many projects will need an extension.”

“For instance, Virginia, which won $121 million to build a flood wall, raise roads and incorporate green infrastructure and pumps to curb flooding in Norfolk, has broken ground on the project, but needs more time to spend all the funds. If Congress does not extend the deadline, most of the 13 projects will not be completed.”

“While U.S. renewable energy generation doubled over the past 10 years, COVID-19 may undo much of this progress—600,000 jobs in renewable energy, energy efficiency, green vehicles and energy storage have been lost since March. The wind industry estimates it could lose 35,000 jobs, and the Solar Energy Industries Association predicts half its workforce will be out of work by the end of 2020. For example, sales and installations in Illinois, a once booming solar market due to its Future Energy Jobs Act enacted in 2016 to move the state to a clean energy future, have slowed due to COVID-19. Many workers have already been laid off or furloughed with more job losses expected; smaller companies may not survive.”

“Scientific research disrupted”

“Due to lockdowns and travel bans, scientists have been unable to travel to do their fieldwork, and there’s a limit to how much some can accomplish with data and computers alone. Columbia University’s Lamont-Doherty Earth Observatory (LDEO) closed its labs in March, affecting its researchers. Jacqueline Austermann, an LDEO earth scientist, had a National Science Foundation grant to collect coral fossil samples in the Bahamas this spring; the samples would have helped researchers better understand historical sea levels and how climate change might affect future sea level. The project was put on hold.”

“Galen McKinley, a professor of Earth and Environmental Sciences at Columbia University and LDEO, studies the ocean and the carbon cycle, working mostly on the computer, running models and simulations. She depends on data collected by investigators who collect surface ocean carbon data, but many research cruises have been cancelled due to COVID-19.”

“McKinley explained that in some parts of the ocean, carbon uptake is only measured once every decade or so. “These sections [of ocean research] are very expensive to do. You have to have a ship out there for a couple months to accomplish it with people and equipment. If these sections get cancelled midstream, as one was in the Pacific, those data won’t be taken. So, we’ll have a hole in our ability to observe the change in the total uptake of carbon and heat by the ocean. There will be a 10-year gap in our ability to monitor that and understand how the ocean is responding to climate change.”

“The cancellation of research cruises not only means a gap in the data; it also means the loss of an unprecedented opportunity. COVID-19 may result in an approximately five to eight percent reduction in average global emissions for the year, and while this is a small amount in the context of the whole system, it offers a rare opportunity to see how Earth responds to cuts on carbon emissions. “All of our observations of the Earth system have been made under a situation where atmospheric CO2 is going up exponentially every year,” said McKinley. “We don’t really know what the Earth will do when we start cutting our emissions, but this is what we want and need to do under the Paris accord. That is one reason why this is a valuable opportunity to tease out any signals of what we can expect the Earth system to do in response to cutting emissions.”

“McKinley and colleagues recently found that the ocean’s capacity to absorb carbon dioxide from the atmosphere depends on the amount of CO2 in the atmosphere; in other words, as CO2 emissions decrease, the ocean’s absorption of CO2 will slow. As we cut our emissions, the ocean will eventually begin to release carbon back into the atmosphere. But we don’t know whether this will happen in a few years or a few decades, and the current dip in emissions could provide some clues if researchers could go out in the field to take measurements. Understanding how the ocean circulation and carbon cycle work is key to making more accurate predictions about future conditions.”

“More plastic”

“COVID-19 has vastly increased our use of plastic: gloves and masks, plexiglass dividers in stores and offices, and disposable shopping bags.”

“Discarded gloves and masks are littering streets and parks, and personal protective gear is already washing up on beaches around the world. The use of plastic packaging and bags has soared because restaurants rely on take-out and delivery food. Ordering all sorts of other items online has also resulted in more packaging materials, increasing the carbon footprint of e-commerce. Some cities and states have temporarily banned reusable shopping bags and delayed or rolled back plastic-bag bans. Most large cities are continuing with recycling, but some smaller communities such as Fayetteville, AK and Dalton, GA, have curtailed it altogether.”

“More cars”

“The CDC has recommended that people returning to work minimize contact with others and urged companies to offer incentives to encourage people to ride or drive alone. These guidelines are prompting more individual car use, which will cause traffic congestion and air pollution, and increase greenhouse gas emissions. Apple Maps data have detected many more requests for directions from people driving cars. The CDC advice will also increase the fear many have of taking public transportation.”

“According to a recent poll, about one third of Americans are considering moving out of cities to less dense areas in the wake of COVID-19. Real estate agents have reported a boom in demand from New York City residents for suburban homes in New Jersey and Connecticut. But suburban living means more driving. A 2014 report found that half the household carbon footprint of the U.S. comes from suburban living, as a result of transportation, household energy use and consumption of food and services.”

“For better”

“Green recovery in other countries”

“The European Commission, the executive branch of the European Union, has put forth the world’s greenest stimulus plan — a 750 billion euro ($825 billion) economic recovery plan with the goal for the EU to be carbon neutral by 2050. It includes financing for renewable energy, electric vehicle charging and other emissions-friendly projects, including retrofitting old buildings and developing no-carbon fuels like hydrogen. The stimulus plan still needs to be approved by the EU’s 27 member states.”

“To the extent that Europe takes moves, that will make it more attractive for other countries to act,” said Scott Barrett, vice dean at Columbia University’s School of International and Public Affairs. “But I don’t think example is enough. I think what’s more powerful would be not only their demonstration that it can be done, but a change in the economic calculus—because technology’s changed, because systems are interconnected, and because when Europe did it, it actually became more economic and easier, and possibly necessary for others to do it. If they [EU] are able to lower the cost of alternative energy sources, then those actions would actually make other countries be more inclined to use those alternatives. That leverage creates a positive feedback so that when more countries do more, others want to do more.”

“Some countries are also using the pandemic as an opportunity to make their societies more resilient to the looming climate crisis. Germany’s $145 billion stimulus plan devotes about one third of its funds to public transportation, electric vehicles and renewable energy, with no money provided for combustion engine vehicles. The government is also driving down the cost of clean energy, increasing research and development of green hydrogen, and investing in more sustainable agriculture and forest management as well as initiatives to decrease shipping and airlines emissions.”

“France is investing $8.8 billion to help its car industry, with the aim of becoming the main producer of electric vehicles in Europe. Its plan includes financial incentives to encourage people to exchange their old cars for lower-emissions vehicles and to buy electric cars.”

“South Korea has introduced a Green New Deal that would make it the first East Asian country to commit to a goal of net-zero emissions by 2050. The plan, which still needs to be signed into law, would include a carbon tax, more investment in renewable energy, training for workers displaced by the transition to clean energy, and an end to public financing of fossil fuel projects.”

“While the U.S.’s relief plans have so far lacked policies that help combat climate change, House Democrats have proposed a $1.5 (Trillion) green infrastructure plan with much of it focused on green initiatives, resiliency, and reducing the emissions of the transportation sector. It allots $300 billion to fixing and building bridges and roads. The plan also includes funding for education, broadband, clean water and housing. The Republican-led Senate, however, is likely to oppose the plan.”

“A renewable energy extension”

“The U.S. Treasury Department has given renewable energy projects more time to take advantage of the production tax credit and the investment tax credit. Renewable energy facilities will now have five years (instead of four) to complete projects that commenced in 2016 and 2017 and still be eligible for the tax credits.”

“More biking and walking”

“To help residents trying to avoid public transportation, many cities have closed off streets for pedestrians and increased bike lanes.”

“Oakland, CA introduced Slow Streets, which banned cars on 74 miles of streets, encouraged slower driving, and promoted biking and walking. New York, San Francisco, Minneapolis and Seattle have followed suit. Brookline, MA, a Boston suburb, used temporary structures to widen sidewalks and increase bike lanes.”

“European cities have also expanded biking. Barcelona added 13 miles of city streets for biking; Berlin has 14 new miles of bike lanes and Rome is building 93 miles for biking. Paris opened almost 400 miles of bikeways as of May.”

“Less international travel”

“Transportation is responsible for 23 percent of global carbon emissions, with 11 percent of the sector’s greenhouse gas emissions attributable to aviation. The enormous decrease in international air travel due to COVID-19 has reduced CO2 and nitrogen oxide emissions as well as ozone creation and particulate matter.”

“As people realize they can be equally or more productive at home, remote working will likely become much more common in the future. This may mean more teleconferencing and less international business travel. International trade may also decrease as countries recognize the need to produce more goods domestically.”

“McKinley said that oceanography research has a particularly large carbon footprint; because collaborators are all over the world, the work entails a lot of long trips. She has been heartened by the success of COVID-19-induced virtual meetings because they actually enable more international colleagues to attend and participate.”

“She cited the example of a virtual meeting in May at Lamont studying the ocean carbon cycle. The working group was only 15 people, but because the meeting was virtual, they ended up with 150 people around the world listening in. Not only did the virtual meeting make for a smaller carbon footprint than an in-person meeting, “I think it really opened up the ideas to a much broader community,” said McKinley. She would still want some scientific meetings be in person, however, because she feels it’s important for young scientists to get to know others face-to-face. “So much of the educational experience of becoming a scientist, particularly for graduate students, is the experience of being part of a scientific community,” she said.”

“Living more simply”

“Lockdowns and quarantines have compelled people to stay at home and cook, which benefits the environment because it requires fewer resources than ordering in or eating out—processing, packaging and transporting food add to its carbon footprint. And because COVID-19 has hit people with preexisting conditions harder and meat prices rose, more people may be trying to eat less meat and instead opt for more organic, vegetarian or vegan foods. Having experienced the sight of empty shelves in grocery stores during the pandemic, they may also be inclined to waste less food. People who want to know where their food comes from may move away from processed foods and eat more locally or grow a garden.”

“Living simply within our homes has encouraged many people to reexamine their pre-pandemic more materialistic and consumerist lives. Do we really need the latest fashion or the newest gadget? Consumer goods contribute to climate change throughout their life cycles: raw materials extraction, processing, logistics, retail and storage, consumer use and disposal all result in carbon emissions. Perhaps we will no longer be as susceptible to the planned obsolescence inherent in fashion and many other consumer products.”

“With stores, restaurants and movie theaters shuttered, people have sought relief by walking outside in parks and in nature. This experience could foster a new appreciation for nature, and more understanding about the impacts humans have on the environment. Hopefully it will translate into an impetus to protect and care for the environment.”

“Renewed faith in science and expertise”

“Our experience with COVID-19 should help people realize the importance of science and of preparing for what is to come, whether that’s a pandemic or climate change, as both are phenomena that scientists have foreseen.”

“Scientists have been waiting for a pandemic like this for a very long time, so for the infectious disease experts and historians who understand pathogens and interactions between humans and their environment, this is not an unusual thing,” said Barrett. “I think what’s been interesting has been how the public and some policy makers have been paying attention to what the infectious disease community, especially the modelers, are telling them. Also, we’re now very aware of the delay between the time you act and the time you start to see results. It’s pretty clear that if we had acted when we should have acted in the U.S., we would have saved a lot of people. This is a reminder that expertise matters. Nature is real. Scientists do understand how it works. We need to heed what they tell us and the warnings that they’ve given us.”

“Hope”

“Barrett believes that problems like COVID-19 and climate are collective problems that have to be addressed collectively. “Ultimately, we’re only going to address these problems if countries work together,” he said. He feels this is a real opportunity. If countries can work collaboratively to develop a vaccine and ultimately eliminate COVID-19, “I think people would say, ‘Wow,’ we can really do something together. Let’s go back to this climate problem.”

Update: Jun 24, 2020

In today’s blog update I’m introducing a recent scientific paper (study) on latitudinal and climate effects in shaping the evolution and spread of SARS-CoV-2 across the globe.  The study is a pre-print (not peer reviewed) so it still needs to be verified/validated.  I recommend that interested readers preview (didn’t work for me) or download the PDF version of the paper and read the full study (weblinks below). These are some of the key points I took away from reading the paper:

  1. The scientific community has identified to date, at least, 176 different strains of SARS-CoV-2.
  2. SARS-CoV-2, to date, has been more prevalent in northern temperate and colder/continental climes (latitudinal zones), and more prevalent along nations’ east and west coast regions; however that may not continue to be the case going forward as it appears the virus is evolving (adapting) to warmer more tropical climes.
  3. Most of earth’s lifeforms decrease (population-wise) as they move further away from the equator; this is known as the Latitudinal Bio-Diversity Gradient. A few unique organisms, possibly including the SARS-CoV-2 virus, follow the Inverse Latitudinal Bio-Diversity Gradient and increase as they move towards equatorial regions.
  4. Structural proteins: S (Spike Glycoprotein), E (Envelope), M (Membrane), and N (Nucleocapsid) play pivotal roles in our host immune responses to the virus.

“Climatic-niche evolution of SARS CoV-2”, preprint version posted June 23, 2020. https://doi.org/10.1101/2020.06.18.147074doi: bioRxiv preprint; Authors: Priyanka Bajaj, Prakash Chandra Arya

https://www.biorxiv.org/content/10.1101/2020.06.18.147074v1

https://www.biorxiv.org/content/10.1101/2020.06.18.147074v1.full.pdf

Update: Jun 14, 2020

In today’s blog update I am introducing excerpts from three current web articles and adding my two cents here in the intro.  First up is a Lancet commentary article discussing Asymptomatic Transmission of COVID-19 and the information that we have derived from two studies of asymptomatic individuals who were quarantined on the Diamond Princess cruise ship. This article gave me the feeling that within the data from these two studies lies some significant information on how this virus interacts with our immune systems.  Honestly, it is slightly over my head medical comprehension-wise, but I can still see that there is some significant value in the analysis of the data presented.  This commentary stood out to me: “these studies describe two remarkable features. First, the presence of comorbidities (underlying illnesses) did not appear to increase susceptibility to symptomatic infection or even disease outcome in these studies. Instead, older age appeared to be the only demographic factor that differentiated symptomatic from asymptomatic outcome in the individuals in Hong Kong,3 as well as differentiating severe from mild cases in the Japanese hospital.2“Second, about 50% of asymptomatic individuals showed radiographic abnormalities, including ground-glass opacities on chest CT scans.” “These findings suggest that the anatomy and extent of infection might not differentiate symptomatic from asymptomatic cases.

The second article is a brief Reuters piece on the recent spike of COVID-19 cases in the US.  What caught my eye in this article was the stats of in-patient hospitalizations in “South Carolina, 69% to 77% of hospital beds are occupied, depending on the region.” Our ability to cope with increased hospitalizations, and ventilator usage, is key to how deadly this virus hits us.

The third article is a Lancet article on a recent Sero (blood antibody) Survey on a select portion of Geneva, Switzerland’s population.  If I interpreted the study correctly, it appears that during five consecutive weeks of sero (antibody) testing, an average of  less than 11% of the studied populace tested positive for COVID-19 antibodies… meaning we all have a long way to go before we get close to Herd Immunity!

“Asymptomatic SARS-CoV-2 infection”, By Eng Eong Ooi and Jenny G. Low, The Lancet, Published Jun 12, 2020, https://doi.org/10.1016/S1473-3099(20)30460-6

“The pandemic spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the cause of COVID-19, has placed lives and economies of many countries under unprecedented stress. Many countries have shut schools and workplaces and imposed physical distancing to reduce virus transmission, in an effort to prevent the number of COVID-19 cases from overwhelming health-care systems. Such measures, however, are not economically sustainable. Schools and workplaces will have to be reopened. An important challenge for returning to normality is the prevalence of asymptomatic infection and the question of whether such individuals could sustain community virus transmission.1

“As the health community debates and examines the epidemiological significance of asymptomatic individuals, such cases present unique opportunities to gain insight into COVID-19 pathogenesis.”

“In The Lancet Infectious Diseases, two independent studies by Sakiko Tabata and colleagues2  and Ivan Fan-Ngai Hung and colleagues3  have focused on the COVID-19 outbreak on board the Diamond Princess cruise ship in February, 2020, to retrospectively and prospectively compare asymptomatic with pre-symptomatic infection. Screening for viral shedding of all individuals on board was done when the ship was docked in Japan and those who tested positive were hospitalised. Individuals who tested negative and who returned to their country of residence were further quarantined and monitored for infection. These control measures provided an opportunity for clinical studies of asymptomatic infection. A previous study found that half of the 634 passengers who screened positive for SARS-CoV-2 while on board the ship were asymptomatic,4 although whether these individuals remained asymptomatic until infection resolution was not prospectively determined.”

“Of the 43 individuals positive for SARS-CoV-2 on RT-PCR who were asymptomatic at admission to a hospital in Tokyo, Japan, ten developed COVID-19, including severe pulmonary disease.2”  Of the 215 asymptomatic individuals who returned to Hong Kong for further quarantine and were enrolled in the study by Hung and colleagues,3  eight became RT-PCR positive and three of them eventually developed symptoms; a ninth individual was seropositive for SARS-CoV-2 and had abnormalities on chest CT scan but remained asymptomatic. The individuals in both studies were monitored until discharge from isolation. Neither of the studies, however, were able to identify the time of initial exposure to the virus that led to infection. Because RT-PCR positivity can persist for weeks and is subject to sampling error,5   the comparison between asymptomatic and symptomatic cases could be confounded by the difference in time from virus exposure.”

“Notwithstanding this limitation, these studies describe two remarkable features. First, the presence of comorbidities did not appear to increase susceptibility to symptomatic infection or even disease outcome in these studies. Instead, older age appeared to be the only demographic factor that differentiated symptomatic from asymptomatic outcome in the individuals in Hong Kong,3 as well as differentiating severe from mild cases in the Japanese hospital.2

“Second, about 50% of asymptomatic individuals showed radiographic abnormalities, including ground-glass opacities on chest CT scans.2,3

“The Hong Kong group also observed that patients with CT scan abnormalities had higher concentrations of SARS-CoV-2 spike protein and nucleoprotein antibodies than those with normal CT scans, regardless of whether they were symptomatic or asymptomatic.3

“These findings suggest that the anatomy and extent of infection might not differentiate symptomatic from asymptomatic cases. A quantitative comparison of the extent of abnormalities in the chest radiographs or CT scans between those with symptomatic and pre-symptomatic infection would have been informative, but this analysis was not carried out in these studies. Nonetheless, these findings suggest that some individuals can tolerate a certain extent of lower respiratory tract infection without developing any symptoms.”

“Besides the extent of pulmonary infection, differentiation between symptomatic and asymptomatic outcomes might be related to the type of host response to infection. In the Japanese study (but not in the Hong Kong study), significantly increased serum lactate dehydrogenase was observed in pre-symptomatic individuals compared with asymptomatic individuals. Lactate dehydrogenase is a marker of pyroptosis, an inflammatory form of programmed cell death.6  Pyroptosis releases proinflammatory molecules,6 including IL-1, which we found to be expressed before the nadir of respiratory function and peak expression of other cytokines in a previous study.7Pyroptosis could therefore be an initiator of pulmonary inflammation and symptomatic disease.”

“In conclusion, outbreak investigations that are able to identify asymptomatic and pre-symptomatic infections have unique opportunities to gain clinical insights into COVID-19 pathogenesis. Such clinical insights will be pivotal for shaping future pathogenesis studies.”

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30460-6/fulltext

“Record spikes in new coronavirus cases, hospitalizations sweep parts of U.S.”, By Lisa Shumaker, Reuters, Published Jun 14, 2020

“Nationally, there were over 25,000 new cases reported on Saturday, the highest tally for a Saturday since May 2, in part due to a significant increase in testing over the past six weeks.”

“Perhaps more troubling for health officials is many of these states are also seeing record hospitalizations – a metric not affected by increased testing.”

“Arkansas, North Carolina, Texas and Utah all had a record number of patients enter the hospital on Saturday. In South Carolina, 69% to 77% of hospital beds are occupied, depending on the region.

https://www.reuters.com/article/us-health-coronavirus-usa/record-spikes-in-new-coronavirus-cases-hospitalizations-sweep-parts-of-u-s-idUSKBN23L0JB

“Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study”, By Silvia Stringhini, PhD , Ania Wisniak, MS , Giovanni Piumatti, PhD , Andrew S Azman, PhD , Stephen A Lauer, PhD , Hélène Baysson, PhD , David De Ridder, MSc, Dusan Petrovic, PhD, Stephanie Schrempft, PhD , Kailing Marcus, MSc, Sabine Yerly, MSc, Isabelle Arm Vernez, MSc, Prof Olivia Keiser, PhD, Prof Samia Hurst, MD , Prof Klara M Posfay-Barbe, MD, Prof Didier Trono, MD, Prof Didier Pittet, MD, Laurent Gétaz, MD, Prof François Chappuis, MD, Prof Isabella Eckerle, MD, Prof Nicolas Vuilleumier, MD, Benjamin Meyer, PhD, Prof Antoine Flahault, MD, Prof Laurent Kaiser, MD, Prof Idris Guessous, PhD , The Lancet, Published Jun 12, 2020

https://doi.org/10.1016/S0140-6736(20)31304-0

“Summary”

“Background”

“Assessing the burden of COVID-19 on the basis of medically attended case numbers is suboptimal given its reliance on testing strategy, changing case definitions, and disease presentation. Population-based sero-surveys measuring anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) antibodies provide one method for estimating infection rates and monitoring the progression of the epidemic. Here, we estimate weekly seroprevalence of anti-SARS-CoV-2 antibodies in the population of Geneva, Switzerland, during the epidemic.”

“Methods”

“The SEROCoV-POP study is a population-based study of former participants of the Bus Santé study and their household members. We planned a series of 12 consecutive weekly sero-surveys among randomly selected participants from a previous population-representative survey, and their household members aged 5 years and older. We tested each participant for anti-SARS-CoV-2-IgG antibodies using a commercially available ELISA. We estimated sero-prevalence using a Bayesian logistic regression model taking into account test performance and adjusting for the age and sex of Geneva’s population. Here we present results from the first 5 weeks of the study.”

Findings

Between April 6 and May 9, 2020, we enrolled 2766 participants from 1339 households, with a demographic distribution similar to that of the canton of Geneva. In the first week, we estimated a sero-prevalence of 4·8% (95% CI 2·4–8·0, n=341). The estimate increased to 8·5% (5·9–11·4, n=469) in the second week, to 10·9% (7·9–14·4, n=577) in the third week, 6·6% (4·3–9·4, n=604) in the fourth week, and 10·8% (8·2–13·9, n=775) in the fifth week. Individuals aged 5–9 years (relative risk [RR] 0·32 [95% CI 0·11–0·63]) and those older than 65 years (RR 0·50 [0·28–0·78]) had a significantly lower risk of being seropositive than those aged 20–49 years. After accounting for the time to seroconversion, we estimated that for every reported confirmed case, there were 11·6 infections in the community.”

“Interpretation”

“These results suggest that most of the population of Geneva remained uninfected during this wave of the pandemic, despite the high prevalence of COVID-19 in the region (5000 reported clinical cases over <2·5 months in the population of half a million people). Assuming that the presence of IgG antibodies is associated with immunity, these results highlight that the epidemic is far from coming to an end by means of fewer susceptible people in the population. Further, a significantly lower sero-prevalence was observed for children aged 5–9 years and adults older than 65 years, compared with those aged 10–64 years. These results will inform countries considering the easing of restrictions aimed at curbing transmission.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31304-0/fulltext#

Update: Jun 7, 2020

Today’s blog update is about a positive or feel-good story related to COVID-19.  As a tribute to COVID-19 victims, and to support the arts and art museums, Dutch art collector and dealer Bob Haboldt gifted to Amsterdam’s Rijksmuseum a 16th century painting by renowned Flemish (Belgian Dutch) artist Bartholomeus Spranger.  The art piece titled “The Body of Christ Supported by Angels” is likely worth a few million dollars or Euros, just a guess, based upon the TEFAF Maastricht 2020 auction price tag for Spranger’s “Venus and Cupid with Mercury and Psyche – An Allegory” (c. 1600), by the Weiss Gallery, for €5.5m. That painting is still for sale:

https://www.weissgallery.com/artworks/9487-bartholomeus-spranger-1546-1611-venus-and-cupid-with-mercury-and-psyche-c.1600/

In the blog today I hope to highlight some background information on the donation, as well as on Spranger, Haboldt and the art world in general.  A brief diversion for the mind if you will from the onslaught of the current crises driven media cycles.  Take-aways from the blog should be 1) AFP’s “One Good Thing” a continuing series of Associated Press stories focusing on glimmers of joy and benevolence in a dark time”. 2) “Museums around the world have been struggling, and UNESCO estimates that one out of eight might not survive” – they need our support and patronage! 3) Art history is so cool! 😊

https://upload.wikimedia.org/wikipedia/commons/0/08/Bartholomeus_Spranger_-_The_Body_of_Christ_Supported_by_Angels_%28ca._1587%29.jpg

“In COVID-19 darkness, gift of a `Moment of Light’ to museum”, By Raf Casert and Aleksander Furtula, Associated Press (AP), Published Jun 3rd, 2020

“AMSTERDAM, Netherlands (AP) — If not for the pandemic, Amsterdam’s Rijksmuseum would have missed out on a classic Dutch 16th century painting it so badly craved.”

“Instead, the work now graces a central hall of one of the world’s most famous cultural institutions — all because a wealthy dealer in old masters elected to pay a very unusual tribute to COVID-19 victims.”

“When the museum reopened Monday (June 1, 20202) after the Dutch lockdown was eased, General Director Taco Dibbits stood beaming before Bartholomeus Spranger’s “Body of Christ Supported by Angels.”

“This gift came, and it was a moment of light,” he said.”

“His joy contrasted sharply with the disappointment he felt at the early March TEFAF (Maastricht) art fair — an annual jamboree in the southern Netherlands where culture meets capital. He thought the oil-on-copper painting was his to buy.”

“We were standing there with our curators around the painting and saying how wonderful it was,” he said. What they didn’t know was that the picture had been sold almost on arrival at the fair.”

“Dibbits went back to Amsterdam, and was forced to deal with the impact of the coronavirus on his institution. With the public shut out, he said, “we were losing 1 million (euros) a week. … That’s really a very substantial part of what we need to make the museum function.”

“So, imagine Dibbits’ surprise when he got a call from international dealer and collector Bob Haboldt, who owned the painting and had earlier said he sold it.”

“It turned out that as soon as the pandemic broke, the sale was canceled.”

“The globe-trotting Dutchman, who lives in France and Italy and has offices in Amsterdam, Paris and New York, was tied down, just like everybody else.”

“In isolation, I took the step that I would not think about its financial value,” he said in a phone interview from Italy. “Only its emotional value.”

“He refused say how much the painting could fetch, but “it is a big gift, no matter how you look at it.”

“Haboldt said he decided to donate the painting “in memory of the victims of COVID-19, not only those who died but also those who suffered,” and to serve as inspiration to others to support the arts.”

“I wanted it to go before a very big audience,” he said, and as a native of Amsterdam, the Rijksmuseum was the obvious choice.”

“The painting itself seems an allegory for both the times in which we live in and the future for which the world hopes.”

“A dead Jesus Christ is lifted from his tomb by three angels and taken skyward. The image recalls the scenes of suffering that have played out all over the world these weeks and months during the pandemic.”

“The picture represents a big message,” Haboldt said. “I hope people will stop in front of it for a moment and realize that although they look at a religious painting, they are looking at something timeless, full of compassion, mercy and hope.”

“Museums around the world have been struggling, and UNESCO estimates that one out of eight might not survive.”

“Said Dibbits: “That in a time where there’s so much uncertainty, also for the art market and the dealers — that a dealer decides to donate a work when he doesn’t know where his future is going, I think that’s something very special.”

“While nonstop global news about the effects of the coronavirus have become commonplace, so, too, are tales of kindness. “One Good Thing” is a continuing series of AP stories focusing on glimmers of joy and benevolence in a dark time. Read the series here:” https://apnews.com/OneGoodThing

https://news.yahoo.com/covid-19-darkness-gift-moment-072806412.html

“Rijksmuseum given unique painting to remember virus victims”, By Agence France-Presse (AFP), Published May 27, 2020

“The Hague (AFP) – Amsterdam’s Rijksmuseum will display a famous 16th-century painting donated to commemorate victims of the coronavirus when it re-opens next week, almost three months after closing its doors, the museum said Wednesday.”

“The (circa) 1587 painting by Flemish master Bartholomeus Spranger called “The Body of Christ Supported by Angels” was given to the museum by Dutch art collector and dealer Bob Haboldt.”

“In the first place, it is a gift to everyone to commemorate the victims of COVID-19,” Haboldt said in a statement, released by the Rijksmuseum.”

“It also serves as an example, encouraging everyone to do good for museums.”

“Haboldt said the donation was to make a contribution “and on how we could best memorialise this period.”

“Coronavirus has affected me, in the first place emotionally,” said the art dealer, who has offices in Amsterdam, Paris and New York.”

“Made around 1587, the oil-on-copper painting depicts angels supporting the body of Christ, illuminated by heavenly light as they remove the body from a tomb.”

“Also called an “imago pietatis” or image of compassion, the painting was originally made for private devotion.”

“It became famous after another Dutch painter, the German-born Hendrick Goltzius copied it as a print that was reproduced and distributed in large numbers, the Rijksmuseum said.”

“Haboldt originally sold the painting at the European Fine Art Fair, commonly known as TEFAF, in the beginning of March, Dutch media reported.”

“However, organisers cut short TEFAF, one of the world’s premier fine arts fairs after one of the exhibitors tested positive for the new coronavirus.”

“The painting’s sale was annulled shortly afterwards and Haboldt decided not to put it up for sale again, the authoritative daily NRC newspaper said on its website.”

“Neither Haboldt nor the Rijksmuseum put a price on the painting but a larger work by Spranger carried a tag of 5.5 million euros ($6 million) at TEFAF, the NRC said.”

“Rijksmuseum director Taco Dibbits said the famous institution was “deeply grateful to Bob Haboldt for his generous gesture.”

“In these difficult times we have seen how art can offer solace and be a source of hope and reflection,” said Dibbits.”

“Amsterdam’s famous Rijks and Van Gogh museums as well as restaurants around the country are reopening Monday (Jun 1, 2020) under strict conditions, following almost three months of lockdown because of the coronavirus pandemic which has claimed 5,781 lives so far.”

https://news.yahoo.com/rijksmuseum-given-unique-painting-remember-virus-victims-152336730.html

Rijksmuseum receives painting by Bartholomeus Spranger; Press Release, Rijksmuseum.NL, May 27., 2020

“The art dealer and collector Bob Haboldt has donated to the Rijksmuseum a masterpiece by Bartholomeus Spranger, The Body of Christ Supported by Angels, painted on copper ca. 1587. Spranger was one of the most important painters in Europe around 1600. From 1 June 2020 it will hang alongside other masterpieces by artists from the same region, including Adriaen de Vries and Joachim Wtewael.”

“Bob Haboldt: Coronavirus has affected me, in the first place emotionally. It gave me occasion to reflect on how I could make a contribution, and on how we could best memorialise this period. What is wonderful about paintings is that they are eternal and can serve as monuments to the difficult times in which we find ourselves. With this thought in mind, I came to the decision that I would donate this exceptional work by Bartholomeus Spranger to the Rijksmuseum. In the first place, it is a gift to everyone to commemorate the victims of COVID-19; it also serves as an example, encouraging everyone to do good for museums. I hope that others will follow.”

“Taco Dibbits, General Director of the Rijksmuseum: In these difficult times we have seen how art can offer solace and be a source of hope and reflection. Much of the art in Dutch museums over the past centuries was donated by private citizens, for the benefit of the general public, and we are deeply grateful to Bob Haboldt for making this generous gesture.”

Imago Pietatis

“Spranger’s painting on this small copper plate is a powerful and poignant image of compassion, or imago pietatis. It shows angels supporting the body of Christ, illuminated by heavenly light. This Man of Sorrows is presented to us almost frontally. The angel in the foreground holds a basket containing attributes associated with the passion, such as the crown of thorns and the nails used to crucify Christ. In the background the three Marys are shown making their way to the grave that they will find empty.”

“This painting was made for private devotion, but quickly garnered wide fame when, in 1587, Hendrick Goltzius copied it as a print that was reproduced and distributed in large numbers.”

Bartholomeus Spranger

“Antwerp-born Bartholomeus Spranger was from 1581 court painter of the Habsburg emperor Rudolf II in Prague, the greatest art collector of his time. Spranger was one of the most important and influential artists at the court, where he embodied the new European Mannerist style. His previous period in Italy, particularly Rome, exerted a major influence on his work in which he combined elements of the Netherlandish tradition and Roman Mannerism. The paintings he made while at the court were highly valued by the emperor and his entourage.”

“Other works by Spranger in the Rijksmuseum include the large canvas Venus and Adonis (ca. 1585-90) and the spectacular drawing The Wedding of Cupid and Psyche (1586-87).”

https://www.rijksmuseum.nl/en/press/press-releases/rijksmuseum-receives-painting-by-bartholomeus-spranger

Note1: Multiple artists throughout Anno Domini (A.D.) history have created artwork using the same title: “The Body of Christ Supported by Angels”.

Note2: A Hendrick Goltzius’ engraving on laid paper of Spranger’s The Body of Christ Supported by Angels is maintained at the US National Gallery of Art (NGA)

https://www.nga.gov/collection/art-object-page.153963.html

This weblink is a short, 3 minutes and 48 seconds, Vimeo video presenting “a selection of the paintings on display at Haboldt & Co during TEFAF Maastricht 2020.”  It includes a review of Spranger’s “The Body of Christ Supported by Angels”. The video and sound score were tastefully done!

https://www.bing.com/videos/search?q=%22bob+haboldt%22&docid=608048007504921217&mid=6D702FD19326179D09FD6D702FD19326179D09FD&view=detail&FORM=VIRE

Two biographical excerpts from a 2014 CODART interview of Bob Haboldt:

FriendsBob Haboldt Interviewed; by Gerdien Verschoor

December 2014; originally published in the CODART eZine, no. 5 Winter 2014

The grandson of an Amsterdam grocer who became a passionate art dealer
“That’s right, for someone of my background, art history was certainly not an obvious choice. I come from a family of entrepreneurs and grew up above my father’s shop in the Staatslieden district of Amsterdam. Later we moved to Baarn, to a small house with a garden, where, as a boy of twelve, I undertook “archeological excavations” and as a result became fascinated with Egyptology. Part of my adolescence was spent at an English boarding school in Switzerland, where I did a lot of drawing. This helped me to train my eye early on, and to develop an international outlook on life. After graduation I wanted to continue on this international course. I received a scholarship to Lewis and Clark College in Portland, Oregon, where I also worked as a trainee at the Portland Art Museum. I received a very broad education there, and that made it increasingly difficult to choose between Egyptology and Western art history, which interested me more and more. In the end I returned to the Netherlands and in 1977 enrolled at the University of Amsterdam – then still the GU, or Gemeente Universiteit (Municipal University) – to study art history.”

But you didn’t become an art dealer simply by studying art history.

“The necessity of earning money had been instilled in me since birth, and my dream was to combine that with art. While still studying I began as a trainee at Sotheby Mak van Waaij on the Rokin, and after that my first job was with Phillips on the Spiegelstraat. It was soon apparent that I possessed both the intellectual curiosity and the entrepreneurial spirit necessary in the art trade, and these jobs gave me an opportunity to continue training my eye. It also became increasingly obvious that I would choose the Old Masters instead of archeology. I went to work for Christie’s in New York and three years later I was asked to set up Colnaghi’s new branch there. Later still, I opened my own office in New York, and from that base I led two expeditions to Peru to inventory the colonial art in churches in the Andes: many works had been stolen from the churches and put on the market illegally.”

Haboldt’s Company:

https://www.masterart.com/galleries/1924/haboldt-pictura

Wikipedia Excerpt on Spranger’s Life:

“Bartholomeus Spranger was born in Antwerp as the third son of Ioachim Spranger and Anna Roelandtsinne. His father was a trader who had spent time abroad including a long stint in Rome.[5] Showing a keen interest in drawing, he was first apprenticed with Jan Mandijn, where he stayed for 18 months. Upon the death of Mandijn, Spranger studied for some time with Frans Mostaert who died after only a few weeks. He finally studied with Cornelis van Dalem for two years after which he stayed on for another two years in the workshop of van Dalem. As his three masters were mainly known as landscape painters. Spranger further copied prints of Frans Floris and Parmigianino.[4] He traveled to Paris on 1 March 1565 where he worked for six weeks in the workshop of Marc Duval. He then travelled on to Italy, where he first stayed for eight months in Milan. He then worked for three months in Parma as an assistant to Bernardino Gatti on the painting of the dome of the Santa Maria della Steccata.”

“He worked on wall paintings in various churches. In Rome he became, like El Greco, a protégé of Giulio Clovio. Here he also met Karel van Mander who later included a biography of Spranger in his Schilder-boeck, first published in 1604 and containing, amongst others, biographies of important Netherlandish painters. Pope Pius V appointed him court painter in 1570. He was summoned to Vienna by Maximilian II, Holy Roman Emperor, who died soon after his arrival in 1576.”

“Maximilian II’s successor Rudolf II was even more keen to employ him, and in 1581 he was appointed court painter and also valet de chambre, the court having moved its seat to Prague, where he stayed until his death there in 1611, shortly before Rudolf was deposed. Spranger occupied a house just outside the castle walls. The artist developed a close personal relationship with Rudolf and the two spent many days together engaged in conversation. The emperor would regularly visit Spranger’s studio. The emperor bestowed on Spranger the coat of arms of a liegeman in 1588 and granted him a hereditary title in 1595. In the meantime, Spranger supplied the emperor with a continuous stream of paintings of mythological scenes with nudes drawn from nature as well as propaganda pieces which extolled the virtues of Rudolf as a ruler. An example of a work combining the two elements of eroticism and propaganda is the Allegory of the virtues of Rudolf II (Kunsthistorisches Museum) which shows Bellona (the Roman goddess of war) sitting on a globe surrounded by Venus, Amor, Athene and Baccus and emblems symbolising Hungary and the Croatian river Sava. The propagandic message is that the empire is safe with Rudolf at the helm. Thanks to the emperor’s patronage, Spranger became very wealthy and owned many properties by the time he died.[6]

“Spranger married Christina Müller, the daughter of a rich jeweler from Prague in 1582. His wife died in 1600 after all their children had died. This sad story is depicted in Aegidius Sadeler‘s Portrait of Bartholomeus Spranger with an Allegory on the Death of his Wife.[7]

https://en.wikipedia.org/wiki/Bartholomeus_Spranger

The Netherlands Institute’s For Art History (RKD) data on Spranger:

https://rkd.nl/en/explore/artists/74418

Update: May 30, 2020

Today’s blog update is about RT-PCR (Reverse Transcription – Polymerase Chain Reaction).  RT-PCR is a bio-chemical process used “for analysis of gene expression and quantification of viral RNA in research and clinical settings.”  Among other things, it tells you the quantity of viral cells in a given sample.  “RT-PCR from a nasopharyngeal swab is the current standard of care for the diagnosis of SARS-CoV-2 infection.”  For us layman, non-medical types, I tried to break it down into smaller more easily understood parts below using Wikipedia data; but, essentially… it is a chemical process used to quantify levels of a specific RNA or Complementary DNA (cDNA) in a given host.  Doctors and scientists use RT-PCR for multiple tasks, including to confirm whether patients have sufficient levels of viral RNA to be contagious to others.  I included in today’s blog excerpts from a recent Journal of the American Medical Association (JAMA) Network article on RT-PCR testing, in a very small Chinese study, that indicated, in a small percentage of the population, COVID-19 (SARS-CoV-2) will stay in the body (host) longer than 14 days – potentially up to 30 days or longer.  The referenced article used the word “Recurrent”; but, I suspect (with no medical training- just a hunch based upon my prior readings) that it is more likely that our current testing capabilities simply aren’t sensitive enough to detect that the virus is still present, hiding, subdued within the bodies of these infected individuals. In any case, the take-away should be that the “14 day” post-infection quarantine protocol is likely arbitrary and more of a guideline. In my brief research on RT-PCR I also stumbled upon the Brigham And Women’s Hospital COVID-19 Protocol Guide, assumedly compiled for their hospital staff’s consumption.  The guide is rich with links to COVID-19 related studies and article citations and provides a unique glimpse into the healthcare communities focus on dealing with COVID-19; worth a quick review, the link is listed below.   

Regards, Proteus

“Reverse transcription polymerase chain reaction (RT-PCR) is a laboratory technique combining reverse transcription of RNA into DNA (in this context called complementary DNA or cDNA) and amplification of specific DNA targets using polymerase chain reaction (PCR).[1] It is primarily used to measure the amount of a specific RNA. This is achieved by monitoring the amplification reaction using fluorescence, a technique called real-time PCR or quantitative PCR (qPCR). Combined RT-PCR and qPCR are routinely used for analysis of gene expression and quantification of viral RNA in research and clinical settings.

“Application:  The exponential amplification via reverse transcription polymerase chain reaction provides for a highly sensitive technique in which a very low copy number of RNA molecules can be detected. RT-PCR is widely used in the diagnosis of genetic diseases and, semi-quantitatively, in the determination of the abundance of specific different RNA molecules within a cell or tissue as a measure of gene expression.”

https://en.wikipedia.org/wiki/Reverse_transcription_polymerase_chain_reaction

“Polymerase chain reaction (PCR) is a method widely used in molecular biology to rapidly make millions to billions of copies of a specific DNA sample, allowing scientists to take a very small sample of DNA and amplify it to a large enough amount to study in detail.”

https://en.wikipedia.org/wiki/Polymerase_chain_reaction

“A reverse transcriptase (RT) is an enzyme used to generate complementary DNA (cDNA) from an RNA template, a process termed reverse transcription.”

https://en.wikipedia.org/wiki/Reverse_transcriptase#Process_of_reverse_transcription

Enzymes /ˈɛnzaɪmz/ are proteins that act as biological catalysts (biocatalysts)

https://en.wikipedia.org/wiki/Enzyme

“Recurrent Positive Reverse Transcriptase–Polymerase Chain Reaction Results for Coronavirus Disease 2019 in Patients Discharged From a Hospital in China”, By Rujun Hu, PhD1; Zhixia Jiang, MS2; Huiming Gao, MS2; et al; Published May 28, 2020, in:  JAMA Netw Open. 2020;3(5):e2010475. doi:10.1001/jamanetworkopen.2020.10475

“Methods”

We collected the clinical data of patients who had been cured and discharged from a hospital designated for patients with COVID-19 in Guizhou Province, China, between January 25, 2020, and February 26, 2020. All COVID-19 infections were classified into 4 different types—mild, moderate, severe, and critical—on the basis of the disease severity.4 Patients could be discharged if they met discharge standards.4 They were required to quarantine for 14 days in a designated hospital,4 and their nasopharyngeal swabs were usually collected on the 7th and 14th days; however, swabs were collected anytime if the patients had clinical symptoms. Real-time reverse transcriptase–polymerase chain reaction (RT-PCR) was performed on nasopharyngeal swabs at the Centers for Disease Control and Prevention of Guizhou Province. The researchers performed follow-up for all the patients, and the demographic data, clinical symptoms, and radiographic and laboratory results at admission were extracted from the electronic medical records.”

“Results”

“We examined data for 69 patients in total (median age, 33 years; range, 2-78 years; 35 male patients [50.7%]). Eleven of the patients (15.9%) had positive RT-PCR results for the COVID-19 nucleic acid test but without any symptoms. Among the 11 patients (median age, 27 years; range, 4-58 years), there were 7 male patients (63.6%), and 3 patients (27.3%) had comorbidities. Most of the 11 patients had moderate (9 patients) or mild infection (1 patient); only 1 patient was classified as having critical infection. The median interval from discharge to positive RT-PCR results was 14 days (range, 9-17 days). None of the patients were medical staff. There were no substantial differences in the demographic and baseline clinical characteristics between the recurrence group and nonrecurrence group (median age, 27 years [range, 4-58 years] vs 34 years [range, 2-78 years]; number of cluster cases, 8 patients [72.7%] vs 41 patients [70.7%]; presence of comorbidities, 3 patients [27.3%] vs 14 patients [24.1%]; median duration of hospital stay, 10 days [range, 7-24 days] vs 13 days [range, 7-38 days]) (Table 1). There also were no substantial differences between the recurrence group and nonrecurrence groups in terms of clinical symptoms (fever, 5 patients [45.5%] vs 26 patients [44.8%]; sore throat, 1 patient [9.1%] vs 4 patients [7.2%]; diarrhea, chill, anorexia, vomiting, and nausea, 0 patients vs 1 patient [1.7%] for all), radiographic findings (changes on chest computed tomography, 9 patients [81.8%] vs 36 patients [62.1%]), and laboratory values except for fatigue (4 patients [36.4%] vs 5 patients [8.6%]), number of initial symptoms (median, 2 symptoms [range, 0-4 symptoms] vs 1 symptom [range, 0-6 symptoms]), and creatine kinase level (median, 70.0 U/L [range 38.0-106.0 U/L] vs 46.0 U/L [range, 24.0-139.0 U/L]; to convert creatine kinase to microkatals per liter, multiply by 0.0167) (Table 2).”

“Discussion”

“On the basis of our follow-up results, 11 of 69 patients with COVID-19 showed positive RT-PCR results after discharge, which suggests that some recovered patients may still be virus carriers even after they reach the basic discharge criteria.4 Lan et al5 reported 4 patients with COVID-19, all medical staff in China, who presented with positive RT-PCR results 5 to 13 days after discharge. Although the participants in our research were not medical staff, our results revealed that the interval from discharge to positive RT-PCR results was 9 to 17 days (the intervals for 4 patients were >14 days), which is longer than the interval reported by Lan et al.5 Therefore, we suggest that medical institutions should pay attention to the follow-up of discharged patients by closely monitoring their RT-PCR results, even if they have been in quarantine for 14 days. In addition, our results revealed that fatigue, number of initial symptoms, and creatine kinase level could be associated with recurrent positive RT-PCR results, but further verification is required because of the limited number of patients.”

“This study was a single-center observational study limited to a small sample size, and 10 of the 11 patients had mild or moderate infection and only 1 patient was classified as having critical infection. Thus, these results may not be generalizable to other populations. Hence, it is necessary to conduct further studies to determine the factors associated with positive RT-PCR results after discharge.”

References

1. Chen  N, Zhou  M, Dong  X,  et al.  Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.   Lancet. 2020;395(10223):507-513. doi:10.1016/S0140-6736(20)30211-7PubMedGoogle ScholarCrossref

2. Shi  H, Han  X, Jiang  N,  et al.  Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study.   Lancet Infect Dis. 2020;20(4):425-434. doi:10.1016/S1473-3099(20)30086-4PubMedGoogle ScholarCrossref

3. Chen  L, Xiong  J, Bao  L, Shi  Y.  Convalescent plasma as a potential therapy for COVID-19.   Lancet Infect Dis. 2020;20(4):398-400. doi:10.1016/S1473-3099(20)30141-9PubMedGoogle ScholarCrossref

4. China National Health Commission. Diagnosis and treatment of 2019-nCoV pneumonia in China (version 7) [in Chinese]. Published March 4, 2020. Accessed March 5, 2020. http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml

5. Lan  L, Xu  D, Ye  G,  et al.  Positive RT-PCR test results in patients recovered from COVID-19.   JAMA. 2020;323(15):1502-1503. doi:10.1001/jama.2020.2783
ArticlePubMedGoogle ScholarCrossref

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766379

Brigham Health – Brigham And Women’s Hospital

COVID-19 Protocols

Diagnostics

SARS-CoV-2 Testing   RT-PCR

  1. “RT-PCR from a nasopharyngeal swab is the current standard of care for the diagnosis of SARS-CoV-2 infection”
  2. “Sensitivity of RT-PCR from nasopharyngeal swab is not optimal”
  3. “One Chinese study of 1014 patients with suspected COVID-19 found that only 59% had positive nasopharyngeal RT-PCR, compared with 88% who had findings on CT chest” (Ai et al, Radiology, 2020)
  4. “In confirmed cases in Shenzhen, nasal and throat swabs were 60-70% sensitive early in illness. This declines, particularly in mild cases, by the second week of symptoms” (Yang et al, preprint)
  5. “Multiple studies have demonstrated that viral shedding, and thus sensitivity of RT-PCR from nasopharyngeal swab, declines over time” (Yang et al, preprint; Zou et al, N Eng J Med, 2020; To et al, Lancet Infect Dis, 2020)
  6. “In the setting of high clinical suspicion, expectorated sputum, tracheal aspirate, or (rarely) bronchoalveolar lavage fluid may be sent for RT-PCR testing”
  7. “Deeper respiratory samples including sputum or bronchoalveolar lavage have higher sensitivity, with reported values of 70-90%” (Yang et al, preprint; Wang et al, JAMA, 2020)
  8. “Ongoing suspicion for COVID-19 with negative nasopharyngeal RT-PCR typically warrants an ID consult”
  9. “Recent reports suggest that salivary samples may potentially be more sensitive for detection of SARS-CoV than nasopharyngeal swab” (Wyllie et al, unpublished data)
  10. “This testing modality is being validated and may become available at BWH in the future”
  11. “Viral shedding has been identified from other body sites” (Wang et al, JAMA, 2020)
  12. “Viral RNA is shed in stool, but may not represent live transmissible virus. Limited viral culture data available indicate little to no live virus is present” (Wolfel et al, Nature, 2020)
  13. “Rarely, viral RNA can be present in blood, but this is not typical”
  14. “No viral RNA has been identified in urine”

“Guidelines for RT-PCR Testing at BWH”

  1. “Current Partners guidelines for inpatient and outpatient testing can be found here (login required)”
  2. “For symptomatic patients with suspicion of COVID-19:”
  3. “Inpatients require two nasopharyngeal tests separated by 12 hours”
  4. “Outpatients require a single nasopharyngeal swab”
  5. “For asymptomatic patients being screened for COVID-19, all patients require a single nasopharyngeal swab”
  6. “All symptomatic testing generates a CoV Risk flag”
  7. “This flag will expire in 14 days”
  8. “If a flag needs to be removed for purposes of precautions and bed placement (inpatient) or because of planned admission or procedure (outpatient), please page corresponding Biothreats pager”
  9. “All positive tests generate a COVID-19 flag”
  10. “All patients with known or highly suspected COVID-19 require repeat testing for clearance:”
  11. “Testing can be performed after 10 days from initial positive test”
  12. “Clearance requires two negative nasopharyngeal swabs separated by 24 hours”
  13. “Alternatively, clearance can be considered after 30 days from positive test”
  14. “Questions about appropriateness of testing or interpretation of results should be directed to respective inpatient or outpatient Biothreats pager”

https://covidprotocols.org/all-chapters/

Update: May 19, 2020

Today’s blog update reports on a promising Chinese therapeutic drug, not yet named/branded, derived from the neutralized plasma antibodies of convalescing COVID-19 patients. A leading Chinese American Biochemist, Dr. Xiaoliang Sunney Xie, director of the Beijing Advanced Innovation Center for Genomics, and a group of distinguished scientists, have utilized single cell RNA sequencing processes to isolate and identify 14 potent neutralized Memory B-cell monoclonal antibodies of which the most promising antibody, BD-368-2, showedstrong therapeutic and prophylactic efficacy in SARS-CoV-2-infected hACE2-transgenic mice.”  Whereas Plasma Therapy often has scalability issues, this new drug apparently does not.  I found it interesting that the drug (antibodies) apparently had preventative value when administered to the mice before administration of the virus. Clinical human trials have not yet begun; but are reportedly in the works. The finer details on the drug, animal testing and the sequencing techniques are documented in the linked “Pre-Proof” article for Cell magazine; key excerpts follow.  I also included multiple links to recent media coverage and to Dr. Xie’s Bios.  

“Here we report the rapid identification of SARS-CoV-2 neutralizing antibodies by high-throughput single-cell RNA and VDJ sequencing of antigen-enriched B cells from 60 convalescent patients. From 8,558 antigen-binding IgG1+ clonotypes, 14 potent neutralizing antibodies were identified with the most potent one, BD-368-2, exhibiting an IC50 of 1.2 ng/mL and 15 ng/mL against pseudo-typed and authentic SARS-CoV-2, respectively. BD-368-2 also displayed strong therapeutic and prophylactic efficacy in SARS-CoV-2-infected hACE2-transgenic mice.”

“Convalescent patients’ plasma, which contains neutralizing antibodies produced by the adaptive immune response, has led to a clear clinical improvement of both mild and severe COVID-19 patients when used as a therapeutic modality (Chen et al., 2020; Shen et al., 2020; Cao, 2020). However, therapeutic use is limited since plasma can not be produced on a large-scale. On the other hand, neutralizing monoclonal antibodies (mAbs) isolated from convalescent patient’s memory B cells may serve as a promising intervention to SARS-CoV-2 due to their scalability and therapeutic effectiveness.

https://www.cell.com/cell/fulltext/S0092-8674(20)30620-6

“Journal Pre-proof”

“Potent neutralizing antibodies against SARS-CoV-2 identified by high-throughput single-cell sequencing of convalescent patients’ B cells”

“Yunlong Cao, Bin Su, Xianghua Guo, Wenjie Sun, Yongqiang Deng, Linlin Bao, Qinyu Zhu, Xu Zhang, Yinghui Zheng, Chenyang Geng, Xiaoran Chai, Runsheng He, Xiaofeng Li, Qi Lv, Hua Zhu, Wei Deng, Yanfeng Xu, Yanjun Wang, Luxin Qiao, Yafang Tan, Liyang Song, Guopeng Wang, Xiaoxia Du, Ning Gao, Jiangning Liu, Junyu Xiao, Xiao-dong Su, Zongmin Du, Yingmei Feng, Chuan Qin, Chengfeng Qin, Ronghua Jin, X. Sunney Xie”

“PII: S0092-8674(20)30620-6”

DOI: https://doi.org/10.1016/j.cell.2020.05.025

“Reference: CELL 11430”

“To appear in: Cell: Received Date: 24 April 2020; Revised Date: 7 May 2020; Accepted Date: 13 May 2020”

“Summary: The COVID-19 pandemic urgently needs therapeutic and prophylactic interventions. Here we report the rapid identification of SARS-CoV-2 neutralizing antibodies by high-throughput single-cell RNA and VDJ sequencing of antigen-enriched B cells from 60 convalescent patients. From 8,558 antigen-binding IgG1+ clonotypes, 14 potent neutralizing antibodies were identified with the most potent one, BD-368-2, exhibiting an IC50 of 1.2 ng/mL and 15 ng/mL against pseudo-typed and authentic SARS-CoV-2, respectively. BD-368-2 also displayed strong therapeutic and prophylactic efficacy in SARS-CoV-2-infected hACE2-transgenic mice. Additionally, the 3.8Å Cryo-EM structure of a neutralizing antibody in complex with the spike-ectodomain trimer revealed the antibody’s epitope overlaps with the ACE2 binding site. Moreover, we demonstrated that SARS-CoV-2 neutralizing antibodies could be directly selected based on similarities of their predicted CDR3H structures to those of SARS-CoV neutralizing antibodies. Altogether, we showed that human neutralizing antibodies could be efficiently discovered by high-throughput single B-cell sequencing in response to pandemic infectious diseases.”

“Introduction: Coronavirus Disease 2019 (COVID-19) caused by a novel coronavirus named Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has spread globally as a severe pandemic (Callaway et al., 2020). Both SARS-CoV-2 and SARS-CoV belong to lineage B of the betacoronavirus genus (Zhou et al., 2020; Wu et al., 2020), and their RNA genomes share around 82% identity (Chan et al., 2020). The mechanisms by which SARS-CoV-2 infects target cells have been well studied and recently reported (Hoffmann et al., 2020; Walls et al., 2020). Similar to SARS-CoV, the spike (S) glycoprotein on the surface of SARS-CoV-2 mediates membrane fusion and receptor recognition of the virus (Wrapp et al., 2020). The S1 subunit at the N-terminal region is responsible for virus attachment and contains the receptor-binding domain (RBD), which directly binds to the ACE2 receptor on the host cell. Currently, no validated therapeutics against virus-target interactions are available for COVID-19.”

“Convalescent patients’ plasma, which contains neutralizing antibodies produced by the adaptive immune response, has led to a clear clinical improvement of both mild and severe COVID-19 patients when used as a therapeutic modality (Chen et al., 2020; Shen et al., 2020; Cao, 2020). However, therapeutic use is limited since plasma can not be produced on a large-scale. On the other hand, neutralizing monoclonal antibodies (mAbs) isolated from convalescent patient’s memory B cells may serve as a promising intervention to SARS-CoV-2 due to their scalability and therapeutic effectiveness. Human-sourced mAbs targeting viral surface proteins have increasingly shown their therapeutic and prophylactic efficacy against infectious diseases such as HIV, Ebola, and MERS (Corti et al., 2016; Wang et al., 2018; Scheid et al., 2009). Their safety and potency in patients have been demonstrated in multiple clinical trials (Xu et al., 2019; Caskey et al., 2017). Despite their advantages, screening for potent neutralizing mAbs from human memory B cells is often a slow and laborious process, which is not ideal when responding to a global health emergency. A rapid and efficient method for screening SARS-CoV-2 neutralizing mAbs is urgently needed.”

“Due to VDJ recombination and somatic hypermutation, B cells exhibit diverse B-cell repertoires, necessitating the analysis of one B cell at a time (Bassing et al., 2002). Techniques, such as single-cell clonal amplification of memory B cells, are usually utilized to obtain paired immunoglobulin heavy-light chain RNA sequences from the heterogeneous B cell population to produce mAbs (Debs et al., 2012; Niu et al., 2019). Clonal amplification of (Epstein-Barr virus) EBV-immortalised memory B cells from convalescent patients has proved successful in isolating neutralizing mAbs against viral infections such as HIV, Dengue, and MERS (Scheid et al., 2009; Burton et al., 2009; Corti et al., 2015). Yet, due to the time-consuming incubation and screening steps, the technique takes several months at least to complete a successful screen.”

“On the other hand, single-cell RT-PCR combined with fluorescence-activated cell sorting (FACS) or optofluidics platform, such as Beacon (Berkley Light), could obtain antibody sequences in several days by performing nested PCR on single antigen-binding memory B cells after single-cell sorting (Tiller et al., 2008; Wardemann et al., 2003; Wrammert et al., 2008; Liao et al., 2009). The method has led to efficient isolation of neutralizing mAbs in various infectious diseases, including HIV and MERS (Scheid et al., 2009; Wang et al., 2018). Nevertheless, the recent development of high-throughput single-cell RNA and VDJ sequencing of B-cell receptor repertoires using 10X Chromium has outperformed single-cell RT-PCR in terms of B cell screening throughput (Goldstein et al., 2019; Horns et al., 2020). The microfluidic-based technique could obtain auto-paired heavy- and light-chain sequences from tens of thousands single B cells in one run and has successfully been used for the isolation of human neutralizing mAbs against HIV (Setliff et al., 2019).”

“Here we report the rapid and efficient identification of SARS-CoV-2 neutralizing antibodies achieved by high-throughput single-cell RNA and VDJ sequencing of antigen-binding B cells from convalescent COVID-19 patients. Over 8,500 antigen-binding B cell clonotypes expressing IgG1 antibodies were identified from 60 convalescent patients. In total, we identified 14 potent neutralizing mAbs, among which the most potent mAb, BD-368-2, exhibited an IC50 of 1.2 ng/mL and 15 ng/mL against pseudotyped and authentic SARS-CoV-2. Additionally, in vivo experiments confirmed that BD-368-2 could provide strong therapeutic efficacy and prophylactic protection against SARS-CoV-2, using the hACE2 transgenic mice model (Bao et al., 2020; Yang et al., 2007; McCray et al., 2007).”

https://www.cell.com/cell/pdf/S0092-8674(20)30620-6.pdf?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867420306206%3Fshowall%3Dtrue

“Scientists in China believe new drug can stop pandemic without vaccine”, by AFP, Published on MSN.com on May 19, 2020

“A drug being tested by scientists at China’s prestigious Peking University could not only shorten the recovery time for those infected, but even offer short-term immunity from the virus, researchers say.” 

“Sunney Xie, director of the university’s Beijing Advanced Innovation Center for Genomics, told AFP that the drug has been successful at the animal testing stage.”

“When we injected neutralising antibodies into infected mice, after five days the viral load was reduced by a factor of 2,500,” said Xie.”

“That means this potential drug has (a) therapeutic effect.”

“The drug uses neutralising antibodies — produced by the human immune system to prevent the virus infecting cells — which Xie’s team isolated from the blood of 60 recovered patients.” 

“A study on the team’s research, published Sunday in the scientific journal Cell, suggests that using the antibodies provides a potential “cure” for the disease and shortens recovery time.”

“Our expertise is single-cell genomics rather than immunology or virology. When we realised that the single-cell genomic approach can effectively find the neutralising antibody we were thrilled.”

“He added that the drug should be ready for use later this year and in time for any potential winter outbreak of the virus, which has infected 4.8 million people around the world and killed more than 315,000.”

“Planning for the clinical trial is underway,” said Xie, adding it will be carried out in Australia and other countries since cases have dwindled in China, offering fewer human guinea pigs for testing.”

“- Prevention and cure –“

“Using antibodies in drug treatments is not a new approach, and it has been successful in treating several other viruses such as HIV, Ebola and Middle East Respiratory Syndrome (MERS). “

“The new drug could even offer short-term protection against the virus.  The study showed that if the neutralising antibody was injected before the mice were infected with the virus, the mice stayed free of infection and no virus was detected.  This may offer temporary protection for medical workers for a few weeks, which Xie said they are hoping to “extend to a few months.”

“More than 100 vaccines for COVID-19 are in the works globally, but as the process of vaccine development is more demanding, Xie is hoping that the new drug could be a faster and more efficient way to stop the global march of the coronavirus.”

“We would be able to stop the pandemic with an effective drug, even without a vaccine,” he said.”

https://www.msn.com/en-us/health/health-news/scientists-in-china-believe-new-drug-can-stop-pandemic-without-vaccine/ar-BB14hvD5?ocid=spartanntp

https://en.wikipedia.org/wiki/Xiaoliang_Sunney_Xie

http://www.sunneyxielab.org/en_xie/

https://www.rte.ie/news/coronavirus/2020/0519/1139228-cornavirus-drug-china/

https://www.hindustantimes.com/india-news/china-claims-this-drug-could-shorten-recovery-time-for-covid-19-patients/story-KSk7COCCmEG1X1OACSMEIL.html

https://www.france24.com/en/20200519-scientists-in-china-believe-new-drug-can-stop-pandemic-without-vaccine

https://phys.org/news/2020-05-team-effective-sars-cov-neutralizing-antibodies.html

https://en.prothomalo.com/lifestyle/health/new-china-drug-can-stop-pandemic-without-vaccine-peking-university-scientists

http://www.chinadaily.com.cn/a/202005/18/WS5ec24a17a310a8b241156880.html

Update: May 13, 2020

Today’s blog update was inspired by CNN’s “Fareed Zakaria’s GPS’ episode on May 10, 2020.  Specifically, Zakaria’s Weekly Take comments.  Two points he made in his conclusion that I feel worthy of paraphrasing here are: 1) Our dependency on Animal Factory Farming is a primary contributor to the spread of disease; and (2) climate change, and human encroachment on nature, has the potential to trigger dormant diseases in species, that heretofore were not virulent or deadly to the host species.  The commentary portion about the Saiga Antelope should be a wake-up call for all of us.  Zakaria’s Weekly Take comments were very similar to his May 7, 2020, Washington Post article titled “The real scandal isn’t what China did to us. It’s what we did to ourselves.”  Since that article had embedded weblinks I opted to use it here instead of the CNN Transcript (link provided below).  I also included excerpts today from a Scientific American Blog by Arthur Wyns, referenced in Zakaria’s article, that clarifies that COVID-19 is not directly impacted nor spawned by climate change.  However, Wyns states “Even though climate change did not cause the emergence of COVID-19, it could indirectly make the effects of a current or future pandemic worse. This is because it undermines the environmental conditions we need for good health—access to water, clean air, food and shelter—and places additional stress on health systems.”

“The real scandal isn’t what China did to us. It’s what we did to ourselves.”, By Fareed Zakaria, The Washington Post, Published May 7, 2020

“The Trump administration is trying to whip the country into an anti-Chinese frenzy because the novel coronavirus might have been accidentally transmitted from a laboratory rather than a wet market. But surely the larger question we should be asking is why we have been seeing viruses jump from animals to humans with such frequency in recent years. SARS, MERS, Ebola, bird flu and swine flu all started as viruses in animals and then jumped to humans, unleashing deadly outbreaks. Why?”Peter Daszak is a disease ecologist and renowned “virus hunter.” He ventures into bat caves in full protective gear to get the animals’ saliva or blood to determine the origins of a virus. During a conversation with me, he was clear: “We are doing things every day that make pandemics more likely. We need to understand, this is not just nature. It is what we are doing to nature.”  Remember, most viruses come from animals. The Centers for Disease Control and Prevention estimates that three-quarters of new human diseases originate in animals.”

“This coronavirus might simply have come from one of the wildlife markets in Wuhan, China, where live animals are slaughtered and sold, a practice that should be banned around the world. But as human civilization expands — building roads, clearing farmland, constructing factories, excavating mines — we are also destroying the natural habitat of wild animals, bringing them closer and closer to us. Some scientists believe this is making the transmission of diseases from animals to humans far more likely.”

“The virus that causes covid-19 appears to have originated in bats, which are particularly good incubators for viruses. Scientists are still studying what happened, but in other cases, we have seen how human encroachment can lead bats to look for food around farmland, where they infect livestock — and through them, humans.”

“There are other paths for pathogens. The most likely one comes directly from our insatiable appetite for meat. As people around the world get richer, they tend to eat more meat. Some 80 billion land animals are slaughtered for meat each year around the world. Most livestock is factory-farmed — an estimated 99 percent in the United States, and 74 percent around the world, according to one animal rights group. That entails crowding thousands of animals inches from each other in gruesome conditions that are almost designed to incubate viruses and encourage them to spread, getting more virulent with each hop. Vox’s Sigal Samuel quotes the biologist Rob Wallace: “Factory farms are the best way to select for the most dangerous pathogens possible.”

“Factory farms are also ground zero for new, antibiotic-resistant bacteria, which is another path toward widespread human infections. Factory-farmed animals are bombarded with antibiotics, which means the bacteria that survive and flourish are highly potent. Some 2.8 million Americans are sickened by antibiotic-resistant bacteria annually — of whom 35,000 die, according to the CDC.”

“And then there is climate change, which intensifies everything — transforming ecosystems, forcing more animals out of their habitats and bringing tropical conditions to places that were previously temperate. Scientific American reports, “The warmer, wetter and more variable conditions brought by climate change are . . . making it easier to transmit diseases such as malaria, dengue fever, chikungunya, yellow fever, Zika virus, West Nile virus and Lyme disease in many parts of the world.” As we change ecosystems and natural habitats, long-dormant diseases can emerge to which we have no immunity.”

“In May 2015, two-thirds of the world’s population of saigas, a small antelope, died suddenly within a few weeks. A bacterium called Pasteurella multocida, which had long lived in the animal without doing harm, suddenly turned virulent. Why? The Atlantic’s Ed Yong explains that the Central Asian region in which the saiga lives was becoming more tropical, and 2015 was a particularly warm, humid year. “When the temperature gets really hot, and the air gets really wet, saiga die. Climate is the trigger, Pasteurella is the bullet.”

“The real scandal is not what China did to us, but what we together are doing to the planet — and what only we together can stop.”

https://www.washingtonpost.com/opinions/global-opinions/the-real-scandal-isnt-what-china-did-to-us-its-what-we-did-to-ourselves/2020/05/07/70b4e0ea-9097-11ea-9e23-6914ee410a5f_story.html

“FAREED ZAKARIA GPS”  “The Post-COVID-19 World; The Future Of Cities; The Future Of Travel; The Future Of Education; The Future Of Daily Life; Fareed Zakaria’s Take On The Post-COVID-19 World. Aired 10-11a ET”

“THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.”

http://transcripts.cnn.com/TRANSCRIPTS/2005/10/fzgps.01.html

Climate Change and Infectious Diseases – It isn’t making COVID-19 worse than the pandemic otherwise would have been—but we can’t say the same for malaria, dengue and other illnesses”, By Arthur Wyns, Blogs-Scientific American, Published Apr 9, 2020

“Is there a link between climate change and COVID-19, and should we be worried about other infectious diseases?”

“We know climate change is having widespread impacts on our health, including by worsening illnesses ranging from seasonal allergies to heart and lung disease. But what do we know about how climate change affects infectious diseases? Here are some answers.”

“Do weather and climate influence the risk of COVID-19?”

“No.  At the moment there is no scientific evidence to believe that either weather or climate have a particularly strong influence on the transmission of the COVID-19 disease, since the new disease currently also spreads in hot and humid climates.”

“There is also no evidence that climate change made the emergence or transmission of COVID-19 more likely. Popular myths around COVID-19, such as that the novel coronavirus will be killed by hot or cold weather have also all been debunked.”

“COVID-19 is mainly transmitted directly from person to person through close contact, or through respiratory droplets produced when an infected person coughs, sneezes or exhales. People can catch the disease if they breathe in those droplets, or by touching objects or surfaces where infected droplets have landed, then touching their eyes, nose or mouth.”

“While temperature and humidity may influence how long the virus survives outside of the human body, this effect is likely to be many degrees smaller compared to the degree of contact between people. Washing hands and reducing physical contact are therefore essential to breaking the chain of transmission, in all locations, seasons and climates.”

“Will climate change make the effects of COVID-19 worse?”

“Even though climate change did not cause the emergence of COVID-19, it could indirectly make the effects of a current or future pandemic worse. This is because it undermines the environmental conditions we need for good health—access to water, clean air, food and shelter—and places additional stress on health systems.”

“For example, climate change is causing widespread drought and desertification in much of the world, threatening the availability of water for consumption, food production, personal hygiene, and medical care, including for infectious disease. In drought-prone areas, medical facilities with water shortages will be ill-equipped to deal with the outbreak. Similarly, COVID-19 outbreaks will cripple already weakened health systems in regions that have seen an increase in the frequency and severity of climate-induced extreme weather events, such as Haiti or Mozambique.”

“For health systems already weakened by climate-related health impacts, flattening the curve of infections to avoid overwhelming the healthcare system becomes much more challenging.”

“What about other infectious diseases?”

“We do know that infections that are transmitted through water, through food, or by vectors such as mosquitoes and ticks, are highly sensitive to weather and climate conditions. The warmer, wetter and more variable conditions brought by climate change are therefore making it easier to transmit diseases such as malaria, dengue fever, chikungunya, yellow fever, Zika virus, West Nile virus and Lyme disease in many parts of the world.

“The Lancet Countdown, a scientific collaboration between 35 institutions, found that the climate suitability for disease transmission has already increased for diseases including dengue, malaria and cholera.”

“As an example, a changing climate is aggravating the negative health impacts of malaria by broadening the range of the Anopheles mosquito, the vector that spreads it. It also lengthens the season in which mosquitos reproduce and transmit the disease, thereby increasing the number of people at risk. A similar escalation takes place for diseases such as dengue fever, chikungunya, yellow fever and Zika, which are spread by Aedes mosquitos.

Lyme disease, which is spread by ticks, is also increasing its range and seasonality in many parts of North America and Europe, while waterborne cholera and cryptosporidiosis are increasing with more frequent droughts and flooding.”

“What can the global response to COVID-19 teach us about our response to climate change?”

“Both climate change and COVID-19 are public health threats, although they are playing out across vastly different timescales. Both require early action to save lives, as well as adequate health systems that provide equitable access to the most vulnerable in society.  Just as with COVID-19, how well communities can cope with infectious diseases and other health impacts that are intensified by climate change ultimately depends on the underlying strength and resilience of the health system, whether it ensures protection for the most vulnerable in society, and the extent to which it protects the public from both short and long-term health threats.”

“ABOUT THE AUTHOR- Arthur Wyns”

“Arthur Wyns is a climate change advisor to the World Health Organization (WHO). He writes in a personal capacity; his views do not necessarily represent those of WHO or any of its member states.”

https://blogs.scientificamerican.com/observations/climate-change-and-infectious-diseases/

Update: May 6, 2020

Today’s blog update provides excerpts from recent news media articles detailing emerging concerns in the global health community about an ill-defined “multisystem inflammatory syndrome potentially associated with Covid-19.”, being seen, in relatively small numbers, in children under 18 years of age.  The syndrome or condition is causing symptoms similar or comparable to Kawasaki Disease, Toxic Shock Syndrome, gastro-intestinal distress and heart inflammation. The mystery syndrome was only loosely associated with COVID-19, as several of the child patients did not test-positive (diagnostic tests?) for the virus; however, some physicians have expressed concerns about the veracity of current COVID-19 diagnostic testing.  The news articles referenced here provide limited data from recent cases in NY, the UK, Italy and Spain.  One physician opined that the symptoms are possibly delayed inflammatory responses to COVID-19 manifesting in the children an estimated four weeks after infection.  Some of the children had no respiratory issues, and some required mechanical ventilation as part of their treatment therapy; none of the children died.  I found the last article referenced here today, The USA Today article by Adrianna Rodriguez, “The “boogeyman” of pediatrics: What is Kawasaki disease and is it linked to coronavirus?”, to be the most informative in the bunch and worth a read; specifically the quotes and comments from Dr. Sood and Dr. Esper. Dr. Sunil Sood, a pediatric infectious disease physician at Northwell Health’s Southside Hospital and Cohen Children’s Medical Center, doesn’t believe the condition is Kawasaki. Sood says patients he’s treated have been sicker, with inflammatory markers 10 to 100 times higher than average child with Kawasaki disease. Although the New York City Health Department only mentioned 15 cases in their alert, Sood says he’s had at least 20 cases between the two hospitals where he works. Only three of his cases tested positive for coronavirus with the regular PCR test, but the rest tested positive for coronavirus antibodies.  Dr. Sood also said “Initially, I thought it was Kawasaki … but it’s going beyond those symptoms,” he said. “Pediatricians and parents should be aware that there’s an outbreak of this right now.”  Note:  “children are still among the least affected group by the coronavirus. Data from more than 75,000 cases in China showed they comprised 2.4% of all confirmed cases and mostly suffered only mild symptoms.”

“15 Children Are Hospitalized With Mysterious Illness Possibly Tied to Covid-19”, By Joseph Goldstein, New York Times, Published May 5, 2020

Fifteen children, many of whom had the coronavirus, have recently been hospitalized in New York City with a mysterious syndrome that doctors do not yet fully understand but that has also been reported in several European countries, health officials announced on Monday night.”

Many of the children, ages 2 to 15, have shown symptoms associated with toxic shock or Kawasaki disease, a rare illness in children that involves inflammation of the blood vessels, including coronary arteries, the city’s health department said.”

“None of the New York City patients with the syndrome have died, according to a bulletin from the health department, which describes the illness as a “multisystem inflammatory syndrome potentially associated with Covid-19.””

“The syndrome has received growing attention in recent weeks as cases began appearing in European countries hit hard by the coronavirus.  “There are some recent rare descriptions of children in some European countries that have had this inflammatory syndrome, which is similar to the Kawasaki syndrome, but it seems to be very rare,” Dr. Maria Van Kerkhove, a World Health Organization scientist, said at a news briefing last week.”

https://www.nytimes.com

“At least 12 UK children have needed intensive care due to illness linked to Covid-19”, By Denis Campbell & Ian Sample, The Guardian, Published Apr 27, 2020

More than a dozen children have fallen ill with a new and potentially fatal combination of symptoms apparently linked to Covid-19, including a sore stomach and heart problems. The children affected appear to have been struck by a form of toxic shock syndrome. All have been left so seriously unwell that they have had to be treated in intensive care.”

At least one has received extra corporeal membrane oxygenation (ECMO) treatment, which is used when someone’s life is at risk because they can no longer breathe for themselvesNHS bosses are so concerned that they have written to doctors alerting them to the emergence of these cases and asked them to urgently refer any children with similar symptoms to hospital.”

Most of the children affected have Kawasaki disease, a rare vascular condition that is the main cause of acquired heart disease in under-18s in the UK. There are estimated to be 4.5 cases for every 100,000 children under the age of 18 in the UK. “These cases happen when someone with Kawasaki disease gets Covid-19 and that produces complications,” said one NHS source.”

“In a letter to GPs in north London, reported by the Health Service Journal , NHS bosses said: “It has been reported that over the last three weeks there has been an apparent rise in the number of children of all ages presenting with a multi-system inflammatory state requiring intensive care across London and also in other regions of the UK.”

“The cases have in common overlapping feature of toxic shock syndrome and atypical Kawasaki disease with blood parameters consistent with severe Covid-19 in children.

“There is a growing concern that a Sars-CoV-2-related inflammatory syndrome is emerging in children in the UK, or that there may be another, as yet unidentified, infectious pathogen associated with these cases.”

https://www.theguardian.com/world/2020/apr/27/nhs-warns-of-rise-in-children-with-new-illness-that-may-be-linked-to-coronavirus

“What is the new illness affecting children, and is it linked to coronavirus?”, By Ian Sample, The Guardian, Published Apr 27, 2020

“In recent weeks, a small number of children have been treated in ICU for a severe immune reaction”

NHS warns of rise in children with new illness that may be linked to coronavirus

“What does the medical alert say?”

“Doctors have picked up a slight rise in the number of children of all ages needing intensive care treatment for a condition called “multi-system inflammatory state”. The rise has happened over the past three weeks in London and elsewhere in the UK. The notice was first issued to GPs in North London and confirmed in an “urgent alert” on Sunday night from the Paediatric Intensive Care Society.”

Is it related to Covid-19?”

“That is the concern, but doctors don’t know. Hospitals have seen it in children who have tested positive and negative for the coronavirus, but test results are not 100% reliable. It may be a rare coronavirus-related inflammatory syndrome that has taken time to come to light, or it may be caused by another pathogen entirely. The NHS said it was important for clinicians to be aware of any emerging links so they can give children the right care quickly.”

What is a multi-system inflammatory state?”

“It’s a severe immune response that can affect the body in multiple ways, most importantly by making the blood vessels leaky, a condition called Kawasaki disease. This leads to low blood pressure and a build-up of fluid in the lungs and organs. It is extremely serious. Patients need urgent intensive care to support the heart, lungs and sometimes other organs such as the kidneys.”

“Are there other symptoms?”

“The children have overlapping symptoms of toxic shock syndrome (another extreme immune reaction) and unusual Kawasaki disease. But other symptoms have also been observed in children, including abdominal pain, gastrointestinal problems and heart inflammation. There is no evidence that the condition is caused by any change in the virus, as that would have shown up in adults first. But it may be a post-infection inflammatory response triggered by the coronavirus. This has been seen in adults, who tend to be more ill in the second phase of the infection, when the initial lung disease gives way to inflammatory damage.”

“Is it common?”

“No. There are only a dozen or so cases nationwide. The alert is intended to raise awareness of the symptoms among GPs and paediatricians so that cases are referred quickly, and so doctors can build up a better picture of what may be causing the illness. Despite the virus spreading around the world, scientists are still getting to grips with how it works. In adults, Covid-19 is an inflammatory disease that can affect different organs, but children have tended to have far milder infections.”

Has public advice changed?”

“No. The Royal College of Paediatrics and Child Health said parents should be reassured that children are unlikely to be seriously ill with Covid-19. The NHS urged parents who are worried about a child to contact NHS 111 or their family doctor for urgent advice, or call 999 in an emergency.”

https://www.theguardian.com/society/2020/apr/27/what-is-the-new-illness-affecting-children-and-is-it-linked-to-coronavirus

“The “boogeyman” of pediatrics: What is Kawasaki disease and is it linked to coronavirus?” By Adrianna Rodriguez, USA Today, published May 5, 2020

“Symptoms of a rare inflammatory condition have been identified in at least 15 children in New York City hospitals, alarming pediatricians across the country and raising concerns about a possible link to the coronavirus.”

“The children were between 2 and 15 years old and were identified between April 29 and May 3. While all the patients had a fever, more than half of them reported a rash, abdominal pain, vomiting or diarrhea.”

“In an alert issued to doctors, the NYC health department said less than half of the patients exhibited respiratory symptoms. Four of the cases tested positive for COVID-19, while 11 tested negative.”

“No deaths have been reported, but many of the patients required blood pressure support and five of them required mechanical ventilation, the city’s health department said.”

“Both Kawasaki disease and COVID-19 are illusive conditions that doctors are still studying. Some experts doubt there’s a link between the two while others don’t believe the mysterious symptoms belong to Kawasaki at all.”

“What is Kawasaki disease?”

“Kawasaki disease is one of the great mysteries in pediatrics,” said Dr. Frank Esper, a physician at the Cleveland Clinic Children’s Center for Pediatric Infectious Diseases. “It’s something we’ve been dealing with for decades.”

“Symptoms include a fever of at least 101 degrees that lasts for five days or more, a rash and swollen glands in the neck, according to Britain’s National Health Service. Esper says that it predominately affects children between the ages of 2 and 6, tends to run during “mini-epidemics,” and is more likely to happen in the winter than the summer.”

“While doctors know how to treat Kawasaki disease, they still don’t know what causes it or why some people get it. Esper says “a cemetery of different reports” have hypothesized the disease is caused by viruses while others say people may be genetically predisposed.  “Kawasaki disease is the boogeyman to pediatricians,” he said. “It’s extremely difficult to diagnose. Even with the most astute clinicians, we have a hard time figuring out who has it and who doesn’t.””

“Esper says the main indicator of the disease can be found in the heart. Coronary artery aneurysm, or a dilation of the coronary arteries, is what distinguishes Kawasaki from any other inflammatory disease.”

“First cases with COVID-19 concern appeared in Europe”

“The condition was first reported by doctors in Britain, Italy and Spain in late April. Britain’s Paediatric Intensive Care Society issued an alert noting there had been an increase in the number of children with “a multi-system inflammatory state requiring intensive care” across the country.”

“The group said there was “growing concern” that either a COVID-19 related syndrome was emerging in children or that a different, unidentified disease might be responsible.”

“Spain’s Association of Pediatrics recently made a similar warning, telling doctors that in recent weeks, there had been a number of school-age children suffering from “an unusual picture of abdominal pain, accompanied by gastrointestinal symptoms” that could lead within hours to shock, low blood pressure and heart problems.”

“In Italy, Dr. Angelo Ravelli of Gaslini Hospital and a member of the Italian Paediatricians’ Society, sent a note to 10,000 colleagues raising his concerns. He and his team reported an unusual increase in the number of patients with Kawasaki disease in regions of Italy hit hard by the pandemic, noting some children had COVID-19 or had contacts with confirmed virus cases.”

“Some possible cases have also been reported in France and Belgium.”

Is Kawasaki disease related to the coronavirus? 

Experts say it’s too early to tell if the disease can be associated with COVID-19. 

“We’ve never seen the coronavirus before but we’ve been dealing with Kawasaki disease for decades,” Esper said.

He also said that experts aren’t even sure if the mystery disease popping up in parts of Europe and the U.S. can be definitively identified as Kawasaki disease. So far, he hasn’t seen any the reports mention coronary artery dilation, which would be a major indication. 

“I will caution that there are many things that look similar to Kawasaki disease,” Esper said. “It could be that what they’re calling Kawasaki is not Kawasaki but an inflammatory disease caused by the coronavirus.” 

Dr. Sunil Sood, a pediatric infectious disease physician at Northwell Health’s Southside Hospital and Cohen Children’s Medical Center, doesn’t believe the condition is Kawasaki. 

Sood says patients he’s treated have been sicker, with inflammatory markers 10 to 100 times higher than average child with Kawasaki disease. 

Although the New York City Health Department only mentioned 15 cases in their alert, Sood says he’s had at least 20 cases between the two hospitals where he works. Only three of his cases tested positive for coronavirus with the regular PCR test, but the rest tested positive for coronavirus antibodies. 

He estimates his patients may have had the virus, even unknowingly, four weeks before developing the inflammatory condition. 

“The immune system can overreact in a delayed timeline many weeks later,” Sood said. “We know this from other infectious diseases.”

He advises parents and pediatricians to look out for a fever as well as a combination of any of these symptoms: Abdominal pain, confusion, diarrhea, red eyes, rash, swollen hands and feet, difficulty breathing and passing out. Sometimes the abdominal pain can be so severe that it mimics appendicitis. 

“Sood urges parents to bring their children to the hospital if they develop any symptoms because it could lead to further heart complications, even acute heart failure.

“Initially, I thought it was Kawasaki … but it’s going beyond those symptoms,” he said. “Pediatricians and parents should be aware that there’s an outbreak of this right now.””

“While there’s a spike in these cases, Sood says that children are still among the least affected group by the coronavirus. Data from more than 75,000 cases in China showed they comprised 2.4% of all confirmed cases and mostly suffered only mild symptoms.”

https://www.usatoday.com/story/news/health/2020/05/05/what-kawasaki-disease-linked-coronavirus/3083545001/

https://www.mayoclinic.org/diseases-conditions/kawasaki-disease/symptoms-causes/syc-20354598

Update: Apr 12, 2020

In today’s blog update I’m providing select excerpts from a recent Chinese scientific study on the ability of COVID-19 to replicate within and transmit from domestic animals with known close relationships to humans… such as cats, dogs, ferrets, pigs, chickens and ducks. The study, which has not yet been peer-reviewed, “found that SARS-CoV-2 replicates poorly in dogs, but efficiently in ferrets and cats. We found that the virus transmits in cats via respiratory droplets.” “Results indicate(d) that pigs, chickens, and ducks are not susceptible to SARS-CoV-2.”  Note: The study only tested to see if COVID-19 could transmit within the referenced species; it did not apparently test for cross-species transmission. The weblink to the full article is listed at the end of today’s post.   

“Susceptibility of ferrets, cats, dogs, and different domestic animals to SARS-coronavirus-2” – By: Jianzhong Shi, Zhiyuan Wen, Gongxun Zhong, Huanliang Yang, Chong Wang, Renqiang Liu, Xijun He, Lei Shuai, Ziruo Sun, Yubo Zhao, Libin Liang, Pengfei Cui, Jinliang Wang, Xianfeng Zhang, Yuntao Guan, Hualan Chen, Zhigao Bu; Posted Mar 31, 2020

doi: https://doi.org/10.1101/2020.03.30.015347  BioRxiv.org

“BioRxiv is receiving many new papers on coronavirus SARS-CoV-2.   A reminder: these are preliminary reports that have not been peer-reviewed. They should not be regarded as conclusive, guide clinical practice/health-related behavior, or be reported in news media as established information.”

“Abstract:  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the infectious disease COVID-19, which was first reported in Wuhan, China in December, 2019. Despite the tremendous efforts to control the disease, COVID-19 has now spread to over 100 countries and caused a global pandemic. SARS-CoV-2 is thought to have originated in bats; however, the intermediate animal sources of the virus are completely unknown. Here, we investigated the susceptibility of ferrets and animals in close contact with humans to SARS-CoV-2. We found that SARS-CoV-2 replicates poorly in dogs, pigs, chickens, and ducks, but efficiently in ferrets and cats. We found that the virus transmits in cats via respiratory droplets. Our study provides important insights into the animal reservoirs of SARS-CoV-2 and animal management for COVID-19 control.” (I would hazard a guess that stray cats are quickly disappearing – being collected, tested and exterminated – all over China!)

“Although SARS-CoV-2 shares 96.2% identity at the nucleotide level with the coronavirus RaTG13, which was detected in horseshoe bats (Rhinolophus spp) in Yunnan province in 2013 (3), it has not previously been detected in humans or other animals. The emerging situation raises many urgent questions. Could the widely disseminated viruses transmit to other animal species, which then become reservoirs of infection? The SARS-CoV-2 infection has a wide clinical spectrum in humans, from mild infection to death, but how does the virus behave in other animals? As efforts are made for vaccine and antiviral drug development, which animal(s) can be used most precisely to model the efficacy of such control measures in humans? To address these questions, we evaluated the susceptibility of different model laboratory animals, as well as companion and domestic animals to SARS-CoV-2.”

All experiments with infectious SARS-CoV-2 were performed in the biosafety level 4 and animal biosafety level 4 facilities in the Harbin Veterinary Research Institute (HVRI) of the Chinese Academy of Agricultural Sciences (CAAS), which was approved for such use by the Ministry of Agriculture and Rural Affairs of China. Details of the biosafety and biosecurity measures taken are provided in the supplementary materials (19). The protocols for animal study and animal welfare were reviewed and approved by the Committee on the Ethics of Animal Experiments of the HVRI of CAAS.”

“Ferrets are commonly used as an animal model for respiratory viruses that infected humans (2026). We therefore tested the susceptibility of SARS-CoV-2 in ferrets. Two viruses [SARS-CoV-2/F13/environment/2020/Wuhan, isolated from an environmental sample collected in the Huanan Seafood Market in Wuhan (F13-E), and SARS-CoV-2/CTan/human/2020/Wuhan (CTan-H), isolated from a human patient] were used in this study. Pairs of ferrets were inoculated intranasally with 105 pfu of F13-E or CTan-H, respectively, and euthanized on day 4 post-inoculation (p.i.). The nasal turbinate, soft palate, tonsils, trachea, lung, heart, spleen, kidneys, pancreas, small intestine, brain, and liver from each ferret were collected for viral RNA quantification by qPCR and virus titration in Vero E6 cells. Viral RNA (Fig. 1A, B) and infectious virus were detected in the nasal turbinate, soft palate, and tonsils of all four ferrets inoculated with these two viruses, but was not detected in any other organs tested (Fig. 1C, D). These results indicate that SARS-CoV-2 can replicate in the upper respiratory tract of ferrets, but its replication in other organs is undetectable.”

“To further investigate whether SARS-CoV-2 replicates in the lungs of ferrets, we intratracheally inoculated eight ferrets with 105 pfu of CTan-H, and euthanized two animals each on days 2, 4, 8, and 14 p.i. to look for viral RNA in the tissues and organs. Viral RNA was only detected in the nasal turbinate and soft palate of one of the two ferrets that were euthanized on days 2 and 4 p.i.; in the soft palate of one ferret and in the nasal turbinate, soft palate, tonsil, and trachea of the other ferret that were euthanized on day 8 p.i.; and was not detected in either of the two ferrets that were euthanized on day 14 p.i. (fig. S4). These results indicate that SARS-CoV-2 can replicate in the upper respiratory tract of ferrets for up to eight days, without causing severe disease or death.”

Cats and dogs are in close contact with humans, and therefore it is important to understand their susceptibility to SARS-CoV-2 for COVID-19 control. We first investigated the replication of SARS-CoV-2 in cats. Five 8-month-old outbred domestic cats (referred to here as “subadult cats”) were intranasally inoculated with 105 pfu of CTan-H. Two of the subadult cats were scheduled to be euthanized on day 6 p.i. to evaluate viral replication in their organs. Three subadult cats were placed in separate cages within an isolator. To monitor respiratory droplet transmission, an uninfected cat was placed in a cage adjacent to each of the infected cats. It was difficult to perform regular nasal wash collection on the subadult cats because they were aggressive. To avoid possible injury, we only collected feces from these cats and checked for viral RNA in their organs after euthanasia.

From the two subadult cats that were euthanized on day 6 p.i. with CTan-H, viral RNA was detected in the nasal turbinates, soft palates, and tonsils of both animals, in the trachea of one animal, and in the small intestine of the other; however, viral RNA was not detected in any of the lung samples from either of these animals (Fig. 2A). Infectious virus was detected in the viral RNA-positive nasal turbinates, soft palates, tonsils, and trachea of these cats, but was not recovered from the viral RNA-positive small intestine (Fig. 2B).”

In the transmission study, viral RNA was detected in the feces of two virus-inoculated subadult cats on day 3 p.i., and in all three virus-inoculated subadult cats on day 5 p.i. (Fig. 3A). Viral RNA was detected in the feces of one exposed cat on day 3 p.i. (Fig. 3A). The subadult cats with viral RNA-positive feces were euthanized on day 11 p.i., and viral RNA was detected in the soft palate and tonsils of the virus-inoculated animal and in the nasal turbinate, soft palate, tonsils, and trachea of the exposed animal (Fig. 3B), indicating that respiratory droplet transmission had occurred in this pair of cats. We euthanized the other pairs of animals on day 12 p.i., and viral RNA was detected in the tonsils of one virus-inoculated subadult cat, in the nasal turbinate, soft palate, tonsils, and trachea of the other virus-inoculated subadult cat, but was not detected in any organs or tissues of the two exposed subadult cats (Fig. 3B). Antibodies against SARS-CoV-2 were detected in all three virus-inoculated subadult cats and one exposed cat by use of an ELISA and neutralization assay (Fig. 3C, D).”

“We replicated the replication and transmission studies in juvenile cats (aged 70–100 days) (Fig. 2C-F and Fig. 3E-G). Histopathologic studies performed on samples from the virus-inoculated juvenile cats that died or euthanized on day 3 p.i. revealed massive lesions in the nasal and tracheal mucosa epitheliums, and lungs of both cats (fig. S5). These results indicate that SARS-CoV-2 can replicate efficiently in cats, with younger cats being more permissive and, perhaps more importantly, the virus can transmit between cats via respiratory droplets.”

We next investigated the replication and transmission of SARS-CoV-2 in dogs. Five 3-month-old beagles were intranasally inoculated with 105 pfu of CTan-H, and housed with two uninoculated beagles in a room. Oropharyngeal and rectal swabs from each beagle were collected on days 2, 4, 6, 8, 10, 12, and 14 p.i., for viral RNA detection and virus titration in Vero E6 cells. Viral RNA was detected in the rectal swabs of two virus-inoculated dogs on day 2 p.i., and in the rectal swab of one dog on day 6 p.i. (Table 1). One dog that was viral RNA positive by its rectal swab on day 2 p.i. was euthanized on day 4 p.i., but viral RNA was not detected in any organs or tissues collected from this dog (fig. S6). Infectious virus was not detected in any swabs collected from these dogs. Sera were collected from all of the dogs on day 14 p.i. for antibody detection by use of an ELISA. Two virus-inoculated dogs seroconverted; the other two virus-inoculated dogs and the two contact dogs were all seronegative for SARS-CoV-2 according to the ELISA (Table 1, fig S7). These results indicate that dogs have low susceptibility to SARS-CoV-2”

We also investigated the susceptibility of pigs, chickens, and ducks to SARS-CoV-2 by using the same strategy as that used to assess dogs; however, viral RNA was not detected in any swabs collected from these virus-inoculated animals or from naïve contact animals (Table 1), and all of the animals were seronegative for SARS-CoV-2 when tested by using the ELISA with sera collected on day 14 p.i. (Table 1). These results indicate that pigs, chickens, and ducks are not susceptible to SARS-CoV-2.”

https://www.biorxiv.org/content/10.1101/2020.03.30.015347v1.full

Update: Apr 10, 2020

Today’s blog update provides select excerpts from an informative article on MSN.com about requesting forbearance (a pause) on your mortgage payments if you’ve found yourself unemployed and unable to make your monthly mortgage payments due to the Novel Coronavirus outbreak.  The article was packed full of valuable info; hence, why I included probably half of the article in today’s blog. Note: Interest on your loan balance will likely still accrue during the pause, even if you’re approved for forbearance.  The article is US-centric, but global readers can still gain valuable insight from review of the article (blog) and subsequently seek to identify their own nation’s specific guidance for possibly applying for mortgage forbearance due to COVID-19.

“Are you a homeowner seeking forbearance on your mortgage? Watch out for these red flags” – By Jacob Passy, MSN.com, Published Apr 10, 2020

The CARES Act stimulus package requires servicers to provide forbearance — a temporary postponement of payments — to any homeowner with a federally-backed mortgage. Americans with other mortgages may also be able to receive forbearance at their servicers’ discretion.”

Forbearance is not forgiveness,” said Karan Kaul, a research associate at the Urban Institute, a left-of-center nonprofit policy group. “You still owe the money that you were paying, it’s just that there’s a temporary pause on making your monthly payments.”

“Under a forbearance agreement, a borrower can pause payments entirely or make reduced payments on their mortgage. Homeowners with federally-backed mortgages are eligible for up to 180 days of forbearance initially under the CARES Act. At that point, if they’re still facing financial difficulty, they can request an extension of up to another 180 days of forbearance.”

The provisions in the stimulus package stipulate that during the forbearance period, mortgage servicers cannot make negative reports about the borrower in question to credit bureaus, including the three main ones, Experian (EXPGY) , Equifax (EFX)  and TransUnion (TRU) . Borrowers also will not owe any late fees or penalties if they are granted forbearance.”

“You need to know who your servicer is. Struggling homeowners won’t automatically receive forbearance. You need to request it from your servicer.”

“Mortgage servicers are the companies who receive your monthly payments. A homeowner’s mortgage servicer isn’t necessarily the same as their lender — many lenders sell the servicing rights for mortgages to other companies.

“The first step to figure out who your servicer is would be to check your mortgage statement. If for some reason the information isn’t there, you can look it up by searching the Mortgage Electronic Registration Systems website. Alternatively, you can check with Fannie Mae and Freddie Mac, if your loan is backed by one of them.”

“How do you know if you qualify? To qualify for forbearance, a borrower must have a mortgage backed by one of the following federal agencies:  Fannie Mae; Freddie Mac; The Federal Housing Administration (FHA); The U.S. Department of Veterans Affairs (VA); The U.S. Department of Agriculture (USDA)

“Borrowers should avoid calling their servicers to find out if they’re eligible, Sharga said.  “Find out what you can before you try and reach your mortgage servicer, because they are overwhelmed with call volume right now,” Sharga said.”

Fannie Mae (FNMA) and Freddie Mac (FMCC) both have websites where you can check whether your loan is backed by one of them. You can access those websites here and here. Almost half of all mortgages in the U.S. are backed by Fannie and Freddie.”

“To find out if your loan is backed by the FHA, check the original closing documents or your most recent mortgage statement. If you pay for FHA Insurance, then that agency is backing your loan. Alternatively, your closing documents should include a HUD (Department of Housing and Urban Development) statement and a 13-digit HUD number.”

“Because the VA and USDA loan programs target specific borrowers, those borrowers should already know if they have loans backed by those agencies. In the event you are still unsure, you can call your servicer.”

“Those who aren’t eligible aren’t necessarily out of luck, though. Servicers for non-federally-backed mortgages may still be willing to provide forbearance to borrowers facing financial trouble right now.”

Be prepared to answer some questions.  You don’t need to provide documentation to prove your financial hardship at this time, but your servicer may have some questions to determine how much assistance they will offer you.”

“The Consumer Financial Protection Bureau suggests being prepared to answer the following:”

• “Why you can’t make your payments?”

• “Is the problem you are facing temporary or permanent?”

• “What is the current state of your income, expenses and other assets, including money in the bank?”

• “Are you a service member with permanent change of station orders?”

Consumers should indicate they have had a hardship due to COVID-19 and ask about their forbearance options with the company servicing the mortgage loan,” said Chris Diamond, director of financial products at online mortgage lender Better.com. “They should ask how long of a forbearance they can qualify for as well as what their options are at the end of that forbearance period.”

Get your forbearance agreement in writing.  The CFPB stresses that any borrower who has received a reprieve on mortgage payments should get their agreement in writing.  Having the agreement in writing will protect you if there are errors in your mortgage statement or your credit report.”

Watch out for balloon payments.  After a borrower has secured a forbearance agreement from their servicer, they should discuss repayment options.

“You don’t want a surprise like finding out that six months of deferred loan payments are all due immediately upon the end of the forbearance,” Sharga said. “Most people simply won’t have six months’ worth of mortgage payments available.”

“While a lender may offer a balloon payment as an option, there is no mandate that a borrower must repay in this manner, Kaul said.”

A borrower may also be offered the option to amortize the balance they owe over the life of the loan. This means they would repay a portion of the balance owed in addition to their usual monthly payments.”

If you’re still in financial trouble after forbearance, consider a loan modification

It’s too soon to tell whether 12 months of forbearance will be enough assistance for those who are among the millions of Americans who have lost their jobs in recent weeks.”

“Unlike forbearance, a loan modification involves a permanent change to the details of the mortgage. This can include adjusting the interest rate, extending the duration of the loan or deferring the amount owed until the end of the loan as a separate lien.  A servicer will determine whether or not a borrower qualifies for the modification.”

https://www.msn.com/en-us/money/realestate/are-you-a-homeowner-seeking-forbearance-on-your-mortgage-watch-out-for-these-red-flags/ar-BB12qwzn?ocid=spartandhp

https://www.consumerfinance.gov/coronavirus/cares-act-mortgage-forbearance-what-you-need-know/

https://www.congress.gov/bill/116th-congress/senate-bill/3548

https://en.wikipedia.org/wiki/Coronavirus_Aid,_Relief,_and_Economic_Security_Act

Update: Apr 9, 2020

Today’s blog update provides select excerpts from a MarketWatch.com article advising that several US-based auto insurance companies are now offering premium discounts and/or credits due to the fact many of us are driving significantly less in compliance with stay-at-home or shelter-in-place directives to flatten the curve of the current virus outbreak. I was pleasantly surprised by this article, as my own auto insurer, one of the insurers referenced below, had not personally emailed or mailed me info about the listed insurance premium discounts.

“Some auto insurers are giving refunds because of the coronavirus outbeak — here’s how you can get a break too” – By Andrew Keshner, Published Apr 9, 2020, MarketWatch.com

“Allstate, Geico and Liberty Mutual are giving refunds to drivers. State Farm says it’s closely monitoring the situation”

“As some auto insurance companies start giving refunds and credits to commuters stuck at home during the coronavirus outbreak, there’s an easy way drivers with other carriers can catch the same break — just pick up the phone and ask.”

“Insurers including Allstate and Liberty Mutual are issuing 15% refunds on premiums, according to announcements earlier this week. Berkshire Hathaway Inc.’s Geico insurance said Tuesday it will give a 15% credit as policies come up for renewal between now and October, and American Family Insurance is issuing a onetime $50 refund per covered vehicle.“

“Farmers Insurance and its subsidiary, 21st Century Insurance, is giving drivers a 25% reduction in April premiums, the company said Wednesday. The same day, USAA, a bank and insurer geared towards military members and their families, announced a 20% credit for auto policy holders on two months of premiums.”

“That makes it an opportune time for drivers with policies elsewhere to see what their car insurance company can do for them, according to one consumer advocate.“

“You’ve got that leverage,” said Robert Hunter, director of insurance at the Consumer Federation of America. “They (insurance companies) want to hold onto their customers, they’ve got to treat them right.”

“A driver will pay an average $1,427 on car insurance during 2020, according to the personal finance website Nerdwallet.”

“State Farm, the largest car insurance company in the U.S., hasn’t announced any refunds, but will make a decision about what its policy will be, a spokeswoman said.”

“Other insurance companies including MetLife, Progressive Insurance and The General did not immediately respond to requests for comment.” (Note: Progressive Insurance is also now offering a premium credit – see below)

https://www.marketwatch.com/story/some-auto-insurers-are-giving-refunds-because-of-the-coronavirus-outbeak-heres-how-you-can-get-a-break-too-2020-04-09?mod=MW_article_top_stories

Progressive.com

A note about COVID-19

“Personal auto premium credit”

“Many of you are staying home to minimize exposure and spread of COVID-19. While you’re doing your part to fight the pandemic, we’re committed to being there in your time of need.”

“If you have an active personal auto policy at the end of April, you’ll receive a credit for 20% of your April premium. We’ll offer the same 20% credit to active personal auto customers at the end of May, and we may offer additional credits in the upcoming months.”

“There’s nothing you need to do. We’ll automatically calculate your credit at the end of each month, and then you’ll see it reflected in your account within a few weeks. If you have a balance on your policy, we’ll apply the credit directly to your remaining balance. And if you’re already paid in full, we’ll return the money to the payment account we have on file—so please make sure your payment details are up to date.”

“This credit is subject to approval by state regulators.”

https://www.progressive.com/support/covid19/

Update: Apr 8, 2020

Today’s blog update provides select excerpts from a ScienceDirect article detailing an Australian study on the potential value of Ivermectin, an FDA approved anti-parasitic, as an in vitro antiviral against SARS-CoV-2.  Additional clinical testing will be needed to see if it will also have inhibitive value against SARS-CoV-2 in vivo (in humans). It sounds very promising!

Wikipedia:

 Studies that are in vivo (Latin for “within the living”; often not italicized in English[1][2][3]) are those in which the effects of various biological entities are tested on whole, living organisms or cells, usually animals, including humans, and plants, as opposed to a tissue extract or dead organism. This is not to be confused with experiments done in vitro (“within the glass”), i.e., in a laboratory environment using test tubes, Petri dishes, etc. Examples of investigations in vivo include: the pathogenesis of disease by comparing the effects of bacterial infection with the effects of purified bacterial toxins; the development of non-antibiotics, antiviral drugs, and new drugs generally; and new surgical procedures.”

https://en.wikipedia.org/wiki/In_vivo

** Don’t take any drug without first consulting your physician!!!

The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro – Published Apr 3, 2020, Sciencedirect.com – Authors: LeonCaly1Julian D.Druce1Mike G.Catton1David A.Jans2Kylie M.Wagstaff2

  1. Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, At the Peter Doherty Institute for Infection and Immunity, Victoria, 3000, Australia
  2. Biomedicine Discovery Institute, Monash University, Clayton, Vic, 3800, Australia

Received 18 March 2020, Revised 27 March 2020, Accepted 29 March 2020, Available online 3 April 2020.

https://doi.org/10.1016/j.antiviral.2020.104787

“Abstract:”

“Although several clinical trials are now underway to test possible therapies, the worldwide response to the COVID-19 outbreak has been largely limited to monitoring/containment. We report here that Ivermectin, an FDA-approved anti-parasitic previously shown to have broad-spectrum anti-viral activity in vitro, is an inhibitor of the causative virus (SARS-CoV-2), with a single addition to Vero-hSLAM cells 2 hours post infection with SARS-CoV-2 able to effect 5000-fold reduction in viral RNA at 48 h. Ivermectin therefore warrants further investigation for possible benefits in humans.’”

“Ivermectin is an FDA-approved broad spectrum anti-parasitic agent1 that in recent years we, along with other groups, have shown to have anti-viral activity against a broad range of viruses2, 3, 4, 5 in vitro. Originally identified as an inhibitor of interaction between the human immunodeficiency virus-1 (HIV-1) integrase protein (IN) and the importin (IMP) α/β1 heterodimer responsible for IN nuclear import6, Ivermectin has since been confirmed to inhibit IN nuclear import and HIV-1 replication5. Other actions of ivermectin have been reported7, but ivermectin has been shown to inhibit nuclear import of host (eg.8,9) and viral proteins, including simian virus SV40 large tumour antigen (T-ag) and dengue virus (DENV) non-structural protein 55, 6. Importantly, it has been demonstrated to limit infection by RNA viruses such as DENV 1-44, West Nile Virus10, Venezuelan equine encephalitis virus (VEEV)3 and influenza2, with this broad spectrum activity believed to be due to the reliance by many different RNA viruses on IMPα/β1 during infection11,12. Ivermectin has similarly been shown to be effective against the DNA virus pseudorabies virus (PRV) both in vitro and in vivo, with ivermectin treatment shown to increase survival in PRV-infected mice13. Efficacy was not observed for ivermectin against Zika virus (ZIKV) in mice, but the authors acknowledged that study limitations justified re-evaluation of ivermectin’s anti-ZIKV activity14. Finally, ivermectin was the focus of a phase III clinical trial in Thailand in 2014-2017, against DENV infection, in which a single daily oral dose was observed to be safe and resulted in a significant reduction in serum levels of viral NS1 protein, but no change in viremia or clinical benefit was observed (see below)15.”

“The causative agent of the current COVID-19 pandemic, SARS-CoV-2, is a single stranded positive sense RNA virus that is closely related to severe acute respiratory syndrome coronavirus (SARS-CoV). Studies on SARS-CoV proteins have revealed a potential role for IMPα/β1 during infection in signal-dependent nucleocytoplasmic shutting of the SARS-CoV Nucleocapsid protein16, 17, 18, that may impact host cell division19,20. In addition, the SARS-CoV accessory protein ORF6 has been shown to antagonize the antiviral activity of the STAT1 transcription factor by sequestering IMPα/β1 on the rough ER/Golgi membrane21. Taken together, these reports suggested that ivermectin’s nuclear transport inhibitory activity may be effective against SARS-CoV-2.”

“To test the antiviral activity of ivermectin towards SARS-CoV-2, we infected Vero/hSLAM cells with SARS-CoV-2 isolate Australia/VIC01/2020 at an MOI of 0.1 for 2 h, followed by the addition of 5 μM ivermectin. Supernatant and cell pellets were harvested at days 0-3 and analysed by RT-PCR for the replication of SARS-CoV-2 RNA (Fig. 1A/B). At 24 h, there was a 93% reduction in viral RNA present in the supernatant (indicative of released virions) of samples treated with ivermectin compared to the vehicle DMSO. Similarly a 99.8% reduction in cell-associated viral RNA (indicative of unreleased and unpackaged virions) was observed with ivermectin treatment. By 48h this effect increased to an 5000-fold reduction of viral RNA in ivermectin-treated compared to control samples, indicating that ivermectin treatment resulted in the effective loss of essentially all viral material by 48 h. Consistent with this idea, no further reduction in viral RNA was observed at 72 h. As we have observed previously3, 4, 5, no toxicity of ivermectin was observed at any of the timepoints tested, in either the sample wells or in parallel tested drug alone samples.”

Taken together these results demonstrate that ivermectin has antiviral action against the SARS-CoV-2 clinical isolate in vitro, with a single dose able to control viral replication within 24-48 h in our system. We hypothesise that this is likely through inhibiting IMPα/β1-mediated nuclear import of viral proteins (Fig. 1G), as shown for other RNA viruses4,5,10; confirmation of this mechanism in the case of SARS-CoV-2, and identification of the specific SARS-CoV-2 and/or host component(s) impacted (see10) is an important focus future work in this laboratory. Ultimately, development of an effective anti-viral for SARS-CoV-2, if given to patients early in infection, could help to limit the viral load, prevent severe disease progression and limit person-person transmission. Benchmarking testing of ivermectin against other potential antivirals for SARS-CoV-2 with alternative mechanisms of action22, 23, 24, 25, 26 would thus be important as soon as practicable. This Brief Report raises the possibility that ivermectin could be a useful antiviral to limit SARS-CoV-2, in similar fashion to those already reported22, 23, 24, 25, 26; until one of these is proven to be beneficial in a clinical setting, all should be pursued as rapidly as possible.”

Ivermectin has an established safety profile for human use1,12,27, and is FDA-approved for a number of parasitic infections1,27. Importantly, recent reviews and meta-analysis indicate that high dose ivermectin has comparable safety as the standard low-dose treatment, although there is not enough evidence to make conclusions about the safety profile in pregnancy28,29. The critical next step in further evaluation for possible benefit in COVID-19 patients will be to examine a multiple addition dosing regimen that mimics the current approved usage of ivermectin in humans. As noted, ivermectin was the focus of a recent phase III clinical trial in dengue patients in Thailand, in which a single daily dose was found to be safe but did not produce any clinical benefit. However, the investigators noted that an improved dosing regimen might be developed, based on pharmacokinetic data15. Although DENV is clearly very different to SARS-CoV-2, this trial design should inform future work going forward. Altogether the current report, combined with a known-safety profile, demonstrates that ivermectin is worthy of further consideration as a possible SARS-CoV-2 antiviral.”

Partial Reference List:

22          L. Dong, S. Hu, J. Gao Discovering drugs to treat coronavirus disease 2019 (COVID-19)

Drug Discov Ther, 14 (1) (2020), pp. 58-60

CrossRefView Record in Scopus Google Scholar

23          A.A. Elfiky Anti-HCV, nucleotide inhibitors, repurposing against COVID-19

Life Sci, 248 (2020), p. 117477

ArticleDownload PDF Google Scholar

24          C.J. Gordon, et al. The antiviral compound remdesivir potently inhibits RNA-dependent RNA polymerase from Middle East respiratory syndrome coronavirus

J Biol Chem (2020) Google Scholar

25          G. Li, E. De Clercq Therapeutic options for the 2019 novel coronavirus (2019-nCoV)

Nat Rev Drug Discov, 19 (3) (2020), pp. 149-150

CrossRefView Record in Scopus Google Scholar

26          M. Wang, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro

Cell Res, 30 (3) (2020), pp. 269-271

CrossRefView Record in Scopus Google Scholar

https://www.sciencedirect.com/science/article/pii/S0166354220302011?via%3Dihub

Update: Apr 7, 2020

Today’s blog update is about Horseshoe Bats, specifically bats in the Rhinolophus genus. Scientific evidence suggests that SAR-CoV-2 may have originated from this genus of bats, who in-turn transmitted the virus to another currently undetermined animal species, that in-turn transmitted the virus to its most suited host: us, humans. These bats probably transmitted the virus to other animals by A) being eaten by another animal or more likely by B) defecating (pooping) on food, such as grass, plants or fruit, that was subsequently consumed by another animal. The WHO has recently issued some guidance advising caution for those that frequent or work in animal wet markets and slaughter-houses. A quick search of Wikipedia revealed that Horseshoe bats are hunted for food in parts of Africa and Asia and that some bat species flesh and guano are used in “traditional medicine in Nepal, India, Vietnam, and Senegal.” A quick search on Bing or Google reveals dozens of mummified or taxidermy Horseshoe Bats are for sale, here in the US and Canada, on eBay and Etsy.

My question is…how is it that we (humanity) continue to allow the ongoing consumption, handling, distribution, sale and trade of these bats as thousands of people around the world are dying from COVID-19?     

P.S.  My inspiration for today’s blog update came from Nickelback’s song “Burn it to the ground”; one line of the song’s lyrics shouts out … “That Shit Makes Me Bat Shit Crazy”

“Origin of SARS-CoV-2 (26 March 2020)” – World Health Organization

“What does the genetic makeup of the SARS-CoV-2 virus tell us?”

All SARS-CoV-2 isolated from humans to date are closely related genetically to coronaviruses isolated from bat populations, specifically, bats from the genus Rhinolophus. SARS-CoV, the cause of the SARS outbreak in 2003, is also closely related to coronaviruses isolated from bats. These close genetic relations suggest that they all have their ecological origin in bat populations. Bats in the Rhinolophus genus are found across Asia, Africa, the Middle East, and Europe. SARS-CoV-2 is not genetically related to other known coronaviruses found in farmed or domestic animals. The analysis of the virus genome sequences also indicates that SARS-CoV-2 is very well adapted to human cell receptors, which enables it to invade human cells and easily infect people.”

“All the published genetic sequences of SARS-CoV-2 isolated from human cases are very similar, suggesting that the start of the outbreak resulted from a single point introduction in the human population around the time that the virus was first reported in humans in Wuhan, China. The analyses of the published genetic sequences further suggest that the spillover from an animal source to humans happened during the last quarter of 2019.”

“What have we learned from the investigations of the first known human COVID-19 cases?”

“As soon as the first cases of COVID-19 were reported in late December 2019, investigations were conducted to understand the epidemiology of COVID-19 and the original source of the outbreak. A large proportion of the initial cases in late December 2019 and early January 2020 had a direct link to the Huanan Wholesale Seafood Market in Wuhan City, where seafood, wild, and farmed animal species were sold. Many of the initial patients were either stall owners, market employees, or regular visitors to this market. Environmental samples taken from this market in December 2019 tested positive for SARS-CoV-2, further suggesting that the market in Wuhan City was the source of this outbreak or played a role in the initial amplification of the outbreak. The market was closed on 1 January 2020 and was cleaned and disinfected. The virus could have been introduced into the human population from an animal source in the market or an infected human could have introduced the virus to the market and the virus may have then been amplified in the market environment. Subsequent investigations into the first human cases have determined that they had onset of symptoms around 1 December 2019. However, these cases had no direct link to the Huanan Wholesale Seafood Market and they may therefore have been infected in November through contact with earlier undetected cases (incubation time between date of exposure and date of symptom onset can be up to 14 days). Additional studies are ongoing to as whether unrecognized infections in humans may have happened as early as mid-November 2019.”

https://www.who.int/health-topics/coronavirus/who-recommendations-to-reduce-risk-of-transmission-of-emerging-pathogens-from-animals-to-humans-in-live-animal-markets

“Horseshoe bats are relevant to humans as a source of disease and as food and medicine in some regions. Several species are the natural reservoirs of SARS coronavirus, though masked palm civets were the intermediate hosts through which humans became infected. Some evidence suggests that some species could be the natural reservoir of SARS-CoV-2, which causes coronavirus disease 2019. They are hunted for food in several regions, particularly Sub-Saharan Africa, but also Southeast Asia. Some species or their guano are used in traditional medicine in Nepal, India, Vietnam, and Senegal.”

https://en.wikipedia.org/wiki/Horseshoe_bat

https://www.bing.com/shop?q=rhinolophus&qs=n&form=SHOPSB&sp=-1&pq=rhinolophus&sc=0-11&sk=&cvid=20699C10294744818A68874B465A490B

https://www.ebay.com/sch/i.html?_from=R40&_trksid=m570.l1313&_nkw=Real%2C+rhinolophus&_sacat=0&LH_TitleDesc=1&_osacat=0&_odkw=Real%2C+rhinolophus

“Burn It to the Ground”

Nickelback

“Advisory – the following lyrics contain explicit language:

“Well it’s midnight, damn right”
“We’re wound up too tight”
“I’ve got a fist full of whiskey”
“The bottle just bit me”
“Oh”
“That shit makes me bat shit crazy”

https://www.metrolyrics.com/burn-it-to-the-ground-lyrics-nickelback.html

Update: Apr 6, 2020

Today’s blog update provides readers with weblinks and excerpts from several online articles detailing current efforts within the Tech and AI industries to promote the sharing of resources, such as cloud storage and supercomputers; the sharing of intelligence; the mingling of great minds; and the solicitation of innovative ideas on a global scale from both the private and public sectors…. To fight COVID-19…and other global concerns like climate change. Two large consortiums are discussed, both of which are seeking proposals from the world’s science and tech. communities on ways in which we can collectively work to mitigate the impact of the virus and also develop a vaccine.  Wikipedia’s vaccine page was the foundation for today’s blog update.  

“COVID-19 vaccine” – (Wikipedia)

“Technology scale-up”

“In March 2020, the US government, industry, and three universities pooled resources to access supercomputers from IBM, combined with cloud computing resources from Hewlett Packard Enterprise, Amazon, Microsoft, and Google.[68][69] The COVID-19 High Performance Computing Consortium is being used to forecast disease spread, model possible vaccines, and screen thousands of chemical compounds to design a COVID-19 vaccine or therapy.”[68][69]

An additional consortium of Microsoft, six universities (including one in the first consortium), and the National Center for Supercomputer Applications, working under the auspices of C3.ai, a company founded by billionaire software developer Thomas Siebel, are currently pooling their supercomputer resources for the same uses alongside developing medical protocols and strengthening public health strategies around the world, as well as awarding large grants to researchers who propose to use AI to carry out similar tasks by May.”[70][71]

https://en.wikipedia.org/wiki/COVID-19_vaccine

  1. Shankland, Stephen. “Sixteen supercomputers tackle coronavirus cures in US”. CNET. Retrieved 23 March 2020.

“The IBM-built Summit machine, the world’s fastest supercomputer today, already has been used to screen 8,000 chemical compounds on a search for COVID-19 medicine that could thwart its infectious power. So far, researchers in that effort at Oak Ridge National Laboratory and the University of Tennessee recommended 77 drug compounds for experimental testing.

https://www.cnet.com/news/sixteen-supercomputers-tackle-coronavirus-cures-in-us/

  1. “Homepage of The COVID-19 High Performance Computing Consortium”. Retrieved 28 March 2020.

“The COVID-19 High Performance Computing
(HPC) Consortium”

“The COVID-19 High Performance Computing Consortium is a unique private-public effort spearheaded by the White House Office of Science and Technology Policy, the U.S. Department of Energy and IBM to bring together federal government, industry, and academic leaders who are volunteering free compute time and resources on their world-class machines.”

Researchers are invited to submit COVID-19 related research proposals to the consortium via this online portal, which will then be reviewed for matching with computing resources from one of the partner institutions. An expert panel comprised of top scientists and computing researchers will work with proposers to assess the public health benefit of the work, with emphasis on projects that can ensure rapid results.”

https://covid19-hpc-consortium.org

70. “C3.ai, Microsoft, and Leading Universities Launch C3.ai Digital Transformation Institute”. 26 March 2020. Retrieved 28 March 2020.

“C3.ai Digital Transformation Institute (C3.ai DTI), a research consortium dedicated to accelerating the application of artificial intelligence to speed the pace of digital transformation in business, government, and society. Jointly managed by UC Berkeley and UIUC, C3.ai DTI will sponsor and fund world-leading scientists in a coordinated effort to advance the digital transformation of business, government, and society.”

“C3.ai DTI First Call for Research Proposals: C3.ai DTI invites scholars, developers, and researchers, to embrace the challenge of abating COVID-19 and advance the knowledge, science, and technologies for mitigating future pandemics using AI. This is the first in what will be a series of bi-annual calls for Digital Transformation research proposals.”

“Immediate First Call for Proposals”

“AI Techniques to Mitigate Pandemic – Research Topics:”

  • “Applying machine learning/AI methods to mitigate the spread of the COVID-19 pandemic”
  • “Genome-specific COVID-19 medical protocols, including precision medicine of host responses”
  • “Biomedical informatics methods for drug design and repurposing”
  • “Design and sharing of clinical trials for collecting and analyzing data on medications, therapies, and interventions”
  • “Modeling, simulation, prediction of COVID-19 propagation and efficacy of interventions”
  • “Logistics and optimization analysis for design of public health strategies and interventions”
  • “Rigorous approaches to designing sampling and testing strategies”
  • “Data analytics for COVID-19 research harnessing private and sensitive data, including the role of edge computing/IoT for gathering data”
  • “Improving societal resilience in response to the spread of COVID-19 Pandemic”

“Broader efforts in biomedicine, infectious disease modeling, response logistics and optimization, public health efforts, tools, and methodologies around the containment of rising infectious diseases, and response to pandemics so as to be better prepared for future infectious diseases.”

“Up to $5.8 million in awards will be funded from this first call, ranging from $100,000 to $500,000 each. In addition to cash awards, C3.ai DTI recipients will be provided with significant cloud computing, supercomputing, data access, and AI software resources and technical support provided by Microsoft and C3.ai. This will include unlimited use of the C3 AI Suite and access to the Microsoft Azure cloud platform and access to the Blue Waters supercomputer at the National Center for Supercomputing Applications (NCSA) at UIUC.”

“The first call for proposals is open now, with a deadline of May 1, 2020. Researchers are invited to learn more about C3.ai DTI and how to submit their proposals for consideration at C3DTI.ai. Selected proposals will be announced by June 1, 2020.

“Advanced computers have defeated chess masters and learned how to pick through mountains of data to recognize faces and voices. Now, a billionaire developer of software and artificial intelligence is teaming up with top universities and companies to see if A.I. can help curb the current and future pandemics.” (NY Times subscription required)

https://www.nytimes.com/2020/03/26/science/ai-versus-the-coronavirus.html/

“C3.ai Digital Transformation Institute”

“The C3.ai Digital Transformation Institute (C3.ai DTI) is a new research consortium established by C3.ai, Microsoft Corporation, the University of Illinois at Urbana-Champaign (UIUC), the University of California, Berkeley, Princeton University, the University of Chicago, the Massachusetts Institute of Technology, Carnegie Mellon University, and the National Center for Supercomputing Applications at UIUC. Jointly managed and hosted by UC Berkeley and UIUC, C3.ai DTI was created to establish the new Science of Digital Transformation of Societal Systems.” 

“Mission”

C3.ai DTI’s mission is to attract the world’s leading scientists to join in a coordinated and innovative effort to advance the digital transformation of business, government, and society. Through partnerships with leading universities and strategic engagement with key industry partners, C3.ai DTI will catalyze advances in mathematical, statistical, and computing research, including Machine Learning (ML), Artificial Intelligence (AI), and the Internet of Things (IoT). Through fundamental scientific advances, algorithms, mechanism designs, business change management practices, and social, legal, and ethical considerations, C3.ai DTI will develop the tools and design thinking necessary to effect digital transformation in basic and applied sciences, diverse industry sectors, and critical infrastructures.”

Update: Apr 4, 2020

In today’s blog update I’m providing multiple weblinks pertaining to the US’ govt.’s efforts to send COVID-19 Economic Impact Payments to many of its citizens. The payment program is a bit opaque, with gaps in information, data and timetables. The top nine things that I took away from these websites and my research follow: 1) Approximately 60 million Americans who filed 2019 or 2018 tax returns, that included direct deposit data, should be receiving direct deposit payments, of varying amounts, during the week of Apr 12-18. 2) “Social Security recipients and railroad retirees who are otherwise not required to file a tax return are also eligible and will not be required to file a (2019) return.”

3) Certain groups of people – “People, like low-income taxpayers and some veterans, who generally don’t file or are not required to file should wait.” (to file a 2019 tax return)** – https://www.irs.gov/filing/free-file-do-your-federal-taxes-for-free

** It appears there are classes of US citizens that the federal government may be considering for possible inclusion, with exceptions, in the relief payments program?? I’m guessing they’re drafting guidance — Why else would the federal govt. ask these classes of people to “wait” on filing their simple 2019 tax return? My web-surfing also indicated that some people who receive SSI benefits are also in a holding pattern for payments as the US govt. irons out the details.

4) “Single filers with income exceeding $99,000 and $198,000 for joint filers with no children are not eligible.” 5) “Eligible taxpayers who filed tax returns for either 2019 or 2018 will automatically receive an economic impact payment of up to $1,200 for individuals or $2,400 for married couples and up to $500 for each qualifying child.” 6) “The IRS will start issuing paper checks, most likely the week of May 4 (maybe sooner), according to the memo. The office that issues paper checks can process about 5 million a week, so it could take 20 weeks — nearly five months — to get them all out.” 7) “The IRS will process paper checks for the lowest-income Americans first.” 8) “The Treasury Department official said it is building a web portal for Americans to provide direct deposit information if it’s not on file with the government.” (No timetable was provided as to when this web portal will be up and running). 9) As far as I can tell the Economic Impact Payments will be considered taxable income for most Americans on their 2020 tax returns. I was unable to locate anything that said otherwise in my web searches, with the exception of a possible 12 month exclusion from income for SSI beneficiaries that receive payments.   

I also included some weblinks in today’s blog for people who may want to update their addresses or names with the IRS; who want to file a free 2019 tax return via the IRS’ “Free-file” software programs: “Use Free File Software if your income is $69,000 or less and Free File Fillable Forms if your income is greater than $69,000.”; and for those who may want to request a replacement SSA-1099 or RRB-1099.

“Many Americans may have to wait months for coronavirus relief checks – The first Americans to get relief payments from the government won’t see checks till mid-April, and many will have to wait longer.” By Kasie Hunt & Alex Moe, Published Apr 2, 2020, NBCnews.com 

“A memo circulated this week by Democrats on the House Ways and Means Committee, obtained by NBC News, says Americans who have direct deposit information on file will get their payments in mid-April, “likely” the week of April 13. The document estimates that 60 million Americans will get checks at that point”

“About three weeks after those deposits go out, the IRS will start issuing paper checks, most likely the week of May 4, according to the memo. The office that issues paper checks can process about 5 million a week, so it could take 20 weeks — nearly five months — to get them all out.”

“However, late Thursday a Treasury Department official told NBC News they believe the IRS will begin sending paper checks starting in at an unspecified date in April, not May.”

The Treasury Department official said it is building a web portal for Americans to provide direct deposit information if it’s not on file with the government. The official couldn’t provide a timeline but said an estimated timetable would be available as soon as Friday.”

“The IRS will process paper checks for the lowest-income Americans first.”

https://www.nbcnews.com/politics/congress/many-americans-may-have-wait-months-coronavirus-relief-checks-n1175216

“Economic impact payments: What you need to know” – Published Mar 30, 2020, IRS.Gov

“Updated with new information for seniors, retirees on April 1, 2020. Also see Treasury news release.”

“Check IRS.gov for the latest information: No action needed by most people at this time” – IR-2020-61, March 30, 2020

“WASHINGTON — The Treasury Department and the Internal Revenue Service today announced that distribution of economic impact payments will begin in the next three weeks and will be distributed automatically, with no action required for most people. However, some taxpayers who typically do not file returns will need to submit a simple tax return to receive the economic impact payment.” (Note: See Below, Social Security recipients and railroad retirees “who are otherwise not required to file a tax return are also eligible and will not be required to file a (tax) return”)  

“Who is eligible for the economic impact payment?”

Tax filers with adjusted gross income up to $75,000 for individuals and up to $150,000 for married couples filing joint returns will receive the full payment. For filers with income above those amounts, the payment amount is reduced by $5 for each $100 above the $75,000/$150,000 thresholds.”

“Single filers with income exceeding $99,000 and $198,000 for joint filers with no children are not eligible.”

Social Security recipients and railroad retirees who are otherwise not required to file a tax return are also eligible and will not be required to file a return.” 

“Eligible taxpayers who filed tax returns for either 2019 or 2018 will automatically receive an economic impact payment of up to $1,200 for individuals or $2,400 for married couples and up to $500 for each qualifying child.”

“How will the IRS know where to send my payment?”

“The vast majority of people do not need to take any action. The IRS will calculate and automatically send the economic impact payment to those eligible.”

“For people who have already filed their 2019 tax returns, the IRS will use this information to calculate the payment amount. For those who have not yet filed their return for 2019, the IRS will use information from their 2018 tax filing to calculate the payment. The economic impact payment will be deposited directly into the same banking account reflected on the return filed.”

(Note: If the direct deposit bank account that you filed your most recent (2019 or 2018) tax return is no longer active (a closed account) than you will likely be waiting longer for a written check or for the Treasury Dept to develop, test, and open up a web-based portal for you to submit updated direct deposit data. Read the next paragraph)     

“The IRS does not have my direct deposit information. What can I do?”

“In the coming weeks, Treasury plans to develop a web-based portal for individuals to provide their banking information to the IRS online, so that individuals can receive payments immediately as opposed to checks in the mail.”

“I am not typically required to file a tax return. Can I still receive my payment?”

“Yes. The IRS will use the information on the Form SSA-1099 or Form RRB-1099 to generate Economic Impact Payments to recipients of benefits reflected in the Form SSA-1099 or Form RRB-1099 who are not required to file a tax return and did not file a return for 2018 or 2019. This includes senior citizens, Social Security recipients and railroad retirees who are not otherwise required to file a tax return.”

“Since the IRS would not have information regarding any dependents for these people, each person would receive $1,200 per person, without the additional amount for any dependents at this time.”

“I have a tax filing obligation but have not filed my tax return for 2018 or 2019. Can I still receive an economic impact payment?”

“Yes. The IRS urges anyone with a tax filing obligation who has not yet filed a tax return for 2018 or 2019 to file as soon as they can to receive an economic impact payment. Taxpayers should include direct deposit banking information on the return.”

“I need to file a tax return. How long are the economic impact payments available?”

“For those concerned about visiting a tax professional or local community organization in person to get help with a tax return, these economic impact payments will be available throughout the rest of 2020.”  (don’t construe this to mean that you’ll get more than one payment!)

“Where can I get more information?”

“The IRS will post all key information on IRS.gov/coronavirus as soon as it becomes available.”

“The IRS has a reduced staff in many of its offices but remains committed to helping eligible individuals receive their payments expeditiously. Check for updated information on IRS.gov/coronavirus rather than calling IRS assistors who are helping process 2019 returns.”

https://www.irs.gov/newsroom/economic-impact-payments-what-you-need-to-know

“How can I get a form SSA-1099/1042S, Social Security Benefit Statement?” – Mar 31, 2020, faq.ssa.gov

An SSA-1099 is a tax form we (the IRS) mail each year in January to people who receive Social Security benefits. It shows the total amount of benefits you received from Social Security in the previous year so you know how much Social Security income to report to IRS on your tax return.”

“If you are a nonresident alien and you received or repaid Social Security benefits last year, we will send you form SSA-1042S instead.”

“The forms SSA-1099 and SSA-1042S are not available for people who receive Supplemental Security Income (SSI).”

“If you currently live in the United States and you need a replacement form SSA-1099 or SSA-1042S, we have a new way for you to get an instant replacement quickly and easily beginning February 1st by:”

  • “Using your online my Social Security account. If you don’t already have an account, you can create one online. Go to Sign In or Create an Account. Once you are logged in to your account, select the “Replacement Documents” tab;”
  • “Calling us at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday from 8:00 am to 5:30 pm; or”
  • “Contacting your local Social Security office.”

“If you live outside of the United States and you need a replacement form SSA-1099 or SSA-1042S, please contact your nearest Federal Benefits Unit.”

https://faq.ssa.gov/en-us/Topic/article/KA-01723

“Introduction”
The Form RRB-1099 tax statement is issued by the U.S. Railroad Retirement Board (RRB) and represents payments made to you in the tax year indicated on the statement. You will need to determine if any of the railroad retirement payments made to you are taxable. Explanation of items on Form RRB-1099 are on the back of this explanation sheet.”

“The mailing address shown on Form RRB-1099 is the address we currently have on our records. Please review the mailing address shown. If the mailing address shown is incorrect or incomplete, please provide the RRB with your correct mailing address.”

“Form RRB-1099”
“Form RRB-1099 reports the Social Security Equivalent Benefit (SSEB) portion of tier I and special guaranty benefits paid and repaid to citizens and/or residents of the United States, and the related U.S. Federal income tax withheld. SSEB payments are similar to social security benefits for U.S. Federal income tax purposes. Payments and repayments resulting from railroad retirement annuity adjustments are shown on your tax statements, and may be fully or partially subject to taxation. This is true whether adjustments result in net amounts due or net overpayments which you are asked to repay, and whether any overpayments are recovered or waived. A repayment is a returned payment, a cash refund, or an amount withheld from your annuity to recover an overpayment. Certain payments and repayments are not taxable and are not reported on your tax statements. These certain payments and repayments include tier I, tier II, and vested dual benefits paid for a period before December 1983; tier II and vested dual benefits repaid for a period before December 1983; separation allowance lump sum amounts; residual lump-sum amounts; lump-sum death payments; and Railroad Retirement Act tax refunds. To determine if your SSEB payments and social security benefits are taxable, refer to the Social Security Benefits worksheet in the Instructions for Form 1040 and/or Form 1040A Booklet(s). For more detailed information about SSEB benefits and Form RRB-1099, get IRS Publication 915, Social Security and Equivalent Railroad Retirement Benefits. Railroad retirement payments are not taxable for state income tax purposes.”

“Note: You should have received Form SSA-1099 and Notice 703 from the Social Security Administration (SSA) if you also received social security benefits for the tax year indicated on the Form RRB-1099. Contact SSA not the RRB if you need Form SSA-1099 and Notice 703.”

https://www.rrb.gov/Benefits/TXL-1099

“Free File: Do Your Federal Taxes for Free” – IRS.Gov

“Free File and Economic Impact Payments”

“If you would normally file a 2019 tax return, you can still use Free File now.”

“People, like low-income taxpayers and some veterans, who generally don’t file or are not required to file should wait. Social Security and Railroad Retirement beneficiaries will receive an Economic Impact Payment automatically deposited into their bank accounts, and DO NOT need to take any action.  We will have more information for you soon. Check IRS.gov/coronavirus.” 

https://www.irs.gov/filing/free-file-do-your-federal-taxes-for-free

“About the Free File Program”- IRS.Gov

“Use Free File Software if your income is $69,000 or less and Free File Fillable Forms if your income is greater than $69,000.” 

“IRS Free File is a partnership between the IRS and the Free File Alliance, a group of industry-leading private-sector tax preparation companies that have agreed to provide free commercial online tax preparation and electronic filing. Read more about our partnership.”

“We do not endorse any individual Free File Alliance company or retain any taxpayer information entered on the Free File site.”

https://www.irs.gov/e-file-providers/about-the-free-file-program

Social Security Commission Addresses COVID-19 Economic Impact Payments for Beneficiaries – Published Apr 4, 2020, WBIW.Com

“Note for Supplemental Security Income (SSI) Recipients: We are working closely with Treasury to address outstanding questions about our SSI recipients in an attempt to make the issuance of economic impact payments as quick and efficient as possible.  We realize people are concerned, and the IRS will provide additional information at www.irs.gov/coronavirus when available.  Please note that we will not consider economic impact payments as income for SSI recipients, and the payments are excluded from resources for 12 months.

“Address Changes” – (Notifying the IRS – If you’ve moved since filing your last tax return)

IRS formUse Form 8822, Change of Address or Form 8822-B, Change of Address or Responsible Party – Business

https://www.irs.gov/faqs/irs-procedures/address-changes

The IRS Youtube video on updating the IRS on Name Changes:

Update: Apr 3, 2020

Today’s blog update is just personal commentary, no site references. At the intro to this blog I have a statement that Fear of a pandemic / contagion can be far more deadly than the contagion itself!  Within that statement lies a cautionary warning, as well as a revelation of my own underlying fears. I fear that the U.S.’ public health & safety infrastructures (hospitals, police departments, emergency services) and our food, medicine and transportation industries will severely buckle, if not collapse, under the stressors of this pandemic. Specifically, I’m worried that there will be tipping points when more than half of the workforces in these essential occupations and trades will be out sick from the virus, or staying home from fear of catching the virus; and that the remaining half, still at work, will break under the overwhelming burden of propping up these key systems. I know it’s a gloom and doom scenario, one which seems unthinkable, but is it really? I’m sure government officials have contemplated a worst-case scenario, but are they making serious contingency plans? I have little confidence in President Trump’s administration having the ability to see beyond the political and financial repercussions of this pandemic. As a nation, our top priority right now, should be the preservation of these key infrastructure workforces. We should be doing everything humanly possible to augment and support them with volunteers, the military and charitable organizations.

I know testing for active cases of the virus is extremely important, but I believe that antibody testing, especially for the aforementioned workforces, and those who will fill their shoes in their absence, should be our primary focus at this time in the crisis.

The best way to decrease crippling anxieties, and to have essential workers continue to show up for work, is to reveal to them that many of them already have the virus!       

Update: Apr 2, 2020

In today’s blog update I’m providing information and links to a new COVID-19 information “alert” service available free of charge to global users of the WhatsApp platform. The service is initially launching in English but will be available in all six United Nations languages (English, Arabic, Chinese, French, Russian and Spanish.) within the coming weeks.” I think this is an excellent idea, as any resource that educates the masses (the public) is a step in the right direction. I don’t personally use WhatsApp myself; I’m a bit of an old-fart. I love technology; however, I’m still using a flip-phone because I strongly suspect that I would quickly become addicted to checking my phone 40 to 50 times each day. I don’t wish to give anything that much power and control over my daily life.

“The World Health Organization launches WHO Health Alert on WhatsApp”- Published (Mar 27, 2020), WhatsApp.com

“As the Coronavirus pandemic spreads, people all over the globe are turning to the World Health Organization for official, trusted health information and advice.”

“Today we are extremely pleased to announce the launch of the World Health Organization’s Health Alert on WhatsApp. The new service, which is free to use, has been designed to answer questions from the public about Coronavirus, and to give prompt, reliable and official information 24 hours a day, worldwide. This will also serve government decision-makers by providing the latest numbers and situation reports.”

“Start by clicking WHO Health Alert, then simply text the word ‘Hi’ in a WhatsApp message to get started. The service responds to a series of prompts and will be updated daily with the latest information.

You can also visit the WhatsApp Coronavirus Information Hub at whatsapp.com/coronavirus, and click on the WHO link on the homepage to open up a chat with the WHO Health Alert if you have WhatsApp installed.

The WHO Health Alert will provide official information on topics such as how to protect yourself from infection, travel advice, and debunking Coronavirus myths. The service is initially launching in English but will be available in all six United Nations languages within the coming weeks (English, Arabic, Chinese, French, Russian and Spanish.)”

Dr Tedros Adhanom Ghebreyesus, Director-General of WHO said: “Digital technology gives us an unprecedented opportunity for vital health information to go viral and spread faster than the pandemic, helping us save lives and protect the vulnerable. We are proud to have partners like Facebook and WhatsApp, that are supporting us in reaching billions of people with important health information.”

“Since February, WhatsApp has reached out to dozens of governments to assist their efforts to provide accurate information to the general public. The WHO Health Alert is the latest official NGO or government helpline to become available on WhatsApp, joining the Singapore Government, The Israel Ministry of Health, the South Africa Department of Health, and KOMINFO Indonesia. We are actively working to launch local services with other countries as well.

Earlier this week WhatsApp, in partnership with the World Health Organization, UNICEF, and UNDP, launched the WhatsApp Coronavirus Information Hub, to provide simple, actionable guidance for health workers, educators, community leaders, nonprofits, local governments and local businesses that rely on WhatsApp to communicate. The site also offers general tips and resources for users around the world to reduce the spread of rumors and connect with accurate health information.”

https://www.whatsapp.com/coronavirus/who

“WHO WhatsApp health alert launches in Arabic, French and Spanish” – Published Mar 27, 2020, World Health Organization

“Today, WHO is launching dedicated messaging services in Arabic, French and Spanish with partners WhatsApp and Facebook to keep people safe from coronavirus. This easy-to-use messaging service has the potential to reach 2 billion people and enables WHO to get information directly into the hands of the people that need it.”

“From government leaders to health workers and family and friends, this messaging service will provide the latest news and information on coronavirus including details on symptoms and how people can protect themselves and others. It also provides the latest situation reports and numbers in real-time to help government decision-makers protect the health of their populations.”

“The service can be accessed by a link that opens a conversation on WhatsApp. Users can simply type “hi”, “salut”, “hola” or “مرحبا” to activate the conversation, prompting a menu of options that can help answer their questions about COVID-19.”

“Join WHO’s Health Alert on WhatsApp:” 

“Arabic  Send “مرحبا”  to +41 22 501 70 23 on WhatsApp”

wa.me/41225017023?text=مرحبا

“French   Send “salut” to +41 22 501 72 98 on WhatsApp”

wa.me/41225017298?text=salut

“Spanish   Send “hola” to +41 22 501 76 90 on WhatsApp”

wa.me/41225017690?text=hola

“English   Send “hi” to +41 79 893 18 92 on WhatsApp”

wa.me/41798931892?text=hi

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen

Update: Apr 1, 2020

Today’s blog update introduces a medical paper (article) which discusses the history and origin of human coronaviruses (HCOVs), which includes the current SARS-CoV-2.  As a layman, non-medical background person, I found the paper quite informative.  A few things I took away from reading the article is that 1) when past human coronaviruses (HCOVs) first emerged, they likely were pandemics initially until humanity (the hosts) and the viruses co-adapted to one another.  2) Humanity probably needs to re-evaluate its relationship with, and exposure to, the animal kingdom — both domestic and wild animals. The domesticated animals (cats, dogs, rabbits, sheep, cows, horses, pigs, chickens, camels, etc…) worry me more so than our exposure to wild animals due to our close relationships, proximity and cohabitation with domesticated animals. 3) the stated observation that “high metabolic activity (in bats) may suppress CoV replication”, made me wonder if an individual human’s metabolism might also play a significant role in his or her unique susceptibility or immunity to CoVs?

A tug-of-war between severe acute respiratory syndrome coronavirus 2 and host antiviral defence: lessons from other pathogenic viruses” – Sin-Yee Fung, Kit-San Yuen, Zi-Wei Ye, Chi-Ping Chan & Dong-Yan Jin, Pages 558-570 | Received 19 Feb 2020, Accepted 25 Feb 2020, Published online: 14 Mar 2020 – Journal of Emerging Microbes & Infections-  – https://doi.org/10.1080/22221751.2020.1736644

“CoV-infected bats are asymptomatic or have mild symptoms suggesting that CoVs and bats are mutually adapted to high degrees. Particularly, bats are well adapted to CoVs anatomically and physiologically. First, a high level of reactive oxygen species (ROS) generated from the high metabolic activity may suppress CoV replication in bats to a manageable level.”

https://www.tandfonline.com/doi/full/10.1080/22221751.2020.1736644

“Calisher CH, Childs JE, Field HE, et al. Bats: important reservoir hosts of emerging viruses. Clin Microbiol Rev. 2006;19:531–545. doi: 10.1128/CMR.00017-06” 

Update: Mar 31, 2020

Today’s blog update provides a weblink and excerpt from the California Dept. of Public Health (CDPH) regarding information for those inclined to file a short-term Disability Insurance (DI) claim and/or a Paid Family Leave (PFL) claim due to exposure to COVID-19.  This link is only for California, USA, residents; still, it provides the reader with important insight into potential financial claims assistance.  For those interested non-CA residents, I recommend that you google your own state or country’s Dept. of Labor or Dept. of Commerce’s legal guidance on filing such claims.  Note: both type of claims will require submission of proof from certified medical personnel; and, submitting a claim does not mean that you are eligible or that you will be approved for benefits.   

“Visit CDPH News Releases for daily COVID-19 updates.”

“En Español: Para obtener información en español, visite nuestra página del Coronavirus 2019 (COVID-19).

Employment

‘What should I do if I am unable to work after being exposed to COVID-19?”

“Individuals who are unable to work due to having or being exposed to COVID-19 (certified by a medical professional) can file a Disability Insurance (DI) claim.”

“Disability Insurance provides short-term benefit payments to eligible workers who have full or partial loss of wages due to a non-work-related illness, injury, or pregnancy. Benefit amounts are approximately 60-70 percent of wages (depending on income) and range from $50 – $1,300 a week.”

“Californians who are unable to work because they are caring for an ill or quarantined family member with COVID-19 (certified by a medical professional) can file a Paid Family Leave (PFL) claim.”

“Paid Family Leave provides up to six weeks of benefit payments to eligible workers who have a full or partial loss of wages because they need time off work to care for a seriously ill family member or to bond with a new child. Benefit amounts are approximately 60-70 percent of wages (depending on income) and range from $50-$1,300 a week.”

“For more information related to resources for California’s Employers and Workers, please visit this Labor and Workforce Development Agency webpage.

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx#Alerts

Update: Mar 30, 2020

Today’s second blog update includes excerpts from a Lancet article indicating that COVID-19 patients could potentially shed virus (be contagious) up to five weeks.  This should be researched further, with transparency, as governments may need to consider revising the 14 day quarantine protocols.  In my opinion, the article also touches upon criteria that could be useful in determining ventilator rationing decisions.

“Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study” – By: Fei Zhou, MD and many more Chinese doctors – Published Mar 11, 2020, The Lancet, DOI:https://doi.org/10.1016/S0140-6736(20)30566-3

“Background”

“Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described.”

“Methods”

In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.”

“Findings”

“191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days.”

“Interpretation”

The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage (read-between-the lines: used in determining ventilator rationing decisions). Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.”

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext

Today’s first blog update emphasizes the need for healthcare workers (HCW) to utilize (when available) protective eye wear such as face shields and goggles, in addition to respirators (N95 masks), surgical masks and other PPE. I see a lot of news footage showing frontline healthcare workers wearing surgical masks, but only about half of them wearing eye protection.

 “2019-nCoV transmission through the ocular surface must not be ignored” – By Chen-wei Lu, Xiu-fen Liu and Zhia-fang Jia, The Lancet, Published Feb 6, 2020, https://doi.org/10.1016/S0140-6736(20)30313-5

“On Jan 22, Guangfa Wang, a member of the national expert panel on pneumonia, reported that he was infected by 2019-nCoV during the inspection in Wuhan.  He wore an N95 mask but did not wear anything to protect his eyes. Several days before the onset of pneumonia, Wang complained of redness of the eyes. Unprotected exposure of the eyes to 2019-nCoV in the Wuhan Fever Clinic might have allowed the virus to infect the body.”

“Infectious droplets and body fluids can easily contaminate the human conjunctival epithelium. Respiratory viruses are capable of inducing ocular complications in infected patients, which then leads to respiratory infection.”

“Severe acute respiratory syndrome coronavirus (SARS-CoV) is predominantly transmitted through direct or indirect contact with mucous membranes in the eyes, mouth, or nose. The fact that exposed mucous membranes and unprotected eyes increased the risk of SARS-CoV transmission suggests that exposure of unprotected eyes to 2019-nCoV could cause acute respiratory infection.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30313-5/fulltext

Update: Mar 29, 2020

Today’s blog update is about the apparent lack of preparedness by the UK’s National Health Service (National Healthcare System); it seems that the US does not have a monopoly on short-sighted planning and inept reactions by their federal government, regarding the current pandemic.  Included are two excerpts from Richard Horton’s commentary piece in the Lancet Journal on Mar 28, 2020. It’s a short read; I recommend reading the whole article at the referenced weblink below.

As for President Trump’s Press Briefing today, Mar 28, and specifically his comment that he could not understand why a large NY hospital that previously used to order 10,000 to 20,000 (N95) masks per order is now suddenly asking for 300,000 masks per order.  I have an answer for you Mr. President… It’s called a fricking pandemic!  These frontline healthcare workers are putting their very lives on the line each day for all of us, and you have the audacity to imply on national television that possibly the masks are being ferreted out the back door of the hospital for personal gain or resale.  You, Mr. President, are an embarrassment to our country!

 “Offline: COVID-19 and the NHS – “A national scandal”” – By Richard Horton, The Lancet, Published Mar 28, 2020 — https://doi.org/10.1016/S0140-6736(20)30727-3

“When this is all over, the NHS England board should resign in their entirety.” So wrote one National Health Service (NHS) health worker last weekend. The scale of anger and frustration is unprecedented, and coronavirus disease 2019 (COVID-19) is the cause. The UK Government’s Contain–Delay–Mitigate–Research strategy failed. It failed, in part, because ministers didn’t follow WHO’s advice to “test, test, test” every suspected case. They didn’t isolate and quarantine. They didn’t contact trace. These basic principles of public health and infectious disease control were ignored, for reasons that remain opaque. The UK now has a new plan— Suppress–Shield–Treat–Palliate. But this plan, agreed far too late in the course of the outbreak, has left the NHS wholly unprepared for the surge of severely and critically ill patients that will soon come. I asked NHS workers to contact me with their experiences. Their messages have been as distressing as they have been horrifying. “It’s terrifying for staff at the moment. Still no access to personal protective equipment [PPE] or testing.” “Rigid command structures make decision making impossible.” “There’s been no guidelines, it’s chaos.” “I don’t feel safe. I don’t feel protected.” “We are literally making it up as we go along.” “It feels as if we are actively harming patients.” “We need protection and prevention.” “Total carnage.” “NHS Trusts continue to fail miserably.” “Humanitarian crisis.”“Forget lockdown—we are going into meltdown.” “When I was country director in many conflict zones, we had better preparedness.” “The hospitals in London are overwhelmed.”The public and media are not aware that today we no longer live in a city with a properly functioning western health-care system.” “How will we protect our patients and staff…I am speechless. It is utterly unconscionable. How can we do this? It is criminal…NHS England was not prepared… We feel completely helpless.””

“The NHS has been wholly unprepared for this pandemic. It’s impossible to understand why. Based on their modelling of the Wuhan outbreak of COVID-19, Joseph Wu and his colleagues wrote in The Lancet on Jan 31, 2020: “On the present trajectory, 2019-nCoV could be about to become a global epidemic…for health protection within China and internationally… preparedness plans should be readied for deployment at short notice, including securing supply chains of pharmaceuticals, personal protective equipment, hospital supplies, and the necessary human resources to deal with the consequences of a global outbreak of this magnitude.” This warning wasn’t made lightly. It should have been read by the Chief Medical Officer, the Chief Executive Officer of the NHS in England, and the Chief Scientific Adviser. They had a duty to immediately put the NHS and British public on high alert. February should have been used to expand coronavirus testing capacity, ensure the distribution of WHO-approved PPE, and establish training programmes and guidelines to protect NHS staff. They didn’t take any of those actions. The result has been chaos and panic across the NHS. Patients will die unnecessarily. NHS staff will die unnecessarily. It is, indeed, as one health worker wrote last week, “a national scandal”. The gravity of that scandal has yet to be understood.”

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30727-3/fulltext

Update: Mar 28, 2020

Today’s second blog update provides excerpts from the US CDC website detailing the federal government’s authority to implement and enforce quarantines. “It is possible for federal, state, local, and tribal health authorities to have and use all at the same time separate but coexisting legal quarantine power in certain events. In the event of a conflict, federal law is supreme.”

“Federal Law”

“The federal government derives its authority for isolation and quarantine from the Commerce Clause of the U.S. Constitution.”

Under section 361 of the Public Health Service Act (42 U.S. Code § 264), the U.S. Secretary of Health and Human Services is authorized to take measures to prevent the entry and spread of communicable diseases from foreign countries into the United States and between states.”

“The authority for carrying out these functions on a daily basis has been delegated to the Centers for Disease Control and Prevention (CDC).”

“CDC’s Role”

“Under 42 Code of Federal Regulations parts 70 and 71, CDC is authorized to detain, medically examine, and release persons arriving into the United States and traveling between states who are suspected of carrying these communicable diseases.”

“As part of its federal authority, CDC routinely monitors persons arriving at U.S. land border crossings and passengers and crew arriving at U.S. ports of entry for signs or symptoms of communicable diseases.”

“When alerted about an ill passenger or crew  member by the pilot of a plane or captain of a ship, CDC may detain passengers and crew as necessary to investigate whether the cause of the illness on board is a communicable disease.”

“State, Local, and Tribal Law”

States have police power functions to protect the health, safety, and welfare of persons within their borders. To control the spread of disease within their borders, states have laws to enforce the use of isolation and quarantine.”

“These laws can vary from state to state and can be  specific or broad. In some states, local health authorities implement state law. In most states, breaking a quarantine order is a criminal misdemeanor.”

“Tribes also have police power authority to take actions that promote the health, safety, and welfare of their own tribal members. Tribal health authorities may enforce their own isolation and quarantine laws within tribal lands, if such laws exist.”

“Who Is in Charge”

“The federal government”

  • “Acts to prevent the entry of communicable diseases into the United States. Quarantine and isolation may be used at U.S. ports of entry.”
  • Is authorized to take measures to prevent the spread of communicable diseases between states.”
  • “May accept state and local assistance in enforcing federal quarantine.”
  • “May assist state and local authorities in preventing the spread of communicable diseases.”

“State, local, and tribal authorities”

  • “Enforce isolation and quarantine within their borders.”

“It is possible for federal, state, local, and tribal health authorities to have and use all at the same time separate but coexisting legal quarantine power in certain events. In the event of a conflict, federal law is supreme.”

“Enforcement”

“If a quarantinable disease is suspected or identified, CDC may issue a federal isolation or quarantine order. Public health authorities at the federal, state, local, and tribal levels may sometimes seek help from police or other law enforcement officers to enforce a public health order.”

U.S. Customs and Border Protection and U.S. Coast Guard officers are authorized to help enforce federal quarantine orders. Breaking a federal quarantine order is punishable by fines and imprisonment. Federal law allows the conditional release of persons from quarantine if they comply with medical monitoring and surveillance.”

“In the rare event that a federal order is issued by CDC, those individuals will be provided with an order for quarantine or isolation. An example of a Quarantine Order for Novel Coronavirus (print-only) pdf icon[PDF – 5 pages] is provided. This document outlines the rationale of the federal order as well as information on where the individual will be located, quarantine requirements including the length of the order, CDC’s legal authority, and information outlining what the individual can expect while under federal order.”

https://www.cdc.gov/quarantine/aboutlawsregulationsquarantineisolation.html

https://www.hhs.gov/answers/public-health-and-safety/who-has-the-authority-to-enforce-isolation-and-quarantine/index.html

Also, see the following websites. There may be a clause in Title 42, Sections 264 and 266 which imply the federal authority will only supersede state authority during a time of war. I don’t know, I’m not a lawyer; anyone with a US legal analyst background care to comment?

“Title 42 USC 264: Regulations to control communicable diseases Text contains those laws in effect on March 27, 2020″

“(e) Preemption”

Nothing in this section or section 266 of this title, or the regulations promulgated under such sections, may be construed as superseding any provision under State law (including regulations and including provisions established by political subdivisions of States), except to the extent that such a provision conflicts with an exercise of Federal authority under this section or section 266 of this title.

“(July 1, 1944, ch. 373, title III, §361, 58 Stat. 703 ; 1953 Reorg. Plan No. 1, §§5, 8, eff. Apr. 11, 1953, 18 F.R. 2053, 67 Stat. 631; Pub. L. 86–624, §29(c), July 12, 1960, 74 Stat. 419 ; Pub. L. 94–317, title III, §301(b)(1), June 23, 1976, 90 Stat. 707 ; Pub. L. 107–188, title I, §142(a)(1), (2), (b)(1), (c), June 12, 2002, 116 Stat. 626 , 627.)”

https://uscode.house.gov/view.xhtml?req=(title:42%20section:264%20edition:prelim)

“Title 42 USC 266: Special quarantine powers in time of war Text contains those laws in effect on March 27, 2020″

https://uscode.house.gov/view.xhtml?req=(title:42%20section:266%20edition:prelim)%20OR%20(granuleid:USC-prelim-title42-section266)&f=treesort&num=0&edition=prelim

Today’s first blog update provides brief excerpts from the WHO–China Joint Mission Report dated 28 Feb 2020.  Also included are excerpts from the US CDC, The British Medical Journal (BMJ) Blog and from Livescience.com. The points that I hope you will take away from the report and the articles are:  1) We need to act immediately with every available resource to protect the health and well-being of our Healthcare Workers (HCW) … if we hope to keep our healthcare systems from crashing.  2)  China encountered similar shortages with PPE and nosocomial (hospital originated) spread of the virus, and we (the US) should have paid attention sooner to their equipment (ventilator) and PPE shortages.  When your neighbor’s house is on fire that’s the time to check your garden hose to see if its working; you don’t wait until the fire reaches your own house.  I suspect that our Case Fatality Rates (CFR) in our major metropolitan cities will be much higher than we modeled due to our failure to provide our healthcare workers with the PPE supplies they need to stay safe and uninfected.  I’m glad President Trump finally signed and implemented the Defense Production Act (DPA); but, I’m afraid that it’s likely too late to help with the wave of infections that are currently hitting New York City and other large US metropolitan cities. I think it’s about to get ugly and sooner than we thought!

“Estimating Risk for Death from 2019 Novel Coronavirus Disease, China, January–February 2020 “– By Kenji Mizumoto and Gerardo Chowell, US CDC, https://doi.org/10.3201/eid2606.200233   DOI: 10.3201/eid2606.200233, Original Publication Date:  Mar 13, 2020

“Abstract: Since December 2019, when the first case of 2019 novel coronavirus disease (COVID-19) was identified in the city of Wuhan in the Hubei Province of China, the epidemic has generated tens of thousands of cases throughout China. As of February 28, 2020, the cumulative number of reported deaths in China was 2,858. We estimated the time-delay adjusted risk for death from COVID-19 in Wuhan, as well as for China excluding Wuhan, to assess the severity of the epidemic in the country. Our estimates of the risk for death in Wuhan reached values as high as 12% in the epicenter of the epidemic and ≈1% in other, more mildly affected areas. The elevated death risk estimates are probably associated with a breakdown of the healthcare system, indicating that enhanced public health interventions, including social distancing and movement restrictions, should be implemented to bring the COVID-19 epidemic under control.”

https://wwwnc.cdc.gov/eid/article/26/6/20-0233_article?deliveryName=USCDC_333-DM22636

“How deadly is the new coronavirus?” – By Stephanie Pappas, Livescience.com, Published Mar 16, 2020

“Another factor affecting the deadliness of the new coronavirus is the quality of medical care. Already, there is evidence that the overwhelmed medical system in Wuhan, where the outbreak began, led to more deaths. The World Health Organization’s joint mission report from Feb. 28 found that among 56,000 laboratory-confirmed coronavirus cases, the case-fatality ratio was 3.8%. However, the case-fatality ratio in Wuhan was 5.8%, while the rest of the country — spared the overwhelming bulk of sick patients — saw a rate of 0.7%.

This means fewer people are likely to die if the medical system is prepared to face an influx of coronavirus patients.”

https://www.livescience.com/is-coronavirus-deadly.html

“Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) – 16-24 February 2020”, World Health Organization, Published Feb 28, 2020.

“Members & Method of Work – The Joint Mission consisted of 25 national and international experts from China, Germany, Japan, Korea, Nigeria, Russia, Singapore, the United States of America and the World Health Organization (WHO).  The Joint Mission was headed by Dr Bruce Aylward of WHO and Dr Wannian Liang of the People’s Republic of China.  The full list of members and their affiliations is available in Annex A.  The Joint Mission was implemented over a 9-day period from 16-24 February 2020.”

“The overall goal of the Joint Mission was to rapidly inform national (China) and international planning on next steps in the response to the ongoing outbreak of the novel coronavirus disease (COVID-191) and on next steps in readiness and preparedness for geographic areas not yet affected.”

Transmission in health care settings and among health care workers (HCW) – The Joint Mission discussed nosocomial infection in all locations visited during the Mission.  As of 20 February 2020, there were 2,055 COVID-19 laboratory-confirmed cases reported among HCW from 476 hospitals across China.  The majority of HCW cases (88%) were reported from Hubei.”

“Remarkably, more than 40,000 HCW have been deployed from other areas of China to support the response in Wuhan.  Notwithstanding discrete and limited instances of nosocomial outbreaks (e.g. a nosocomial outbreak involving 15 HCW in Wuhan), transmission within health care settings and amongst health care workers does not appear to be a major transmission feature of COVID-19 in China.  The Joint Mission learned that, among the HCW infections, most were identified early in the outbreak in Wuhan when supplies and experience with the new disease was lower.  Additionally, investigations among HCW suggest that many may have been infected within the household rather than in a health care setting.  Outside of Hubei, health care worker infections have been less frequent (i.e. 246 of the total 2055 HCW cases).  When exposure was investigated in these limited cases, the exposure for most was reported to have been traced back to a confirmed case in a household.“

“The Joint Team noted that attention to the prevention of infection in health care workers is of paramount importance in China.  Surveillance among health care workers identified factors early in the outbreak that placed HCW at higher risk of infection, and this information has been used to modify policies to improve protection of HCW.”

https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

“Protecting healthcare workers in China during the coronavirus outbreak” –By Min Zang, Feb 14, 2020, The British Medical Journal (BMJ) Blog

“Yet despite all these efforts, gaps still exist between these well intentioned policies and the effective protection and support of staff. I’d argue that three aspects are of particular importance.

“Firstly, healthcare workers’ need for protective equipment at work has been outpacing supply. From the initial phases of the outbreak, there have been shortages of personal protective equipment, such as suits, masks, and eye protection. Numerous outlets have cited these shortages happening in various health services, with some outlets even reporting that in some instances medical staff had resorted to using raincoats for protection in a county hospital.“

Secondly, the continual reports of healthcare workers becoming infected would suggest that staff are not always aware of or able to implement the standard precautions, as required by the technical guidance provided by the National Health Commission and World Health Organization (WHO). This seems to especially be the case for those who work in posts outside of the emergency department or infectious disease, or the designated hospitals that have been established for covid-19. For instance, five medical workers in a Beijing hospital’s cardiology department were recently infected. Making sure that staff have the awareness and capacity to protect themselves is especially a challenge in local level health services.” 

“Thirdly, there is no standardised procedure for daily or even routinely carrying out the health surveillance and environmental monitoring of healthcare workers. In the case of this outbreak, during the pre-deployment stage, healthcare workers had no national standards for health conditions that might rule out their treating patients who have been infected. For example, guidance from WHO and the International Labour Office on occupational safety and health in public health emergencies recommends that pregnant healthcare workers should not have emergency duties.”

Update: Mar 27, 2020

Today’s blog update includes excerpts from two online articles indicating that CPAP (Continuous Positive Airway Pressure) & BIPAP (Bi-level Positive Airway Pressure) machines have the potential to aerosolize viruses, and consequently you should take precautionary measures when using them, so as not to inadvertently pump airborne virus particles into the air, and infect other people in your household with COVID-19.  A second point from the articles is that BIPAP machines, even with the concerns of possible aerosolizing of the the virus, could potentially be utilized by hospitals as a ventilator alternative, for COVID-19 patients with less severe respiratory symptoms, if the machines are properly fitted to each individual patient.  

“Not So Fast Using CPAPs In Place Of Ventilators. They Could Spread The Coronavirus.” – By Markian Hawryluk, Published by Kaiser Health News (KHN), Mar 27, 2020

  • “The limited supply of ventilators is one of the chief concerns facing hospitals as they prepare for more COVID-19 cases. In Italy, where hospitals have been overwhelmed with patients in respiratory failure, doctors have had to make difficult life-or-death decisions about who gets a ventilator and who does not.”
  • “In the U.S., emergency plans developed by states for a shortage of ventilators include using positive airway pressure machines — like those used to treat sleep apnea — to help hospitalized people with less severe breathing issues.”
  • “While that measure could stretch the supply of ventilators and save lives, it has a major drawback. Officials and scientists have known for years that when used with a face mask such alternative devices can possibly increase the spread of infectious disease by aerosolizing the virus, whether used in the hospital or at home.”
  • “Indeed, that very scenario may have contributed to the spread of COVID-19 within a Washington state nursing home that became ground zero in the United States early on. First responders called to the Life Care Center of Kirkland starting Feb. 24 initially used continuous positive airway pressure machines, often known as CPAPs, to treat residents before it was known the patients were infected with the COVID-19 virus.”
  • The American Society of Anesthesiologists issued guidance (excerpt below, at the end of this post) on Feb. 23 discouraging CPAP use in COVID-19 patients — advice largely informed by experience with the SARS epidemic in 2003. Studies dating to 2003 suggest such devices can pump viruses into the air, potentially increasing the spread of a contagious disease.
  • “During the SARS outbreak in Toronto, half of all SARS cases, including three deaths, occurred among health care workers. Some of the greatest risk arose when doctors and nurses were exposed to aerosolized virus through the use of positive airway pressure machines or other respiratory therapy devices.”
  • “The experiences from the Life Care Center of Kirkland now have doctors rethinking their strategies when faced with ventilator shortages and their advice to first responders about using CPAP machines in the field.”
  • “In general, we’re just telling them not to use it,” said Dr. Comilla Sasson, an associate clinical professor of emergency medicine at the University of Colorado School of Medicine. “Because we are concerned about community spread, and we have to assume that anybody with respiratory distress is a COVID patient.”
  • “And doctors even suggest those who use the devices at home should take precautions to prevent infecting others.”

How CPAPs Spread The Coronavirus

  • “Ventilators are machines that push air into and out of the lungs through tubes inserted down patients’ airways when they have trouble breathing on their own. The machines allow health care providers to fine-tune the volume of air supplied, the rate of breathing, the amount of oxygen and the pressure as needed.”
  • “Both hospital and home versions of positive airway pressure machines are much simpler devices that use high pressure to push air into the airway, generally through a face mask. CPAPs provide a continuous flow of air at a constant pressure. More advanced bilevel versions, called BiPAPs, which can be used at home or in health care facilities, push the air in, but then lower the pressure to allow the air to be exhaled.”
  • You can actually function certain BiPAP machines to run like ventilators,” said Dr. James Finigan, a pulmonology and critical care specialist at National Jewish Health in Denver.”
  • “The key issue, Finigan said, is how the device connects to the patient. Ventilators require a breathing tube and operate as closed systems with a filter that traps any pathogens. Face masks generally used on CPAPs or BiPAPs allow air to escape, pumping the virus into the surroundings and potentially infecting other patients, caregivers or anyone nearby.”
  • “Dr. Jeff Sippel, a critical care specialist at UCHealth, based in Aurora, Colorado, said BiPAPs could be used for COVID-19 in a closed system without a mask if patients are first fitted with a breathing tube.” “The hardware actually fits,” he said.”
  • “The jury-rigged devices could then be used for less severe COVID-19 patients, as well as for other patients who might not be first in line for a ventilator. More severe cases would still require full mechanical breathing like that provided by a ventilator, and it’s unlikely that BiPAP could fully make up for the undersupply of ventilators in a full-blown pandemic.”
  • “Some doctors have suggested that governors should put out a call for people with spare BiPAP machines in their homes to donate them to hospitals. But Sippel said hospitals have other steps they would take first.”

What About CPAPs For Home Use?

  • “Dr. Christopher Winter, a sleep medicine specialist in Charlottesville, Virginia, said people who rely on CPAP machines for sleep apnea can continue to use them as long as they have no symptoms of COVID-19. But they should speak to their physicians if they develop upper-respiratory symptoms, to help determine if they should continue.”
  • Anybody who uses a CPAP machine at home, he said, may want to sleep in a separate room from loved ones to avoid infecting them. That’s true even if the person with apnea doesn’t have any COVID-19 symptoms. And if patients are advised by their doctors to stop using their machines, Winter said, they should also avoid driving, because they may be sleep-deprived.”

COVID-19    Information for Health Care Professionals”By The American Society of Anesthesiologists (ASA), Committee on Occupational Health – Published Feb 23, 2020

“When considering a procedure for a patient with known or suspected COVID-19 infection:”

  • “In patient with acute respiratory failure, it may be prudent to proceed directly to endotracheal intubation, because non-invasive ventilation (e.g. CPAP or biPAP) may increase the risk of infectious transmission.”

https://www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on-occupational-health/coronavirus

Update: Mar 26, 2020

Today’s second blog update is a call to our elected leaders. Forgive me for being a bit melodramatic in my text but it seems appropriate in the current circumstances. After watching two weeks of White House press briefings, I’ve come to the conclusion that our (US) federal government, under President Trump, will never take a leading role in the fight against this pandemic. I have no idea what President Trump’s motivations are for the stance he has chosen to take, be they political, personal, economical, or something else altogether. Regardless of why he’s opting to have the federal government sit on the sidelines in this expanding crisis, it is obvious to me now, today, that the federal government will not be coming to the rescue in this dire time of need. It is now essentially up to us: each state, each city, each citizen to do our very best to pull together and help each other survive the trials and challenges of this pandemic. Our state governors, and city mayors, need to form alliances and work together to mobilize, and to share and shift resources and personnel.

Thomas Paine: “If we do not hang together, we shall surely hang separately.”

Today’s first blog update provides key excerpts from the US CDC’s recent March 18, 2020, Morbidity and Mortality Weekly Report (MMWR), which covers the period 12 Feb thru 16 Mar, 2020. The report indicates that COVID-19 patients aged 65 and older, especially those with underlying conditions, will suffer the brunt of our fatalities from this pandemic. Note: the report and the data are now 10 days old, and the US has had at least one death with a COVID-19 patient under 19 years of age. I’m speculating that this Morbidity and Mortality data will change significantly in the upcoming CDC reports for two reasons: First, the lack of available ventilators will drastically impact all hospitalized ICU patients, COVID-19 and otherwise, of all ages…essentially everyone in need of a ventilator. Second, the likely (my opinion) collapse of our healthcare systems under the increasing stressors will add to the mounting fatalities. Let’s hope that I’m wrong!

Morbidity and Mortality Weekly Report (MMWR)

Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep” 2020;69:343-346. DOI: http://dx.doi.org/10.15585/mmwr.mm6912e2

“Summary”

  • “What is already known about this topic?”

“Early data from China suggest that a majority of coronavirus disease 2019 (COVID-19) deaths have occurred among adults aged ≥60 years and among persons with serious underlying health conditions.”

  • “What is added by this report?”

This first preliminary description of outcomes among patients with COVID-19 in the United States indicates that fatality was highest in persons aged ≥85, ranging from 10% to 27%, followed by 3% to 11% among persons aged 65–84 years, 1% to 3% among persons aged 55-64 years, <1% among persons aged 20–54 years, and no fatalities among persons aged ≤19 years.”

  • “What are the implications for public health practice?”

“COVID-19 can result in severe disease, including hospitalization, admission to an intensive care unit, and death, especially among older adults. Everyone can take actions, such as social distancing, to help slow the spread of COVID-19 and protect older adults from severe illness.”

Discussion

  • “Since February 12, 4,226 COVID-19 cases were reported in the United States; 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths occurred among adults aged ≥65 years with the highest percentage of severe outcomes among persons aged ≥85 years. These findings are similar to data from China, which indicated >80% of deaths occurred among persons aged ≥60 years. These preliminary data also demonstrate that severe illness leading to hospitalization, including ICU admission and death, can occur in adults of any age with COVID-19. In contrast, persons aged ≤19 years appear to have milder COVID-19 illness, with almost no hospitalizations or deaths reported to date in the United States in this age group. Given the spread of COVID-19 in many U.S. communities, CDC continues to update current recommendations and develop new resources and guidance, including for adults aged ≥65 years as well as those involved in their care.”
  • Approximately 49 million U.S. persons are aged ≥65 years, and many of these adults, who are at risk for severe COVID-19–associated illness, might depend on services and support to maintain their health and independence. To prepare for potential COVID-19 illness among persons at high risk, family members and caregivers of older adults should know what medications they are taking and ensure that food and required medical supplies are available. Long-term care facilities should be particularly vigilant to prevent the introduction and spread of COVID-19. In addition, clinicians who care for adults should be aware that COVID-19 can result in severe disease among persons of all ages. Persons with suspected or confirmed COVID-19 should monitor their symptoms and call their provider for guidance if symptoms worsen or seek emergency care for persistent severe symptoms. Additional guidance is available for health care providers on CDC’s website (https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html).”

This report describes the current (as of publishing date: Mar 18, 2020) epidemiology of COVID-19 in the United States, using preliminary data. The findings in this report are subject to at least five limitations. First, data were missing for key variables of interest. Data on age and outcomes, including hospitalization, ICU admission, and death, were missing for 9%–53% of cases, which likely resulted in an underestimation of these outcomes. Second, further time for follow-up is needed to ascertain outcomes among active cases. Third, the initial approach to testing was to identify patients among those with travel histories or persons with more severe disease, and these data might overestimate the prevalence of severe disease. Fourth, data on other risk factors, including serious underlying health conditions that could increase risk for complications and severe illness, were unavailable at the time of this analysis. Finally, limited testing to date underscores the importance of ongoing surveillance of COVID-19 cases. Additional investigation will increase the understanding about persons who are at risk for severe illness and death from COVID-19 and inform clinical guidance and community-based mitigation measures.”

“The risk for serious disease and death in COVID-19 cases among persons in the United States increases with age. Social distancing is recommended for all ages to slow the spread of the virus, protect the health care system, and help protect vulnerable older adults. Further, older adults should maintain adequate supplies of nonperishable foods and at least a 30-day supply of necessary medications, take precautions to keep space between themselves and others, stay away from those who are sick, avoid crowds as much as possible, avoid cruise travel and nonessential air travel, and stay home as much as possible to further reduce the risk of being exposed. Persons of all ages and communities can take actions to help slow the spread of COVID-19 and protect older adults.”

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm6912e2_w

Update: Mar 25, 2020

Today’s blog update introduces excerpts from an article on two variants of a promising antiviral, b-D-N4-hydroxycytidine (NHC), drug that could prove useful as a therapeutic against COVID-19.  The article’s authors stated “We show that NHC is potently antiviral against the newly emerging SARS-CoV-2 as well as against coronavirus bearing resistance mutations to the potent nucleoside analog inhibitor, remdesivir (RDV).”   Also, in today’s blog, I’ll provide a brief commentary on my personal observations of grocery shopping today in Southwest Washington state a day after the state of Washington implemented a Shelter-In-Place state-wide order.

**For those interested in Remdesivir, my blog update on Feb 29, 2020, provides some background info on that promising drug.

An orally bioavailable broad-spectrum antiviral inhibits SARS-CoV-2 and multiple endemic, epidemic and bat coronavirus”By Timothy P. Sheahan, Amy C. Sims, Shuntai Zhou, Rachel L. Graham, Collin S. Hill, Sarah R. Leist, Alexandra Schäfer, Kenneth H. Dinnon III, Stephanie A. Montgomery, Maria L. Agostini, Andrea J. Pruijssers, James D. Chapell, Ariane J. Brown, Gregory R. Bluemling, Michael G. Natchus, Manohar Saindane, Alexander A. Kolykhalov, George Painter, Jennifer Harcourt, Azaibi Tamin, View ORCID ProfileNatalie J. Thornburg, Ronald Swanstrom, Mark R. Denison, Ralph S. Baric – Published 3/19/2020 on BIORXIV – doi: https://doi.org/10.1101/2020.03.19.997890

  • “Introduction:  The genetically diverse Orthocoronavirinae (coronavirus, CoV) family circulates in many avian and mammalian species. Phylogenetically, CoVs are divided into 4 genera: alpha (group 1), beta (group 2), gamma (group 3) and delta (group 4). Three new human CoV have emerged in the past 20 years with severe acute respiratory syndrome CoV (SARS-CoV) in 2002, Middle East respiratory syndrome CoV (MERS-CoV) in 2012, and now SARS-CoV-2 in 201913. The ongoing SARS-CoV-2 epidemic (referred to as COVID-19, Coronavirus disease 2019) has caused over 89,000 infections and over 3,000 deaths in 71 countries. Like SARS- and MERS-CoV, the respiratory disease caused by SARS-CoV-2 can progress to acute lung injury (ALI), an end stage lung disease with limited treatment options and very poor prognoses35. This emergence paradigm is not limited to humans. A novel group 1 CoV called swine acute diarrhea syndrome CoV (SADS-CoV) recently emerged from bats causing the loss of over 20,000 pigs in Guangdong Province, China6. More alarmingly, many group 2 SARS-like and MERS-like coronaviruses are circulating in bat reservoir species that can use human receptors and replicate efficiently in primary human lung cells without adaptation69. The presence of these “pre-epidemic” zoonotic strains foreshadow the emergence and epidemic potential of additional SARS-like and MERS-like viruses in the future. Given the diversity of CoV strains in zoonotic reservoirs and a penchant for emergence, broadly active antivirals are clearly needed for rapid response to new CoV outbreaks in humans and domesticated animals.”
  • Currently, there are no approved therapies specific for any human CoV. β-D-N4-hydroxycytidine (NHC, EIDD-1931) is orally bioavailable ribonucleoside analog with broad-spectrum antiviral activity against various unrelated RNA viruses including influenza, Ebola, CoV and Venezuelan equine encephalitis virus (VEEV)1013. For VEEV, the mechanism of action (MOA) for NHC has been shown to be through lethal mutagenesis where deleterious transition mutations accumulate in viral RNA11,14. Here, we demonstrate that NHC exerts potent, broad-spectrum activity against SARS-CoV, MERS-CoV and their related bat-CoV in primary human airway epithelial cell cultures (HAE), a biologically relevant model of the human conducting airway. In addition, we show that NHC is potently antiviral against the newly emerging SARS-CoV-2 as well as against coronavirus bearing resistance mutations to the potent nucleoside analog inhibitor, remdesivir (RDV). In SARS- or MERS-CoV infected mice, both prophylactic and therapeutic administration EIDD-2801, an oral NHC-prodrug (b-D-N4-hydroxycytidine-5’-isopropyl ester) improved pulmonary function and reduced virus titer and ameliorated disease severity. In addition, therapeutic EIDD-2801 reduced the pathological features of ALI in SARS-CoV infected mice. Using a high-fidelity deep sequencing approach (Primer ID), we found that increased mutation rates coincide with decreased MERS-CoV yields in vitro and protective efficacy in vivo supporting the MOA of lethal mutagenesis against emerging CoV13. The broad activity and therapeutic efficacy of NHC/EIDD-2801 highlight its potential to diminish epidemic disease today and limit future emerging CoV outbreaks.”
  • “Results:  NHC potently Inhibits MERS-CoV, SARS-CoV and newly emerging SARS-CoV-2 Replication”

https://www.biorxiv.org/content/10.1101/2020.03.19.997890v1.full

Today, my wife and I went to the grocery stores Costco and Winco, and we stocked up on as much food, and some booze, as we could afford; I’m guessing that in total we now have enough food supplies to last the two of us for over the next six to eight weeks, if we were strictly confined to our home. 

My wife and I donned our N95 respirator masks and our nitrile gloves before entering each store. We also have the goggles (chemical safety goggles) at home, but we elected not to wear them, as a risk we were willing to take. My wife and I are in decent health; we have some minor health issues like anyone in their 50s, but no serious underlying conditions (comorbidities) that we’re aware of.  I’m guessing that we both probably already have the virus – as one of the many asymptomatic millions. Still, we wore the gear because we don’t want to be responsible for spreading the virus to anyone in case my guess is correct, and we are possibly contagious.  I was surprised that among the estimated 300 or so patrons that we saw, in total, in both stores, only about half a dozen wore respirators or surgical masks.  Most people seemed politely indifferent to our masks, but a few gawked and some even smirked. It’s obvious, that America is still not taking the threat of communal spread serious.

Both grocery stores had procedures and protocols in place to emphasize social distancing, and both stores had plenty of groceries and sundries available.  The stores were not overly crowded. None of the store employees wore masks.

Two things that surprised me on the trip to and from the stores: First, was the level of traffic; hundreds of people were out and about driving between 10 and 12 A.M. – I doubt all of them were out grocery shopping.  Second, I saw construction workers still working and plenty of non-grocery small businesses were still open.  With Congress dragging their feet on the stimulus package I can’t blame these folks for doing everything they can to make a living; but, if we don’t take draconian-like measures to halt life as normal activities we will make little progress towards “flattening the curve” and our healthcare personnel and hospitals will certainly pay a terrible price for our hubris.  

Update: Mar 24, 2020

Today’s blog update provides a weblink to a YouTube video of NY Governor (Gov.) Andrew Cuomo’s 3/24/2020 Daily Press Briefing. I was very impressed with the briefing for two reasons: First, Gov. Cuomo delineated a viable approach to dealing with the virus by rotating (moving) ventilators and medical specialists across the US as the waves of infection peak at different locations and at different time periods over the coming months. The EU countries should be considering a similar strategy with allocating ventilators and personnel to Italy and Spain right now. The modelling on forecasted wave peaks need to be transparent so we can get resources and personnel in the places where they can do the most good. Second, it was extremely refreshing to see a government leader who spoke clearly, honestly and with empathy; leaders across the globe could take some serious pointers from this briefing on how to speak to their respective nations’ citizens about the coming difficult challenges that we all will have to face.

Update: Mar 23, 2020

Today’s blog update introduces the 15 points – recommendations of the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) on triaging COVID-19 patients for Intensive Care / Therapy.  For those closely watching the healthcare situation in Italy – which should be most of the world – these 15 points should be our wake-up call.  Our inability to grasp the gravity of the situation will be our sad legacy in the history books.  We should be moving heaven and earth right now to prop up and support our healthcare systems and personnel.

** I don’t speak Italian, so please forgive me if the translation is off a bit. I used the Google Translator (Italian to English) to do a paragraph-by-paragraph translation of SIAARTI’s Mar 7, 2020, Press Release and their accompanying 15 point Recommendation Letter.

Press Release – SIAARTI (The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care) – Mar 7, 2020

“EMERGENZA COVID-19: ECCO LE RACCOMANDAZIONI DI ETICA CLINICA DELLA SIAARTI”

EMERGENCY COVID-19: HERE ARE THE RECOMMENDATIONS OF CLINICAL ETHICS OF THE SIAARTI

“Un documento della Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva per gestire l’ammissione ai trattamenti intensivi, dopo che da parte dei soggetti coinvolti sono stati compiuti tutti gli sforzi possibili per aumentare la disponibilità di risorse erogabili.”

A document from the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Therapy to manage admission to intensive care, after all possible efforts have been made by the stakeholders to increase availability of available resources

“A fronte dell’attuale situazione di emergenza a causa della diffusione del COVID-19, la SOCIETA’ ITALIANA DI ANESTESIA ANALGESIA RIANIMAZIONE E TERAPIA INTENSIVA (SIAARTI) ha prodotto il documento tecnico “RACCOMANDAZIONI DI ETICA CLINICA PER L’AMMISSIONE A TRATTAMENTI INTENSIVI E PER LA LORO SOSPENSIONE, IN CONDIZIONI ECCEZIONALI DI SQUILIBRIO TRA NECESSITÀ E RISORSE DISPONIBILI”.”

In view of the current emergency situation due to the spread of COVID-19, the ITALIAN SOCIETA OF ANESTESIA ANALGESIA RESUSCITATION AND INTENSIVE TERAPIA (SIAARTI) produced the technical document ” INTENSIVE TREATMENT AND THEIR SUSPENSION, IN EXCEPTIONAL CONDITIONS OF IMBALANCE BETWEEN NEEDS AND AVAILABLE RESOURCES.”

“Si tratta di un documento in 15 punti che SIAARTI ha diffuso e pubblicato integralmente e senza alcuna restrizione, pur essendo indirizzato a colleghi ed esperti: è un testo finalizzato a fornire un supporto agli anestesisti-rianimatori attualmente impegnati a gestire in prima linea una maxi-emergenza che non precedenti per caratteristiche e proporzioni.”

It is a 15-point document that SIAARTI has disseminated and published in full and without any restrictions, while being addressed to colleagues and experts: it is a text aimed at providing support to anesthesiologists-resuscitators currently engaged in managing on the front line a maxi-emergency that is unprecedented for features and proportions.

“Come SIAARTI crediamo sia importante ed essenziale in un momento così drammatico come quello che stiamo attraversando a causa del COVID-19, offrire un supporto professionale e scientifico autorevole a chi è costretto dagli eventi quotidiani a prendere decisioni a volte difficili e dolorose. Migliaia di anestesisti e rianimatori oggi in Italia fanno parte di quella “prima linea medica” che sta assommando turni di 24 ore, insieme agli colleghi medici e infermieri, pur di assicurare assistenza di qualità e in continuità di cure.”

As SIAARTI we believe it is important and essential at such a dramatic time as what we are going through because of COVID-19, to offer authoritative professional and scientific support to those forced by everyday events to make decisions sometimes difficult and painful. Thousands of anesthesiologists and resuscitators in Italy today are part of that “first medical line” that is combining 24-hour shifts, together with fellow doctors and nurses, in order to ensure quality and continuous care.

“Ma in una situazione così complessa, ogni medico può trovarsi a dover prendere in breve tempo decisioni laceranti da un punto di vista etico oltre che clinico: quali pazienti sottoporre a trattamenti intensivi quando le risorse non sono sufficienti per tutti i pazienti che arrivano, non tutti con le stesse chance di ripresa (leggasi: posti con speciali caratteristiche, disponibili in aree che non possono essere ampliate in breve tempo, al netto che il loro numero possa essere al momento supportato da Sale Operatorie “convertite” bloccando l’attività chirurgica…).”

But in such a complex situation, every doctor may have to make short-term decisions that are ethically tearing from an ethical as well as a clinical point of view: which patients to undergo intensive care when the resources are not sufficient for all patients who arrive, not all with the same chance of recovery (read: places with special features, available in areas that cannot be expanded in a short time, net that their number can be supported at the moment by Operating Rooms “converted” blocking surgical activity…).

“Nel Documento SIAARTI si privilegia la “maggior speranza di vita”: questo comporta di non dover necessariamente seguire un criterio di accesso alle cure intensive di tipo “first come, first served”. Abbiamo voluto nelle Raccomandazioni sottolineare che l’applicazione di criteri di razionamento è giustificabile soltanto DOPO che da parte di tutti i soggetti coinvolti sono stati compiuti tutti gli sforzi possibili per aumentare la disponibilità di risorse erogabili (nella fattispecie, posti letto di Cure Intensive) e DOPO che è stata valutata ogni possibilità di trasferimento dei pazienti verso centri di cura con maggiore disponibilità di risorse.”

The SIAARTI document focuses on “greater life expectancy”: this means that you do not necessarily have to follow a criterion of access to “first come, first served” intensive care. We wanted to emphasise in the Recommendations that the application of rationing criteria is justifiable only AFTER all those involved have made all possible efforts to increase the availability of resources (in this case, intensive care beds) and AFTER that any possibility of transferring patients to care centres with greater availability of resources has been assessed.

“Le Raccomandazioni SIAARTI così definite sono frutto di un lavoro collegiale che mette a fattor comune la normativa nazionale, le esperienze e i riferimenti scientifici, clinici e assistenziali nazionali e internazionali, profondamente intrecciati con le riflessioni dell’etica in situazioni emergenziali. I punti del Documento sono 15 e comprendono ambiti differenti su cui l’emergenza ci sta interrogando, dalla flessibilità dei criteri alla gestione delle comorbidità, dalla presenza di dichiarazioni anticipate di trattamento (DAT) all’inappropriatezza dei trattamenti.”

The SIAARTI Recommendations as defined are the result of collegiate work that brings together national legislation, national and scientific, clinical and charitable experiences and references, deeply intertwined with the reflections on ethics in emerging situations. There are 15 points in the Document and include different areas on which the emergency is questioning us, from the flexibility of the criteria to the management of comorbidities, from the presence of advance declarations of treatment (DAT) to the inappropriateness of Treatments.

“Siamo consapevoli che affrontare questo tema può essere moralmente ed emotivamente difficile. Come Società Scientifica avremmo potuto (tacendo) affidare tutto al buon senso, alla sensibilità e all’esperienza del singolo AR, oppure tentare – come abbiamo scelto di fare – di illuminarne il processo decisionale con questo piccolo supporto che potrebbe contribuire a ridurne l’ansia, lo stress e soprattutto il senso di solitudine. Oltre a rappresentare per il paziente una tutela in termini di limitazione dell’arbitrarietà delle scelte del team curante.”

We understand that addressing this issue can be morally and emotionally difficult. As a Scientific Society we could (silently) entrust everything to the common sense, sensitivity and experience of the individual AR, or attempt – as we have chosen to do – to illuminate the decision-making process with this little support that could contribute anxiety, stress and, above all, a sense of loneliness. In addition to representing for the patient a protection in terms of limiting the arbitrariness of the choices of the healing team.

“Non è la SIAARTI, con questo Documento di Raccomandazioni, a proporre di trattare alcuni pazienti e di limitare i trattamenti su altri. Al contrario, sono gli eventi emergenziali che stanno costringendo gli anestesisti-rianimatori a focalizzare l’attenzione sull’appropriatezza dei trattamenti verso chi ne può trarre maggiore beneficio, laddove le risorse non sono sufficienti per tutti pazienti. La domanda che come SIAARTI ci sentiamo di fare in conclusione è dunque se l’insufficienza delle risorse poteva essere considerata, valutata e gestita in precedenza, ma la risposta a questo interrogativo (che si pone oggi di fronte ad un’epidemia che non ha eguali negli ultimi decenni) con ogni probabilità è nelle competenze e nelle disponibilità delle Istituzioni.”

It is not SIAARTI, with this Recommendations Document, that proposes to treat some patients and limit treatments on others. On the contrary, it is the emerging events that are forcing anesthesiologists-resuscitators to focus attention on the appropriateness of treatments towards those who can benefit the most, where resources are not sufficient for all patients. The question that we as SIAARTI we feel to be asking in conclusion is therefore whether the inadequacy of resources could be considered, assessed and managed previously, but the answer to this question (which today arises in the face of an epidemic that is unparalleled in the decades) is likely to be in the competence and availability of the institutions.

http://www.siaarti.it/News/comunicato%20raccomandazioni%20di%20etica%20clinica%20siaarti.aspx

“RACCOMANDAZIONI DI ETICA CLINICA PER L’AMMISSIONE A TRATTAMENTI INTENSIVI E PER LA LORO SOSPENSIONE, IN CONDIZIONI ECCEZIONALI DI SQUILIBRIO TRA NECESSITÀ E RISORSE DISPONIBILI”

CLINICAL ETHICS RECOMMENDATIONS FOR ADMISSION TO INTENSIVE CARE AND FOR THEIR SUSPENSION, IN EXCEPTIONAL CONDITIONS OF IMBALANCE BETWEEN NEEDS AND AVAILABLE RESOURCES

“Gruppo di lavoro (Working Group) Marco Vergano, Guido Bertolini, Alberto Giannini, Giuseppe Gristina, Sergio Livigni, Giovanni Mistraletti, Flavia Petrini”

“Le previsioni sull’epidemia da Coronavirus (Covid-19) attualmente in corso in alcune regioni italiane stimano per le prossime settimane, in molti centri, un aumento dei casi di insufficienza respiratoria acuta (con necessità di ricovero in Terapia Intensiva) di tale entità da determinare un enorme squilibrio tra le necessità cliniche reali della popolazione e la disponibilità effettiva di risorse intensive.  È uno scenario in cui potrebbero essere necessari criteri di accesso alle cure intensive (e di dimissione) non soltanto strettamente di appropriatezza clinica e di proporzionalità delle cure, ma ispirati anche a un criterio il più possibile condiviso di giustizia distributiva e di appropriata allocazione di risorse sanitarie limitate. Uno scenario di questo genere è sostanzialmente assimilabile all’ambito della “medicina delle catastrofi”, per la quale la riflessione etica ha elaborato nel tempo molte concrete indicazioni per i medici e gli infermieri impegnati in scelte difficili. Come estensione del principio di proporzionalità delle cure, l’allocazione in un contesto di grave carenza (shortage) delle risorse sanitarie deve puntare a garantire i trattamenti di carattere intensivo ai pazienti con maggiori possibilità di successo terapeutico: si tratta dunque di privilegiare la “maggior speranza di vita”. Il bisogno di cure intensive deve pertanto essere integrato con altri elementi di “idoneità clinica” alle cure intensive, comprendendo quindi: il tipo e la gravità della malattia, la presenza di comorbidità, la compromissione di altri organi e apparati e la loro reversibilità. Questo comporta di non dover necessariamente seguire un criterio di accesso alle cure intensive di tipo “first come, first served”.”

Predictions of the Coronavirus outbreak (Covid-19) currently underway in some Italian regions estimate for the next few weeks, in many centers, an increase in cases of acute respiratory failure (with need for hospitalization in intensive care) of this a huge imbalance between the real clinical needs of the population and the actual availability of intensive resources.  It is a scenario in which criteria for access to intensive care (and discharge) may be needed, not only strictly clinical appropriateness and proportionality of care, but also inspired by a criterion as shared as possible of justice. appropriate allocation of limited health resources. Such a scenario is broadly comparable to the field of “disaster medicine”, for which ethical reflection has developed over time many concrete indications for doctors and nurses engaged in difficult choices. As an extension of the principle of proportionality of care, the allocation in a context of severe shortage of health resources must aim to ensure intensive treatments for patients with greater chances of therapeutic success: It is therefore a question of prioritising “greater life expectancy”. The need for intensive care must therefore be supplemented with other elements of “clinical fitness” for intensive care, including: the type and severity of the disease, the presence of comorbidity, the impairment of other organs and apparatuses and their Reversibility. This means that you don’t necessarily have to follow a “first come, first served” policy of access to intensive care

“È comprensibile che i curanti, per cultura e formazione, siano poco avvezzi a ragionare con criteri di triage da maxi-emergenza, in quanto la situazione attuale ha caratteristiche di eccezionalità. La disponibilità di risorse non entra solitamente nel processo decisionale e nelle scelte del singolo caso, finché le risorse non diventano così scarse da non consentire di trattare tutti i pazienti che potrebbero ipoteticamente beneficiare di uno specifico trattamento clinico. È implicito che l’applicazione di criteri di razionamento è giustificabile soltanto dopo che da parte di tutti i soggetti coinvolti (in particolare le “Unità di Crisi” e gli organi direttivi dei presidi ospedalieri) sono stati compiuti tutti gli sforzi possibili per aumentare la disponibilità di risorse erogabili (nella fattispecie, letti di Terapia Intensiva) e dopo che è stata valutata ogni possibilità di trasferimento dei pazienti verso centri con maggiore disponibilità di risorse. È importante che una modifica dei criteri di accesso possa essere condivisa il più possibile tra gli operatori coinvolti. Ai pazienti e ai loro familiari interessati dall’applicazione dei criteri deve essere comunicata la straordinarietà delle misure in atto, per una questione di dovere di trasparenza e di mantenimento della fiducia nel servizio sanitario pubblico. Lo scopo delle raccomandazioni è anche quello:”

“A) di sollevare i clinici da una parte della responsabilità nelle scelte, che possono essere emotivamente gravose, compiute nei singoli casi; (B) di rendere espliciti i criteri di allocazione delle risorse sanitarie in una condizione di una loro straordinaria scarsità.”

It is understandable that caregivers, for culture and training, are not accustomed to reasoning with criteria of maxi-emergency triage, since the current situation has characteristics of exceptionality. The availability of resources does not usually enter the decision-making process and the choices of the individual case, until the resources become so scarce that they do not allow to treat all patients who could hypothetically benefit from a specific clinical treatment. It is implied that the application of rationing criteria is justifiable only after all those involved (in particular the “Crisis Units” and the governing bodies of hospital wards) have made all possible efforts to increase the availability of available resources (in this case, intensive care beds) and after any possibility of transferring patients to centres with greater availability of resources has been assessed. It is important that a change in access policies can be shared as much as possible among the operators involved. Patients and their families affected by the application of the criteria must be notified of the extraordinary nature of the measures in place, for a matter of duty of transparency and maintenance of trust in the public health service. The purpose of the recommendations is also to:

 (A) to relieve clinicians of part of the responsibility in choices, which can be emotionally burdensome, made in individual cases; (B) to make explicit the criteria for allocating health resources in a condition of their extraordinary scarcity.”

“Dalle informazioni ad ora disponibili, una parte consistente di soggetti con diagnosi di infezione da Covid-19 richiede supporto ventilatorio a causa di una polmonite interstiziale caratterizzata da ipossiemia severa. L’interstiziopatia è potenzialmente reversibile, ma la fase di acuzie può durare molti giorni.”

From the information available to date, a substantial proportion of people diagnosed with Covid-19 infection require ventilator support due to intertial pneumonia characterized by severe hypoxia. Interstitiapathy is potentially reversible, but the acute phase can last many days.

“A differenza di quadri di ARDS più familiari, a parità di ipossiemia, le polmoniti da Covid-19 sembrano avere compliance polmonare leggermente migliore e rispondere meglio a reclutamenti, PEEP medioalte, cicli di pronazione, ossido nitrico inalatorio. Come per i quadri più noti di ARDS abituali, questi pazienti richiedono una ventilazione protettiva, con bassa driving pressure. Tutto questo comporta il fatto che l’intensità di cura può essere elevata, così come l’impiego di risorse umane. Dai dati riferiti alle prime due settimane in Italia, circa un decimo dei pazienti infetti richiede un trattamento intensivo con ventilazione assistita, invasiva o non invasiva.”

Unlike more familiar ARDS frameworks, with the same hypoxemia, Covid-19 pneumonia appears to have slightly better lung compliance and respond better to recruits, medium-range PEEPs, pronation cycles, inhalatory nitric oxide. As with the best-known paintings of habitual ARDS, these patients require protective ventilation, with low driving pressure. All this entails the fact that the intensity of care can be high, as well as the use of human resources. From the data reported for the first two weeks in Italy, about one-tenth of the infected patients require intensive treatment with assisted, invasive or non-invasive ventilation.

“RACCOMANDAZIONI” (RECOMMENDATIONS)

1. “I criteri straordinari di ammissione e di dimissione sono flessibili e possono essere adattati localmente alla disponibilità di risorse, alla concreta possibilità di trasferire pazienti, al numero di accessi in atto o previsto. I criteri riguardano tutti i pazienti intensivi, non-solo i pazienti infetti con infezione da Covid-19.”

1. The extraordinary admission and discharge criteria are flexible and can be adapted locally to the availability of resources, the concrete possibility of transferring patients, to the number of accesses in place or expected. The criteria apply to all intensive patients, not just patients infected with Covid-19 infection.

2. “L’allocazione è una scelta complessa e molto delicata, anche per il fatto che un eccessivo aumento straordinario dei letti intensivi non garantirebbe cure adeguate ai singoli pazienti e distoglierebbe risorse, attenzione ed energie ai restanti pazienti ricoverati nelle Terapie Intensive. È da considerare anche l’aumento prevedibile della mortalità per condizioni cliniche non legate all’epidemia in corso, dovuta alla riduzione dell’attività chirurgica ed ambulatoriale elettiva e alla scarsità di risorse intensive.”

2. Allocation is a complex and very delicate choice, not only because an excessive extraordinary increase in intensive beds would not provide adequate care for individual patients and would divert resources, attention and energy away from the remaining patients admitted to Intensive Therapies. The foreseeable increase in mortality due to clinical conditions not related to the ongoing epidemic, due to reduced elective surgical and outpatient activity and the scarcity of intensive resources, should also be considered.

3. “Può rendersi necessario porre un limite di età all’ingresso in TI. Non si tratta di compiere scelte meramente di valore, ma di riservare risorse che potrebbero essere scarsissime a chi ha in primis più probabilità di sopravvivenza e secondariamente a chi può avere più anni di vita salvata, in un’ottica di massimizzazione dei benefici per il maggior numero di persone.  In uno scenario di saturazione totale delle risorse intensive, decidere di mantenere un criterio di “first come, first served” equivarrebbe comunque a scegliere di non curare gli eventuali pazienti successivi che rimarrebbero esclusi dalla Terapia Intensiva.”

3. It may be necessary to place an age limit when entering IT. It is not a question of making purely value choices, but of reserving resources that could be very scarce to those who are primarily more likely to survive and secondly to those who may have more years of life saved, with a view to maximizing the benefits for the greater number of people. In a scenario of total saturation of intensive resources, deciding to maintain a “first come, first served” criterion would still be tantamount to choosing not to treat any subsequent patients who would be excluded from intensive care.

4. “La presenza di comorbidità e lo status funzionale devono essere attentamente valutati, in aggiunta all’età anagrafica. È ipotizzabile che un decorso relativamente breve in persone sane diventi potenzialmente più lungo e quindi più “resource consuming” sul servizio sanitario nel caso di pazienti anziani, fragili o con comorbidità severa.  Possono essere particolarmente utili a questo scopo i criteri clinici specifici e generali presenti nel Documento SIAARTI multisocietario del 2013 sulle grandi insufficienze d’organo end-stage (https://bit.ly/2Ifkphd). È inoltre opportuno fare riferimento anche al documento SIAARTI relativo ai criteri di ammissione in Terapia Intensiva (Minerva Anestesiol 2003;69(3):101–118)”

4. The presence of comorbidity and functional status should be carefully assessed, in addition to the age of the age. It is conceivable that a relatively short course in healthy people will potentially become longer and therefore more resource consuming on the health service in the case of elderly patients, frail or with severe comorbidity. The specific and general clinical criteria present in the 2013 SIAARTI Multi-Company Document on large end-stage organ deficiencies may be particularly useful for this purpose.

https://bit.ly/2Ifkphd. The SIAARTI document on the criteria for admission to intensive care (Minerva Anesthesiol 2003;69(3):101–118)

5. “Deve essere considerata con attenzione l’eventuale presenza di volontà precedentemente espresse dai pazienti attraverso eventuali DAT (disposizioni anticipate di trattamento) e, in modo particolare, quanto definito (e insieme ai curanti) da parte delle persone che stanno già attraversando il tempo della malattia cronica attraverso una pianificazione condivisa delle cure.”

5. (The SIAARTI document on the criteria for admission to intensive care) should also be referred to. It should be carefully considered the presence of will previously expressed by patients through any DATs (early treatment provisions) and, in particular, what is defined (and together with the caregivers) by people who are already going through the time of chronic disease through shared planning of care.

6. “Per i pazienti per cui viene giudicato “non appropriato” l’accesso a un percorso intensivo, la decisione di porre una limitazione alle cure (“ceiling of care”) dovrebbe essere comunque motivata, comunicata e documentata. Il ceiling of care posto prima della ventilazione meccanica non deve precludere intensità di cura inferiori.”

6. For patients who are deemed “inappropriate” to access an intensive pathway, the decision to place a “ceiling of care” restriction should still be justified, communicated and documented. The ceiling of care placed before mechanical ventilation should not preclude lower care intensity.

7. “Un eventuale giudizio di inappropriatezza all’accesso a cure intensive basato unicamente su criteri di giustizia distributiva (squilibrio estremo tra richiesta e disponibilità) trova giustificazione nella straordinarietà della situazione.”

7. Any judgment of inappropriateness to access to intensive care based solely on criteria of distributive justice (extreme imbalance between demand and availability) is justified in the extraordinary nature of the situation.

8. “Nel processo decisionale, qualora si presentino situazioni di particolare difficoltà e incertezza, può essere utile avere una “second opinion” (eventualmente anche solo telefonica) da parte di interlocutori di particolare esperienza (ad esempio, attraverso il Centro Regionale di Coordinamento).”

8. In the decision-making process, if there are situations of particular difficulty and uncertainty, it may be useful to have a ” second opinion ” (possibly even just telephone) from stakeholders of particular experience (for example, through the Regional Coordination Centre).

9. “I criteri di accesso alla Terapia Intensiva andrebbero discussi e definiti per ogni paziente in modo il più possibile anticipato, creando idealmente per tempo una lista di pazienti che saranno ritenuti meritevoli di Terapia Intensiva nel momento in cui avvenisse il deterioramento clinico, sempre che le disponibilità in quel momento lo consentano. Un’eventuale istruzione “do not intubate” dovrebbe essere presente in cartella clinica, pronta per essere utilizzata come guida se il deterioramento clinico avvenisse precipitosamente e in presenza di curanti che non hanno partecipato alla pianificazione e che non conoscono il paziente.”

9. The criteria for access to ICU should be discussed and defined for each patient as early as possible, ideally creating in time a list of patients who will be deemed worthy of intensive care when clinical deterioration occurred, provided that availability at that time permits.  A possible “do not intubate” instruction should be present in the medical record, ready to be used as a guide if the clinical deterioration occurred hastily and in the presence of caregivers who did not participate in the planning and who did not know the patient.

10. “La sedazione palliativa nei pazienti ipossici con progressione di malattia è da considerarsi necessaria in quanto espressione di buona pratica clinica, e deve seguire le raccomandazioni esistenti. Qualora si dovesse prevedere un periodo agonico non breve, deve essere previsto un trasferimento in ambiente non intensivo.”

10. Palliative sedation in hypoxic disease-progression patients is considered necessary as an expression of good clinical practice and must follow existing recommendations. If a non-short agonical period is envisaged, a transfer to a non-intensive environment should be provided.

11. “Tutti gli accessi a cure intensive devono comunque essere considerati e comunicati come “ICU trial” e sottoposti pertanto quotidiana rivalutazione dell’appropriatezza, degli obiettivi di cura e della proporzionalità delle cure. Nel caso si ritenga che un paziente, ricoverato magari con criteri borderline, non risponda a trattamento iniziale prolungato oppure si complichi in modo severo, una decisione di “desistenza terapeutica” e di rimodulazione delle cure da intensive a palliative – in uno scenario di afflusso eccezionalmente elevato di pazienti – non deve essere posticipata.”

11. All access to intensive care must still be considered and communicated as an ICU trial and therefore subjected to daily reassessment of the appropriateness, care objectives and proportionality of care. If a patient, admitted perhaps with borderline criteria, is deemed to be unresponsive to prolonged initial treatment or severely complicates, a decision of “therapeutic care” and re-modulation of intensive to palliative care – in one scenario of exceptionally high influx of patients – should not be postponed.

12. “La decisione di limitare le cure intensive deve essere discussa e condivisa il più possibile collegialmente dell’équipe curante e – per quanto possibile – in dialogo con il paziente (e i familiari), ma deve poter essere tempestiva.  È prevedibile che la necessità di compiere ripetutamente scelte di questo tipo renda in ciascuna Terapia Intensiva più solido il processo decisionale e meglio adattabile alla disponibilità di risorse.”

12. The decision to limit intensive care should be discussed and shared as much as possible collectively by the care team and – as far as possible – in dialogue with the patient (and family members), but it must be in a timely manner.  The need to make repeated choices of this kind is to make decision-making more robust in each intensive therapy and better adaptable to resource availability.

13. “Il supporto ECMO, in quanto resource consuming rispetto a un ricovero ordinario in Terapia Intensiva, in condizioni di afflusso straordinario, dovrebbe essere riservato a casi estremamente selezionati e con previsione di svezzamento relativamente rapida. Dovrebbe essere riservato idealmente a centri hub ad elevato volume, per i quali il paziente in ECMO assorbe in proporzione meno risorse di quante ne assorbirebbe in un centro con meno expertise.”

13. ECMO support, as a resource consuming compared to an ordinary hospital stay in intensive care, in conditions of extraordinary influx, should be reserved for highly selected cases with a relatively rapid weaning expectation. It should ideally be reserved for high volume hub centers, for which the ECMO patient absorbs proportionately fewer resources than he would absorb in a center with less expertise.

14. “È importante “fare rete”, attraverso l’aggregazione e lo scambio di informazioni tra centri e singoli professionisti. Quando le condizioni lavorative lo consentiranno, al termine dell’emergenza, sarà importante dedicare tempo e risorse a momenti di debriefing e di monitoraggio dell’eventuale burnout professionale e del moral distress degli operatori.”

14. It is important to “network” through the aggregation and exchange of information between centres and individual professionals. When the working conditions allow, at the end of the emergency, it will be important to devote time and resources to moments of debriefing and monitoring of the possible professional burnout and moral distress of the operators.

15. “Devono essere considerate anche le ricadute sui familiari ricoverati nelle TI Covid-19, soprattutto nei casi in cui il paziente muoia al termine di un periodo di restrizione totale delle visite.”

15. The impact on family members admitted to TI Covid-19 should also be considered, especially in cases where the patient dies at the end of a total period of restriction of visits.

http://www.siaarti.it/SiteAssets/News/COVID19%20-%20documenti%20SIAARTI/SIAARTI%20-%20Covid19%20-%20Raccomandazioni%20di%20etica%20clinica.pdf

Update: Mar 22, 2020

Today’s blog update is a call for the US federal government and individual state governors to consider, in addition to activating National Guard units, to activating the Armed Forces Selected Reserves; and, preferably granting waivers to Key Personnel currently employed in essential (i.e. healthcare, law enforcement, food distribution) positions in their respective civilian communities.  Considering the logistics involved in such an activation, we need to start it soon! Our leaders should also consider activating the Individual Ready Reserves and mustering the Retired Reserves and Retired Members. We need to consider the worst case scenario – that there will likely come a point in which we will have to implement Martial Law.  If (when) the healthcare systems collapse, along with food distribution chains, we will need the military to maintain order.  Posse Comitatus concerns will need to be addressed by Congress now, not when it’s too late!

“10 U.S.C. § 12304a – U.S. Code – Unannotated Title 10. Armed Forces § 12304a. Army reserve, navy reserve, marine corps reserve, and air force reserve:  order to active duty to provide assistance in response to a major disaster or emergency”

“(a) Authority. When a Governor requests Federal assistance in responding to a major disaster or emergency (as those terms are defined in section 102 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act ( 42 U.S.C. 5122 )), the Secretary of Defense may, without the consent of the member affected, order any unit, and any member not assigned to a unit organized to serve as a unit, of the Army Reserve, Navy Reserve, Marine Corps Reserve, and Air Force Reserve to active duty for a continuous period of not more than 120 days to respond to the Governor’s request.”

https://codes.findlaw.com/us/title-10-armed-forces/10-usc-sect-12304a.html

The Selected Reserve – Wikipedia

  • “The Selected Reserve (also called SELRES, SR, or mistakenly Selective Reserve) are the members of a U.S. military Ready Reserve unit that are enrolled in the Ready Reserve program and the reserve unit that they are attached to. Selected Reserve members and units are considered to be in an active status.”
  • “When the term is applied to personnel, it is contrasted to the Full-time Reserve Unit Support (also called Full Time Support or FTS) members of the same reserve unit who are Active Duty. It is also contrasted to members of the Individual Ready Reserve who are not in active status.”

https://en.wikipedia.org/wiki/Selected_Reserve

Individual Ready Reserves – Wikipedia

“Callup authority and activation”

  • “Presidential Reserve Callup Authority” (PRCA) is a provision of a public law (US Code, Title 10 (DOD), section 12304) that provides the President a means to activate, without a declaration of national emergency, not more than 200,000 members of the Selected Reserve and the Individual Ready Reserve (of whom not more than 30,000 may be members of the Individual Ready Reserve), for not more than 400 days to meet the support requirements of any operational mission. Members called under this provision may not be used for disaster relief or to suppress insurrection. This authority has particular utility when used in circumstances in which the escalatory national or international signals of partial or full mobilization would be undesirable. Forces available under this authority can provide a tailored, limited-scope, deterrent or operational response, or may be used as a precursor to any subsequent mobilization.”
  • “When the nation is under a presidentially declared state of national emergency in accordance with the National Emergencies Act the President has even broader authority, allowing him to activate not more than 1,000,000 members of the Ready Reserve with no further limitation.”

https://en.wikipedia.org/wiki/Individual_Ready_Reserve

“10 USC 688: Retired members: authority to order to active duty; duties Text contains those laws in effect on March 21, 2020”

  • “688. Retired members: authority to order to active duty; duties

“(a) Authority.-Under regulations prescribed by the Secretary of Defense, a member described in subsection (b) may be ordered to active duty by the Secretary of the military department concerned at any time.”

“(b) Covered Members.-Except as provided in subsection (d), subsection (a) applies to the following members of the armed forces:

(1) A retired member of the Regular Army, Regular Navy, Regular Air Force, or Regular Marine Corps.

(2) A member of the Retired Reserve who was retired under section 1293, 7311, 7314, 8323, 9311, or 9314 of this title.

(3) A member of the Fleet Reserve or Fleet Marine Corps Reserve.”

“(c) Duties of Member Ordered to Active Duty.-The Secretary concerned may, to the extent consistent with other provisions of law, assign a member ordered to active duty under this section to such duties as the Secretary considers necessary in the interests of national defense.”

“(d) Exclusion of Officers Retired on Selective Early Retirement Basis.-The following officers may not be ordered to active duty under this section:

(1) An officer who retired under section 638 of this title.

(2) An officer who-

(A) after having been notified that the officer was to be considered for early retirement under section 638 of this title by a board convened under section 611(b) of this title and before being considered by that board, requested retirement under section 7311, 8323, or 9311 of this title; and

(B) was retired pursuant to that request.”

“(e) Limitation of Period of Recall Service.-(1) A member ordered to active duty under subsection (a) may not serve on active duty pursuant to orders under that subsection for more than 12 months within the 24 months following the first day of the active duty to which ordered under that subsection.

(2) Paragraph (1) does not apply to the following officers:

(A) A chaplain who is assigned to duty as a chaplain for the period of active duty to which ordered.

(B) A health care professional (as characterized by the Secretary concerned) who is assigned to duty as a health care professional for the period of active duty to which ordered.

(C) An officer assigned to duty with the American Battle Monuments Commission for the period of active duty to which ordered.

(D) An officer who is assigned to duty as a defense attaché or service attaché for the period of active duty to which ordered.”

“(f) Waiver for Periods of War or National Emergency.-Subsections (d) and (e) do not apply in time of war or of national emergency declared by Congress or the President.”

(Added Pub. L. 104–201, div. A, title V, §521(a), Sept. 23, 1996, 110 Stat. 2515 ; amended Pub. L. 105–85, div. A, title V, §502, Nov. 18, 1997, 111 Stat. 1724 ; Pub. L. 107–107, div. A, title V, §509(a), Dec. 28, 2001, 115 Stat. 1091 ; Pub. L. 115–232, div. A, title VIII, §809(a), Aug. 13, 2018, 132 Stat. 1840 .)

https://uscode.house.gov/view.xhtml?req=(title:10%20section:688%20edition:prelim)%20OR%20(granuleid:USC-prelim-title10-section688)&f=treesort&num=0&edition=prelim

Martial Law -Wikipedia:

  • “The martial law concept in the United States is closely tied with the right of habeas corpus, which is in essence the right to a hearing on lawful imprisonment, or more broadly, the supervision of law enforcement by the judiciary. The ability to suspend habeas corpus is related to the imposition of martial law.[33] Article 1, Section 9 of the US Constitution states, “The Privilege of the Writ of Habeas Corpus shall not be suspended, unless when in Cases of Rebellion or Invasion the public Safety may require it.” There have been many instances of the use of the military within the borders of the United States, such as during the Whiskey Rebellion and in the South during the Civil Rights Movement, but these acts are not tantamount to a declaration of martial law. The distinction must be made as clear as that between martial law and military justice: deployment of troops does not necessarily mean that the civil courts cannot function, and that is one of the keys, as the Supreme Court noted, to martial law.”

https://en.wikipedia.org/wiki/Martial_law

Posse Comitatus – Wikipedia

  • “In the United States, a federal statute known as the Posse Comitatus Act, enacted in 1878, forbade the use of the US Army, and through it, its offspring, the US Air Force, as a posse comitatus or for law enforcement purposes without the approval of Congress. While the act does not explicitly mention the US Navy and the US Marine Corps, the US Department of the Navy has prescribed regulations that are generally construed to give the act force with respect to branches as well.”

https://en.wikipedia.org/wiki/Posse_comitatus

Update: Mar 21, 2020

Today’s second blog update is a simple request to the White House: Please stop having President Trump and VP Pence conduct the daily briefings. They both seem totally disconnected from reality, and instead of inspiring hope, they’re making a portion of the US population seriously doubt their federal government’s ability to comprehend and effectively deal with the crisis at hand.

Today’s first blog update contains excerpts from a recent New England Journal of Medicine (NEJM) letter that indicates the Novel Coronavirus (AKA: SARS-CoV-2) can be aerosolized and that the virus remains viable while suspended in air for up to three hours – facilitating faster and easier spread of the virus.  It appears the Novel Coronavirus has multiple weapons in it’s toolkit to ensure its continued spread: airborne droplets (via coughs, sneezing), airborne molecules (just breathing the infected air), droplets that land or transfer to contact surfaces (like door knobs, countertops, elevator buttons), direct exchange of bodily fluids (kissing, sex), and through fecal transmission (fecal particles on toilets, hands). This is why social distancing and disinfecting protocols are so important!

For those of you who need a bit of dark humor: this also means people can possibly shed the virus through farting.

“Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1” – By Dr. van Doremalen, Mr. Bushmaker, and Mr. Morris – New England Journal of Medicine (NEJM) – Mar 17, 2020

  • SARS-CoV-2 (Novel Coronavirus) remained viable in aerosols throughout the duration of our experiment (3 hours), with a reduction in infectious titer from 103.5 to 102.7 TCID50 per liter of air. This reduction was similar to that observed with SARS-CoV-1, from 104.3 to 103.5 TCID50 per milliliter (Figure 1A).”
  • SARS-CoV-2 was more stable on plastic and stainless steel than on copper and cardboard, and viable virus was detected up to 72 hours after application to these surfaces (Figure 1A), although the virus titer was greatly reduced (from 103.7 to 100.6 TCID50 per milliliter of medium after 72 hours on plastic and from 103.7 to 100.6 TCID50 per milliliter after 48 hours on stainless steel). The stability kinetics of SARS-CoV-1 were similar (from 103.4 to 100.7 TCID50 per milliliter after 72 hours on plastic and from 103.6 to 100.6 TCID50 per milliliter after 48 hours on stainless steel). On copper, no viable SARS-CoV-2 was measured after 4 hours and no viable SARS-CoV-1 was measured after 8 hours. On cardboard (i.e. mail packages), no viable SARS-CoV-2 was measured after 24 hours and no viable SARS-CoV-1 was measured after 8 hours (Figure 1A).”
  • Our results indicate that aerosol and fomite transmission of SARS-CoV-2 is plausible, since the virus can remain viable and infectious in aerosols for hours and on surfaces up to days (depending on the inoculum shed). These findings echo those with SARS-CoV-1, in which these forms of transmission were associated with nosocomial spread and super-spreading events,5 and they provide information for pandemic mitigation efforts.”

https://www.nejm.org/doi/full/10.1056/NEJMc2004973#.XnGGKWVPq0Q

Definition of fomite: “an object (such as a dish or a doorknob) that may be contaminated with infectious organisms and serve in their transmission”

https://www.merriam-webster.com/dictionary/fomite

Definition of titer: “the quantity of a substance required to react with or to correspond to a given amount of another substance.”

https://medical-dictionary.thefreedictionary.com/titer

Coronavirus spread via aerosol raises concern as death toll rises- By Angela Betsaida B. Laguipo, BSN, News Medical Lifesciences, Feb 10, 2020

  • Aerosol transmission of airborne mode refers to situations where droplets nuclei, which are residue from evaporated droplets or dust particles that contain pathogens or disease-causing microorganisms are suspended in the air for long periods. The microorganisms can survive in the air and outside the body until another host inhales it.”
  • “If the coronavirus can be transmitted via aerosols, the rate of infection is faster, and the spread is harder to contain.”

https://www.news-medical.net/news/20200210/Coronavirus-spread-via-aerosol-raises-concern-as-death-toll-rises.aspx

Update: Mar 20, 2020

Today’s blog update introduces another radical idea.  Before I introduce the idea, let me lay the groundwork.  Right now, some of us – the ones that are paying attention – feel helpless because we recognize the coming tsunami of illness that will befall our healthcare systems, as it is so obviously doing right now in countries like Italy, Iran and Spain.  Most of the world is grossly unprepared in so many ways that our governments are grasping at straws and downplaying the severity of what’s to come in order to avoid mass hysteria, panic, chaos, looting, riots, etc….  So that’s the bad news!  The good news is we’re not completely helpless, we can do something!  We just have to think beyond our own borders, and we have to look at this problem as one species (Humanity vs. The Virus).  We have a much better chance of “flattening the curve” if we tackle this crisis together.  My proposal is this:  For countries that have apparently passed their peak in the curve (i.e. China, South Korea), and countries or states that seem to have 30 days before their peak (the US, UK) – send 10% of your nation’s medical personnel (volunteers only) to the global hot zones to relieve and augment the exhausted medical staff of those afflicted nations.  This seems counterintuitive, but our best hope for decreasing global mortality rates and preventing healthcare systems from collapsing is to have 10% or more of the world’s medical personnel contract the virus early on in the pandemic, before the curves rise, so that they (most of them) will recover and be available to help their own healthcare systems when the virus waves peak in their respective home countries.  I know that’s asking a hell of lot from healthcare workers – probably too much; still, it’s an idea, and we seem to be short of ideas these days.  Maybe I’m grasping at straws too!

Update: Mar 19, 2020

Today’s second blog update is about COVID-19 testing, not to see if you have the virus, but to see if you already had the virus. The Dutch are already doing this with blood tests looking for COVID-19 antibodies. If these tests are easier and less expensive to conduct they might be very helpful in the future in getting the already infected people back to work. Strange, but I can see a not too distant future in which we group or categorize people into two classes: the infected and uninfected, and that it will be viewed socially/culturally/financially as a positive to be among the previously infected.

“Dutch test blood donations for unseen coronavirus spread” – Reuters, Mar 19, 2020

  • “AMSTERDAM (Reuters) – Dutch health authorities have begun a major project testing blood donation samples to see how many people in the Netherlands may have already had the new coronavirus, often with symptoms so mild they hardly noticed.  The project is being carried out on 10,000 blood donation samples a week by blood bank Sanquin, in cooperation with the country’s National Institute for Health (RIVM).”
  • “It’s possible that you had coronavirus without being sick,” Sanquin spokesman Merlijn van Hasselt told national broadcaster NOS. “If we test for antibodies, we can see whether you’ve already had it … and over time get a picture of how that’s evolving.”
  • “However, RIVM spokesman Harald Wychgel said that there is vast uncertainty as to how many people may have already had the virus and have beaten the disease, which the blood tests would show.  Active tests for coronavirus among healthcare workers with cold symptoms at hospitals in the province of Noord Brabant on March 6-8 showed a surprising 3.9% of them had the virus.”

https://news.yahoo.com/dutch-test-blood-donations-unseen-112650245.html

Today’s first blog update is about blood donations. The US Surgeon General’s call for blood donations spurred me to do a quick web search which disclosed the linked “Journal of Emerging Microbes & Infections” article. To clarify, I have no medical background; however, I don’t think it takes a medical degree to read the following excerpts and conclude that the Novel Coronavirus is detectable and transmissible in the blood stream. I’m all for donating blood, and suggest that we all continue to do so; however, I also think we should identify all blood donated since Dec 2019 as possibly COVID-19 contaminated! Consequently, the medical community should consider restricting transfusions of such blood supplies only to individuals who have tested positive for COVID-19. If it’s not too expensive, maybe they could test the blood supplies for COVID-19 antibodies, like the Dutch are doing in their medical study.

Detectable 2019-nCoV viral RNA in blood is a strong indicator for the further clinical severity” – By Weilie Chen, Yun Lan, Xiaozhen Yuan, Xilong Deng, Yueping Li, Xiaoli Cai, Liya Li, Ruiying He, Yizhou Tan, Xizi Deng, Ming Gao, Guofang Tang, Lingzhai Zhao, Jinlin Wang, Qinghong Fan, Chunyan Wen, Yuwei Tong, Yangbo Tang, Fengyu Hu, Feng Li & Xiaoping Tang

Emerging Microbes & Infections, Volume 9, 2020 – Issue 1

Published online: 26 Feb 2020 (Pages 469-473 | Received 08 Feb 2020, Accepted 15 Feb 2020, Published online: 26 Feb 2020), https://doi.org/10.1080/22221751.2020.1732837

  •  “The novel coronavirus (2019-nCoV) infection caused pneumonia. we retrospectively analyzed the virus presence in the pharyngeal swab, blood, and the anal swab detected by real-time PCR in the clinical lab. Unexpectedly, the 2109-nCoV RNA was readily detected in the blood (6 of 57 patients) and the anal swabs (11 of 28 patients). Importantly, all of the 6 patients with detectable viral RNA in the blood cohort progressed to severe symptom stage, indicating a strong correlation of serum viral RNA with the disease severity (p-value = 0.0001). Meanwhile, 8 of the 11 patients with annal swab virus-positive was in severe clinical stage. However, the concentration of viral RNA in the anal swab (Ct value = 24 + 39) was higher than in the blood (Ct value = 34 + 39) from patient 2, suggesting that the virus might replicate in the digestive tract. Altogether, our results confirmed the presence of virus RNA in extra-pulmonary sites.”
  • “Finally, we described here the four patients with detectable serum viral RNA. Patient 3 (Figure 3(A)) was transferred to the ICU directly on illness day 11 because of his severe condition, the 2019-nCoV virus was laboratory detected both in pharyngeal (Ct = 30 + 30) and blood samples (Ct = 37 + 39) on day 12, And his infection was confirmed by CDC on day 13. Pharyngeal samples were PCR positive on days 14 and 17 and became negative on day 22. Patient 4 (Figure 3(B)) was transferred to the ICU ward on the illness day 6 with a CDC confirmation. His disease advanced pretty fast and became severe on day 7 and he was transferred to ICU after his blood sample was detected to be virus-positive (Ct = 32 + 37). On day 9, he was transferred out. Patient 5 (Figure 3(C)) was admitted on illness day 4 and his blood sample was virus-positive (Ct = 38 + Neg) on day 6. Her disease progressed rapidly to a severe stage within the next 3 days. Patient 6 (Figure 3(D)) with a clear history of virus infection was confirmed to be infected on infection day 7. Viral RNA was detected in his blood sample on day 9, one day ahead of his transfer into ICU. As his condition worsens, he was transferred out on day 13.”

https://www.tandfonline.com/doi/full/10.1080/22221751.2020.1732837?src=recsys

Update: Mar 18, 2020

Today’s second blog update is about grocery stores.  Government monetary (fiscal) stimulus plans around the world sound great on the whole, but consider this:  the millions of grocery store workers who go to work every day to pay the rent, pay bills, buy groceries, etc.… will they reconsider why they show up for work and take the chance of catching COVID-19 when they could instead stay home, stay safe, and still get paid, granted likely less, by their governments or employers.  What happens when workers stop showing up for work. Is the military (National Guard) ready to go to work at Walmart or Amazon?  Essential Businesses will need to raise wages and change operational protocols significantly to motivate employees to keep showing up for work!

Okay, next grocery store suggestion: grocery stores need to close their front doors and switch to strictly online, pick-up and delivery; this will reduce the chances of store workers catching the virus, at least at work, and also reduce food hoarding.  Stores need to take some ownership and responsibility and start limiting quantities of sales of high-demand items. It’s easier to keep people from hoarding, when you only send or give them one or two of each high-demand item.   City governments need to consider increasing law enforcement patrols (presence) at their local larger grocery stores.

Today’s first blog update introduces the idea of using cruise ships as augmenting or substitute hospital ships.  I know this idea seems paradoxical or counterintuitive considering the current analogy of cruise ships as huge floating petri dishes; however, if you consider that the ships’ occupants (guests) will already be COVID-19 confirmed…it actually makes sense! One ship alone could provide several thousand beds in independent rooms, with independent toilet facilities.  We could moor five of these in New York City harbor and add 10,000 to 20,000 hospital bed capacity.  Obviously, these ship rooms won’t substitute as ER or ICU beds, but they could house hospitalized overflow or recovering patients. These ships already have available infrastructure:  food services, power grid, water, maintenance, etc…  This concept could also throw a lifeline to the cruise ship industry as nations or states would be leasing out these ships and providing continuing employment for a select few of the industry’s labor force.  As for after, when we get to the other side of this first (my opinion) infection wave, there should be little stigma associated with using the ships for fighting the virus as it’s likely that more than 60%, if not more (again – my opinion), of the entire global population will have a strain of the Novel Coronavirus inside them.

Update: Mar 17, 2020

Today’s blog update provides brief excerpts of a Politico article that provides insight into Italy’s ongoing struggle with the virus and what every nation will eventually face in their battle against the Novel Coronavirus. Our hospital systems are grossly ill prepared to meet the strains the virus will place on them. If we, everyone, do not take this issue more seriously we will only add to the duration and the extent of the misery humanity will endure from this crisis. All nations should seriously consider simultaneously implementing nation-wide quarantines immediately! If we continue to implement quarantines and sheltering-in place in uncoordinated regional efforts and in phases — then we’re only increasing the likelihood of additional waves of infections resurfacing around the globe.

Italian doctors on coronavirus frontline face tough calls on whom to save– By Greta Privitera, Politico, Published Mar 9, 2020

  • For now, the marching orders are: Save scarce resources for those patients who have the greatest chance of survival. That means prioritizing younger, otherwise healthy patients over older patients or those with pre-existing conditions.”

“We do not want to discriminate,” said Luigi Riccioni, an anesthesiologist and head of the ethical committee of Siiarti, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, who co-authored new guidelines on how to prioritize treatment of coronavirus cases in hospitals. “We are aware that the body of an extremely fragile patient is unable to tolerate certain treatments compared to that of a healthy person.”

https://www.politico.eu/article/coronavirus-italy-doctors-tough-calls-survival/

Update: Mar 16, 2020

Today’s second blog update is about cremations. We need to discuss this topic before we have massive numbers of dead from the virus. I suggest we all consider cremation as the wiser choice for burial of our loved ones. If there is any chance the virus can be transmitted post-mortem we should close out / remove that possibility.

China says Wuhan Coronavirus victims who die should be quickly cremated without funerals as death toll rises” – by Ryan Pickrell, Business Insider, Published Feb 2, 2020

  • “In China, according to the NHC guidelines issued Saturday, if a coronavirus victims dies, the following measures are to be taken as quickly as possible.”
  • “First, the medical staff at the medical facility where the person was being treated are required to disinfect and seal the remains. It is forbidden to open the remains once they have been sealed. Second, the medical staff will issue a death certificate and notify the family. At this point, the local funeral services facility will be contacted. Third, funeral services personnel will then collect the body, deliver it to the relevant facility, and directly cremate the remains. A cremation certificate will then be issued.”
  • “No one is permitted to visit the remains during this process. Relatives will, however, be allowed to take the remains after cremation has been completed and documented, the NHC explained in its Saturday announcement.”

https://www.msn.com/en-my/news/world/china-says-wuhan-coronavirus-victims-who-die-should-be-quickly-cremated-without-funerals-as-death-toll-rises/ar-BBZyWal

Today’s first blog update is about brainstorming; we need to get everyone thinking and discussing ways to deal with the coming crisis. I don’t know how feasible these two ideas I have are, but in my opinion the only bad ideas are the ones people keep to themselves! First, I suggest we take the drive-thru testing concept and use the same protocols to run drive-thru chest CTs. The results will be instantly available, and doctors could use the results in triaging which symptomatic people should be hospitalized and which ones should be sent home for self-quarantine. Second, we should look at utilizing the existing state unemployment systems as a means or conduit to funnel funds to those individuals most in need. The federal govt. could reimburse states directly for all expenses related to the Novel Coronavirus unemployment filings; we’d have to waive the normal employment history criteria associated with standard unemployment approvals to cover newly-hired workers and gig-workers. Lastly, I want to comment that everyday we wait to implement a nation-wide quarantine we amplify the fatality-rate we will eventually have to deal with!

Update: Mar 15, 2020

Today’s blog update is about our president. I try to avoid politics in this blog; but, I can’t any longer there is too much at stake. I’m watching this joke of a White House press briefing, in the midst of this enfolding tragedy, and it’s blatantly obvious that the President is more concerned with his polling numbers and the stock markets than any loss of life; it’s truly sad! All he talked about was himself, the markets and food hoarding. Our country is on the verge of a terrible human catastrophe and our federal government is either asleep at the wheel or worse – wearing blinders! Virus testing is an important issue, but we’re so far behind now it might be an obsolete issue; we should be implementing nation-wide lock-downs, quarantines, school closures, social distancing, business closures and travel bans! We should be building medical tent cities, ramping up 24/7 PPE manufacturing -especially mechanical ventilators. We need to treat this like an immediate all-hands-on-deck crisis! Our (the US’) best hope now for dealing with the impending disaster lies with our state governors and city mayors; let’s hope they rise to the task. Hundreds of thousands, if not millions, of people are going to die from the Novel Coronavirus, yet the President is “Very Happy” that the Fed rate has been cut to zero; think about that!

Update: Mar 14, 2020

Today’s blog is just a simple recommendation: Decide today where you’d prefer or need to be for the next six weeks to six months — then get there quickly, preferably by car if feasible! Quarantines, travel bans, and Cordon Sanitaire are likely to become more commonplace in the coming weeks, both on national borders and also within nations in individual states, provinces, counties and cities. Personal mobility is a privilege many of us take for granted; one we have to restrict or give up temporarily to slow the virus’ spread!

Update: Mar 13, 2020

Today’s second blog update provides excerpts from a NY Times article detailing US CDC modelling of worst-case scenarios for Novel Coronavirus mortality rates in the US. I highly recommend reading the entire article (weblink below).

“Worst-Case Estimates for U.S. Coronavirus Deaths” – By Dr. Sherry Fink, New York Times, Published Mar 13, 2020

  • “Between 160 million and 214 million people in the United States could be infected over the course of the epidemic, according to one projection. That could last months or even over a year, with infections concentrated in shorter periods, staggered across time in different communities, experts said. As many as 200,000 to 1.7 million people could die.”
  • “And, the calculations based on the C.D.C.’s scenarios suggested, 2.4 million to 21 million people in the United States could require hospitalization, potentially crushing the nation’s medical system, which has only about 925,000 staffed hospital beds. Fewer than a tenth of those are for people who are critically ill.”
  • “The assumptions fueling those scenarios are mitigated by the fact that cities, states, businesses and individuals are beginning to take steps to slow transmission, even if some are acting less aggressively than others. The C.D.C.-led effort is developing more sophisticated models showing how interventions might decrease the worst-case numbers, though their projections have not been made public.”
  • “When people change their behavior,” said Lauren Gardner, an associate professor at the Johns Hopkins Whiting School of Engineering who models epidemics, “those model parameters are no longer applicable,” so short-term forecasts are likely to be more accurate. “There is a lot of room for improvement if we act appropriately.”  
  • “Studies of previous epidemics have shown that the longer officials waited to encourage people to distance and protect themselves, the less useful those measures were in saving lives and preventing infections.”

https://www.msn.com/en-us/news/us/worst-case-estimates-for-us-coronavirus-deaths/ar-BB118txk?ocid=spartandhp

Today’s first blog update highlights the US CDC Director’s recent testimony before Congress that some recorded/reported flu deaths in the US in the last few months were actually deaths caused by the Novel Coronavirus. It appears the US CDC’s surveillance methods for pneumonia-related deaths is spotty; still, I think the CDC should be transparent with the data that they do have. That data could be helpful to the global medical community in their efforts to track the origin(s), progression, and spread of the virus. I also want to comment on two other issues: First, the International Olympic Committee (IOC) and Japan are being ridiculously optimistic for not postponing the 2020 Summer Olympics; does anyone truly believe this pandemic will be concluded by July? Second, 500,000 US census workers are soon to be conducting the census, many of them going door-to-door across America; the 2020 census should be postponed or limited to online and mail-in reporting only. Social distancing and minimizing unnecessary exposure needs to be everyone’s focus in the near-term.

CDC director says some coronavirus-related deaths have been found posthumously”  – By Veronica Rocha, Fernando Alfonso III, Joshua Berlinger, Jessie Yeung, Adam Renton and Meg Wagner, CNN, 3:46 p.m. ET, March 11, 2020

“During the House Oversight Committee discussion on the novel coronavirus response, the director of the US Centers for Disease Control and Prevention said some deaths from coronavirus have been discovered posthumously.

“Rep. Harley Rouda asked CDC director Dr. Robert Redfield if it’s possible that some flu patients may have been misdiagnosed and actually had coronavirus. “The standard practice is the first thing you do is test for influenza, so if they had influenza they would be positive,” Redfield said. Rouda then asked Redfield if they are doing posthumous testing. Redfield said there has been “a surveillance system of deaths from pneumonia, that the CDC has; it’s not in every city, every state, every hospital.”  Rouda followed up and asked, “So we could have some people in the United States dying for what appears to be influenza when in fact it could be the coronavirus?” The doctor (Redfield) replied that “some cases have actually been diagnosed that way in the United States today.”

https://www.cnn.com/world/live-news/coronavirus-outbreak-03-11-20-intl-hnk/h_1319f66f92245a2fe4ec63fe91ab66c9

Update: Mar 12, 2020

Today’s blog update emphasizes something I touched upon in the Feb 13, 2020, blog update: the lack of available oxygen ventilators in the US (and globally). Two things are going to make this virus’ mortality rates higher than we think: First is the lack of ventilators, and second is the illness and quarantine of medical staff. When we get to the point that we have 50 people needing forced oxygen therapy for every available ventilator the fatality rates will skyrocket. Mankind can be very creative when we put our minds to it! We should be hosting thinktank forums on how to convert (jury-rig) simple oxygen tanks into ventilators. They may already be doing this in Italy for all we know. The medical community needs to get with the science community and make something happen! The same can be done with PPE. If you can’t afford or find the real thing, make the next best thing out of cloth and plastic. We need to share these substitute innovations with the world. There is probably little chance that we will catch up with ventilator and PPE manufacturing/production at this point.

Update: Mar 9, 2020

Today’s blog update highlights the estimated high number of US citizens with Diabetes, 34 million; Chronic Kidney Disease (CKD), 37 million; Asthma, nearly 26 million. Both diabetes and CKD can also cause cardiovascular – heart disease issues.  We’ve been told that people with underlying chronic conditions are more susceptible to having adverse responses to the Coronavirus.  Someone needs to ask global health officials to elaborate on which underlying chronic conditions are being noted in the virus’ global mortality rates.  Someone also needs to ask the FDA, or their country’s equivalent agency, what their country’s stockpiled (available) inventories are for all key pharmaceuticals, including insulin-based drugs; if supply chains fail or are interrupted we’ll need to be prepared. China’s CDC reported the following mortality rate data in a Feb 2020 report referenced/linked below: “While patients who reported no comorbid conditions had a case fatality rate of 0.9%, patients with comorbid conditions had much higher rates—10.5% for those with cardiovascular disease, 7.3% for diabetes, 6.3% for chronic respiratory disease, 6.0% for hypertension, and 5.6% for cancer. Case fatality rate was also very high for cases categorized as critical at 49.0%.”

“Type II Diabetes”

  • More than 34 million Americans have diabetes (about 1 in 10), and approximately 90-95% of them have type 2 diabetes. Type 2 diabetes most often develops in people over age 45, but more and more children, teens, and young adults are also developing it.”

https://www.cdc.gov/diabetes/basics/type2.html

  • “Diabetes is a chronic (long-lasting) health condition that affects how your body turns food into energy.  Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream. When your blood sugar goes up, it signals your pancreas to release insulin. Insulin acts like a key to let the blood sugar into your body’s cells for use as energy.”
  • ‘If you have diabetes, your body either doesn’t make enough insulin or can’t use the insulin it makes as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream. Over time, that can cause serious health problems, such as heart disease, vision loss, and kidney disease.”

https://www.cdc.gov/diabetes/basics/diabetes.html

Diabetes Drug Manufacturers for the US Market: “Novo Nordisk, Sanofi, Eli Lilly, AstraZeneca, Astellas, Janssen, Merck, Others” (Sun Pharma)

https://www.mordorintelligence.com/industry-reports/diabetes-drugs-market

About Chronic Kidney Disease”

  • “More than 1 in 7, 15% of US adults are estimated to have chronic kidney disease, that is about 37 million people.”
  • “CKD is a condition in which the kidneys are damaged and cannot filter blood as well as they should. Because of this, excess fluid and waste from blood remain in the body and may cause other health problems, such as heart disease and stroke.”

https://www.cdc.gov/kidneydisease/basics.html

“Chronic Kidney Disease in the United States, 2019” “Fast Stats”

  • “15% of US adults—37 million people—are estimated to have CKD.”
  • “Most (9 in 10) adults with CKD do not know they have it.”
  • “1 in 2 people with very low kidney function who are not on dialysis do not know they have CKD.”

“CKD Risk Factors”

  • “Diabetes and high blood pressure (hypertension) are the major causes of CKD in adults. Other risk factors include heart disease, obesity, a family history of CKD, past damage to the kidneys, and older age.”

https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html

CDC’s National Asthma Control Program

  • “Nearly 26 million people (Americans) have asthma.” Of which approximately six million are children.

https://www.cdc.gov/nceh/information/asthma.htm

Vital Surveillances: The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020 – China CDC Weekly  > 2020, 2(8): 113-122 Published xx Feb 2020

Abstract:

  • “Background: An outbreak of 2019 novel coronavirus diseases (COVID-19) in Wuhan, Hubei Province, China has spread quickly nationwide. Here, we report results of a descriptive, exploratory analysis of all cases diagnosed as of February 11, 2020.”

“Deaths, Case Fatality Rates, and Mortality”

  • “As shown in Table 1, a total of 1,023 deaths have occurred among 44,672 confirmed cases for an overall case fatality rate of 2.3%. Additionally, these 1,023 deaths occurred during 661,609 PD of observed time, for a mortality rate of 0.015/10 PD.”
  • “The ≥80 age group had the highest case fatality rate of all age groups at 14.8%. Case fatality rate for males was 2.8% and for females was 1.7%. By occupation, patients who reported being retirees had the highest case fatality rate at 5.1%, and patients in Hubei Province had a >7-fold higher case fatality rate at 2.9% compared to patients in other provinces (0.4%). While patients who reported no comorbid conditions had a case fatality rate of 0.9%, patients with comorbid conditions had much higher rates—10.5% for those with cardiovascular disease, 7.3% for diabetes, 6.3% for chronic respiratory disease, 6.0% for hypertension, and 5.6% for cancer. Case fatality rate was also very high for cases categorized as critical at 49.0%.”

http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51

Update: Mar 7, 2020

Today’s blog update will be very brief, but, probably the most important one to date. We need to identify contingency plans on how we will keep our infrastructure of commercial transport (cargo, freight) trucks on the roads when much of our older truck driver population will be either sick or in self-quarantine. We should be training younger and healthier back-up truck drivers, and identifying trained retired personnel, right now! The same emphasis on back-up plans should be applied to train engineers and airline pilots/navigators, and commercial ship captains/navigators. Food supply chains need to be maintained!

Update: Mar 6 2020

The markets, media and governments are missing a major point. When people get sick they stay home…for good reason! When the workers aren’t there the economic machine stops! Data (statistics) from China are questionable at best. Governments, the US, China, Russia, etc… will skew the data to keep the financial markets buoyed. No amount of fiscal stimulus or quantitative easing will keep supply and demand flowing. The infection data is easy to manipulate.. just don’t do the tests or categorize the deaths as something else! Settle in for the long haul!

Update: Mar 5, 2020

Today’s blog update highlights key statements made in a recent JAMA article that discuss the US medical community’s priorities in preparing for and dealing with the impending wave of COVID-19 cases.

My comments and take-aways from the article: 1) Several members of the global medical community have concluded that we are well beyond the point of containment for the virus. “From the outset, SARS-CoV-2 posed a near impossible challenge for containment.” 2) Having a sufficient quantity of test kits is crucial to slowing the virus, assessing accurate mortality rates, and it appears that, like PPE, we are sadly short in our inventories, and also in our efforts to expedite the manufacture of new test kits.  3) Hospitals need to be proactive in ensuring their emergency rooms do not become overwhelmed with potentially mild or asymptomatic COVID-19 patients which would/will drive up the number of nosocomial (hospital originated) infections and expedite the spread of the virus.  4) Nursing homes and elderly care facilities will be especially vulnerable to the virus and health agencies need to be taking active steps now to lessen these vulnerabilities. 5) Sentinel surveillance for the virus has started in five US cities (Chicago, Los Angeles, New York, San Francisco and Seattle).  6) Social distancing measures need to be considered. 7) Pharmaceutical supplies and supply chains were not highlighted in this article, but they also need to be included in healthcare preparation planning.  

My suggestion:  Local healthcare agencies (hospitals) need to implement, if they haven’t already, weekly online – virtual meetings with their respective city and county-level governments, including police and emergency management authorities, to address how they will jointly work to deal with the evolving crisis.  Their progress, or lack thereof, can be further coordinated with state and federal authorities.  Local govt. officials should utilize existing notification resources (like Amber or Weather Alert phone numbers or email addresses on file with state voting and/or tax agencies) to communicate to the public, in real-time, local medical concerns and priorities.  A call for PPE donations might be more effective at local city and town levels; people are more likely to help their neighbors and people that they know.   

For those interested in learning more on this hospital readiness topic, I recommend reading my Feb 14, 2020, posting on this article: “Coronavirus: home testing pilot launched in London to cut hospital visits and ambulance use BMJ 2020;368:m621, Published Feb 14, 2020

Priorities for the US Health Community Responding to COVID-19 –Amesh A. Adalja, MD1; Eric Toner, MD1; Thomas V. Inglesby, MD1 JAMA. Published online March 3, 2020. doi:10.1001/jama.2020.3413

“Prepare Hospitals and Clinics to Respond”

  • Hospitals and clinics will have critical roles in the response. This includes establishing protocols for triaging and isolating patients suspected of having infection in emergency departments and urgent care centers so patients with SARS-CoV-2 do not infect others. Similar procedures need to be established in outpatient clinics, dialysis centers, and other medical facilities—especially nursing homes, assisted living centers, and long-term care facilities with particularly vulnerable populations—so that COVID-19 does not disrupt normal medical care and compound the direct morbidity and mortality of the disease.”
  • A serious challenge in responding to COVID-19 is protecting health care workers and preventing nosocomial infection, which have been major problems in China.2 This will take a combination of hospital administrative approaches, engineering controls, special training of hospital staff, and use of personal protective equipment (PPE). Health care leaders will need to work closely with PPE suppliers and government agencies to maximize manufacture and access to PPE.”
  • “Because some proportion of patients will be severely ill and require critical care interventions, specific preparation is needed in ICUs. This planning includes evaluation of ICU bed capacity, the ability to augment ICU-level bed space with alternative care sites such as step-down units and post-anesthesia care units, mechanical ventilator stock and supply chains, and the logistics of isolating and cohorting patients. Many hospitals operate at or near capacity already, and even an above-average flu season can cause operational disruption.”
  • “In the 2009 influenza pandemic, advanced modalities such as extracorporeal membrane oxygenation (ECMO) were used for many patients with severe acute respiratory distress syndrome (ARDS). Criteria to use ECMO for COVID-19—resources permitting—should be developed at centers adept at managing ARDS.3 Additionally, hospital plans regarding crisis standards of care and allocation of scarce resources should be developed if resources are insufficient to treat all those who need them.”
  • “Clinicians will need to stay closely attuned to specific clinical guidance that will evolve as more is learned about COVID-19. However, adherence to existing guidance for pneumonia, sepsis, and ARDS will help ensure that the most evidence-based care is provided. This may include the use of investigational antiviral or monoclonal antibody therapy.”

“Diagnostic Testing Needs to Be Rapidly Expanded”

  • “Until recently, all diagnostic testing was performed by the CDC and was based on the presence of both travel history to China plus clinical symptoms. This week, state and public health laboratories as well as other laboratories were granted the authority to develop and use their own SARS-CoV-2 diagnostic tests. This will allow broader testing and has already resulted in various places in the US with the recognition of additional cases without travel links to China.4 Plans to start sentinel surveillance for COVID-19 in 5 major cities was announced.”
  • “To better understand the burden of COVID-19, medical and public health experts need to expand testing to all patients who have unexplained ARDS or severe pneumonia, and ultimately to patients who have mild symptoms consistent with COVID-19. The CDC and public health laboratories are not designed to process testing on the scale needed for clinics and hospitals to make diagnoses in an epidemic. To reach a high-level testing capacity will require the major clinical diagnostic companies to develop and manufacture testing kits at large scale. Diagnostic companies may simply be able to add SARS-CoV-2 to existing nucleic acid–based respiratory viral panels or create stand-alone tests. Ideally, such diagnostic tests would be rapid, CLIA-waived, and available at the point of care. Serological assays are also needed especially for surveillance purposes and to help determine accurate case-fatality rate.”
  • “Clinicians and public health experts will need to be given clear information regarding the operating characteristics of SARS-CoV-2 diagnostic tests. They need to know the false-positive, false-negative, and predictive values of these tests to make the best clinical and public health decisions. The ability to accurately test individuals for SARS-CoV-2 is critical in all aspects of preparedness.”

“Public Health Actions to Slow the Spread of the Epidemic”

  • From the outset, SARS-CoV-2 posed a near impossible challenge for containment. The outbreak was first recognized in late December and large-scale containment efforts started in mid-January. The virus spread through the respiratory route, caused a spectrum of illness including very mild cases, was efficiently transmitted between humans with an epidemic doubling time of about a week, and was surreptitiously spreading for at least 6 weeks. As more and more countries report cases, including those with no link to the disease epicenter, it is clear that there are many more unrecognized cases in the world and that community transmission is happening in many countries.”
  • “In China the spread of COVID-19 was fast and intense, particularly in Wuhan. It is not clear yet whether that pattern will occur in other cities around the world. One important goal of public health response efforts now should be diminishing the speed of spread and the peak of the epidemic curve. In seasonal influenza and pandemic influenza, cities have experienced peaks at different times in the epidemic. Working to slow the spread of disease in a city could help diminish the peak burden of disease. The most important public health interventions to slow the spread will be rapid diagnosis and isolation of cases.5 At this early stage of the epidemic, when numbers of cases are low, public health workers should track contacts of cases to the extent resources allow and have them stay home for the virus’ incubation period of 2 weeks. However, beyond a certain threshold, it will no longer be feasible to track all contacts.”
  • Public health personnel will also need to consider additional measures to slow the spread of the disease in a community, actions categorized as “social distancing.” These measures could include cancellation of large gatherings, telecommuting to work when feasible, and school closures. Although there is limited evidence for these measures historically, there is some common sense behind them given that they would reduce social interaction and the chance for the virus to spread in a community. However, political and public health leaders will need to consider the potential benefit of these measures along with their negative societal costs. For example, school closures mean that many children who depend on school meals will not receive them, and many single parents will be out of the workforce.”
  • “Public health leaders will also need to clearly communicate to the public about the way that they can lower the risk of infection and spread, eg, when and how to wash hands correctly, covering coughs and sneezes, staying home if unwell. It will also be important to communicate to the public and to the health care system that persons who test positive for this virus but who do not need hospital care should stay at home while they are ill and not go to hospitals. Hospitals may have serious challenges in handling the number of people who do need acute care, so it will be important for those who are infected but otherwise well to not contribute to hospital demands.”

“The High Value in Preparations”

  • “While it is clear now that SARS-CoV-2 will spread widely in the world, including in the US, the effect of this disease among those who become ill and broader society will be substantially influenced by the preparedness and response work of the health care and public health communities. Preparation will take time, so health care and public health systems need to move quickly forward in their efforts to be ready to confront this disease around the country.”

https://jamanetwork.com/journals/jama/fullarticle/2762690

Update Mar 4, 2020

Today’s blog update emphasizes that people need to read-between-the-lines when reading and reviewing public statements by government and health agencies. The World Health Organization’s focus is on slowing the virus — That means they have little hope of a near-term vaccine. Humanity is so conditioned to have our crises come and go in two weeks or less, that most of us can’t or won’t even conceptualize a long-term, year or more, crisis.

WHO Director-General’s opening remarks at the Mission briefing on COVID-19 – Published Mar 4, 2020

  • “This virus is not SARS, it is not MERS and it is not influenza. The nature of this virus means we have an opportunity to break the chains of transmission and contain its spread. At the very least, we can slow it down and buy time. That must remain our singular focus.”

https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-mission-briefing-on-covid-19—4-march-2020

Update Mar 3, 2020

Today’s blog update is about Human Nature. The WHO and the US Surgeon General both are calling upon Americans and global citizens to stop buying up all the Personal Protective Equipment (PPE) on the global markets; because it’s needed for healthcare workers and their (infected) patients. This sounds like some very poor planning on the part of governments, hospitals and global health agencies. Yes, it would be the noble thing to do: not buying the PPE and presumably reserving the gear (masks, goggles, suits, etc..) for the healthcare workers and the sick; but, have you met your fellow humans?! Our basic instinct for survival is overwhelming. You’d have better odds convincing a male dog not to lick his balls. Let’s just hope this virus is not that deadly, and that we plan much better if or when its more lethal sibling (mutated version) comes knocking on the door in the future.

“Shortage of personal protective equipment endangering health workers worldwide” – World Health Organization, New Release, Published Mar 3, 2020

  • “The World Health Organization has warned that severe and mounting disruption to the global supply of personal protective equipment (PPE) – caused by rising demand, panic buying, hoarding and misuse – is putting lives at risk from the new coronavirus and other infectious diseases.”
  • “Healthcare workers rely on personal protective equipment to protect themselves and their patients from being infected and infecting others.”
  • But shortages are leaving doctors, nurses and other frontline workers dangerously ill-equipped to care for COVID-19 patients, due to limited access to supplies such as gloves, medical masks, respirators, goggles, face shields, gowns, and aprons.”
  • “Without secure supply chains, the risk to healthcare workers around the world is real. Industry and governments must act quickly to boost supply, ease export restrictions and put measures in place to stop speculation and hoarding. We can’t stop COVID-19 without protecting health workers first,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.”
  • “Since the start of the COVID-19 outbreak, prices have surged. Surgical masks have seen a sixfold increase, N95 respirators have trebled and gowns have doubled.”
  • “Supplies can take months to deliver and market manipulation is widespread, with stocks frequently sold to the highest bidder.”
  • “WHO has so far shipped nearly half a million sets of personal protective equipment to 47 countries,* but supplies are rapidly depleting.”
  • “Based on WHO modelling, an estimated 89 million medical masks are required for the COVID-19 response each month.(What does this modeling represent – How many new infected patients are they anticipating each month?) For examination gloves, that figure goes up to 76 million, while international demand for goggles stands at 1.6 million per month.” 
  • “Recent WHO guidance calls for the rational and appropriate use of PPE in healthcare settings, and the effective management of” supply chains.
  • “WHO is working with governments, industry and the Pandemic Supply Chain Network to boost production and secure allocations for critically affected and at-risk countries.”

https://www.who.int/news-room/detail/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide

Update: Mar 1, 2020

Today’s blog is about preparedness; kind of the underlying theme of much that I discuss here. We can’t stop what’s enfolding around us, but we can mitigate the harm it causes to us if we open our eyes and plan to adapt – as best as we can! Individuals and families should be making plans to deal with the coming food, water and gas shortages; stock up on needed medicines, discuss medical care options for loved ones if the hospitals are overwhelmed, child care if the schools are closed; and home/self protection … if things get really bad. Businesses need to figure out how they will continue in this likely chaos. It’s possible that many employees will quit and choose to stay home to take care of children and ill loved ones. Employers need to start thinking outside the box now. Start protecting employees from the virus: issue them masks and goggles at work; discourage communal work gatherings; beef up your HR hiring staff; disinfect work areas daily; set up hand-washing stations; screen employees for fevers and illness at the entrances to your businesses before they get inside the work environment; set up on-site individual sleep stations for single employees.

I live in southwest Washington state. Today, people are swarming the local grocery stores and buying out all the bottled water and toilet paper. People are also talking about other people they know that have been placed in self-quarantine. My wife just told me one of her coworkers came to work today sick complaining of chest pains, and they finally convinced her to go home. This is how it starts folks; are we ready?

“Live updates: Last of Diamond Princess crew disembarks in Japan; Washington state announces new cases”, By Katie Mettler, Alex Horton, Meryl Kornfield, Joel Achenbach, Washington Post, Published Mar 1, 2020

  • “The novel coronavirus has probably been spreading undetected for about six weeks in Washington state, where the first U.S. death was reported this weekend. A genetic analysis suggests that the cases are linked through community transmission and that this has been going on for weeks, with hundreds of infections likely in the state.”
  • “Earlier Saturday, the Trump administration outlined new travel restrictions affecting Iran, Italy and South Korea in response to the outbreak, and President Trump said he was considering further restrictions across the southern border.” (See Feb 28 Blog Update)

https://www.msn.com/en-us/news/world/live-updates-last-of-diamond-princess-crew-disembarks-in-japan-washington-state-announces-new-cases/ar-BB10A0Aq?ocid=spartanntp

Update: Feb 29, 2020

Today’s blog update covers the antiviral drug Remdesivir; one of several drug candidates being tested, and perhaps our best hope at a near-term (6 -18 months?) vaccine for COVID-19.  Remdesivir is produced by Gilead Sciences Inc. (NASDAQ: GILD).  Also covered in the blog, but to a lesser degree, is the antiviral drug Chloroquine; Produced by Bayer (NYSE: BAYRY). Chloroquine has been in use for 70 years, mostly as an anti-malaria drug. I’m not making stock recommendations for either drug; do your own due diligence! I’ve grouped the data presented here into two blocks: first the medical data, and second the investor-focused data on Gilead.

Remdesivir Medical Data:

“Gilead Sciences Initiates Two Phase 3 Studies of Investigational Antiviral Remdesivir for the Treatment of COVID-19 – Press Release- February 26, 2020

  • “FOSTER CITY, Calif.–(BUSINESS WIRE) –Feb. 26, 2020– Gilead Sciences, Inc. (Nasdaq: GILD) today announced the initiation of two Phase 3 clinical studies to evaluate the safety and efficacy of remdesivir in adults diagnosed with COVID-19 (novel coronavirus). These randomized, open-label, multicenter studies will enroll approximately 1,000 patients at medical centers primarily across Asian countries, as well as other countries globally with high numbers of diagnosed cases, beginning in March. The studies will assess two dosing durations of remdesivir, administered intravenously. The initiation of these studies follows the U.S. Food and Drug Administration’s (FDA) rapid review and acceptance of Gilead’s investigational new drug (IND) filing for remdesivir for the treatment of COVID-19.”

http://investors.gilead.com/news-releases/news-release-details/gilead-sciences-initiates-two-phase-3-studies-investigational

Remdesivir – Wikipedia

https://en.wikipedia.org/wiki/Remdesivir

“Gilead Sciences drug Remdesivir may help treat coronavirus symptoms, according to WHO” – By Paul R La Monica, CNN Business, Feb 25, 2020

  • “There is only one drug right now that we think may have real efficacy and that’s remdesivir,” Bruce Aylward, an assistant director-general of the World Health Organization (WHO), said at a press conference in Beijing.”

“WHO officials added that clinical trials for Remdesivir in humans are now taking place and results could be available within weeks.” (Sounds a bit optimistic)

https://www.cnn.com/2020/02/24/investing/gilead-sciences-coronavirus-who-remdesivir/index.html

“Coronavirus Susceptibility to the Antiviral Remdesivir (GS-5734) Is Mediated by the Viral Polymerase and the Proofreading Exoribonuclease.” – mBio. 2018 Mar 6;9(2). pii: e00221-18. doi: 10.1128/mBio.00221-18

Abstract:

  • “Emerging coronaviruses (CoVs) cause severe disease in humans, but no approved therapeutics are available. The CoV nsp14 exoribonuclease (ExoN) has complicated development of antiviral nucleosides due to its proofreading activity. We recently reported that the nucleoside analogue GS-5734 (Remdesivir) potently inhibits human and zoonotic CoVs in vitro and in a severe acute respiratory syndrome coronavirus (SARS-CoV) mouse model. However, studies with GS-5734 have not reported resistance associated with GS-5734, nor do we understand the action of GS-5734 in wild-type (WT) proofreading CoVs. Here, we show that GS-5734 inhibits murine hepatitis virus (MHV) with similar 50% effective concentration values (EC50) as SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV). Passage of WT MHV in the presence of the GS-5734 parent nucleoside selected two mutations in the nsp12 polymerase at residues conserved across all CoVs that conferred up to 5.6-fold resistance to GS-5734, as determined by EC50 The resistant viruses were unable to compete with WT in direct coinfection passage in the absence of GS-5734. Introduction of the MHV resistance mutations into SARS-CoV resulted in the same in vitro resistance phenotype and attenuated SARS-CoV pathogenesis in a mouse model. Finally, we demonstrate that an MHV mutant lacking ExoN proofreading was significantly more sensitive to GS-5734. Combined, the results indicate that GS-5734 interferes with the nsp12 polymerase even in the setting of intact ExoN proofreading activity and that resistance can be overcome with increased, nontoxic concentrations of GS-5734, further supporting the development of GS-5734 as a broad-spectrum therapeutic to protect against contemporary and emerging CoVs.  IMPORTANCE Coronaviruses (CoVs) cause severe human infections, but there are no approved antivirals to treat these infections. Development of nucleoside-based therapeutics for CoV infections has been hampered by the presence of a proofreading exoribonuclease. Here, we expand the known efficacy of the nucleotide prodrug remdesivir (GS-5734) to include a group β-2a CoV. Further, GS-5734 potently inhibits CoVs with intact proofreading. Following selection with the GS-5734 parent nucleoside, 2 amino acid substitutions in the nsp12 polymerase at residues that are identical across CoVs provide low-level resistance to GS-5734. The resistance mutations decrease viral fitness of MHV in vitro and attenuate pathogenesis in a SARS-CoV animal model of infection. Together, these studies define the target of GS-5734 activity and demonstrate that resistance is difficult to select, only partial, and impairs fitness and virulence of MHV and SARS-CoV, supporting further development of GS-5734 as a potential effective pan-CoV antiviral.”

https://www.ncbi.nlm.nih.gov/pubmed/29511076

https://mbio.asm.org/content/9/2/e00221-18

“Broad-spectrum antiviral GS-5734 (Remdesivir) inhibits both epidemic and zoonotic coronaviruses.” – Sci Transl Med., 2017 Jun 28;9(396). pii: eaal3653. doi: 10.1126/scitranslmed.aal3653

Abstract

  • “Emerging viral infections are difficult to control because heterogeneous members periodically cycle in and out of humans and zoonotic hosts, complicating the development of specific antiviral therapies and vaccines. Coronaviruses (CoVs) have a proclivity to spread rapidly into new host species causing severe disease. Severe acute respiratory syndrome CoV (SARS-CoV) and Middle East respiratory syndrome CoV (MERS-CoV) successively emerged, causing severe epidemic respiratory disease in immunologically naïve human populations throughout the globe. Broad-spectrum therapies capable of inhibiting CoV infections would address an immediate unmet medical need and could be invaluable in the treatment of emerging and endemic CoV infections. We show that a nucleotide prodrug, GS-5734, currently in clinical development for treatment of Ebola virus disease, can inhibit SARS-CoV and MERS-CoV replication in multiple in vitro systems, including primary human airway epithelial cell cultures with submicromolar IC50 values. GS-5734 was also effective against bat CoVs, prepandemic bat CoVs, and circulating contemporary human CoV in primary human lung cells, thus demonstrating broad-spectrum anti-CoV activity. In a mouse model of SARS-CoV pathogenesis, prophylactic and early therapeutic administration of GS-5734 significantly reduced lung viral load and improved clinical signs of disease as well as respiratory function. These data provide substantive evidence that GS-5734 may prove effective against endemic MERS-CoV in the Middle East, circulating human CoV, and, possibly most importantly, emerging CoV of the future.” (Note: this paper was published Jun 28, 2017)

https://www.ncbi.nlm.nih.gov/pubmed/28659436

“China’s Wuhan Institute Files to Patent the Use of Gilead’s Remdesivir for Coronavirus” – By Mark Terry, Biospace.com, Published Feb 5, 2020

  • “The company has partnered with Chinese health authorities to run a Phase III clinical trial to assess remdesivir for treatment of the virus. The drug was originally developed to treat the Ebola virus, but wasn’t effective. Preclinical assays have suggested that the drug might be effective against the coronavirus, 2019-nCoV, as was published in the New England Journal of Medicine (NEJM). The drug was given to a U.S. patient for compassionate use on day seven of the disease and their condition improved on day eight.”
  • “The new clinical trial will be conducted at Friendship Hospital in Beijing, China. The trial will enroll 270 patients with mild and moderate pneumonia caused by the virus.”
  • “Gilead is working closely with global health authorities to respond to the novel coronavirus (2019-nCoV) outbreak through the appropriate experimental use of our investigational compound Remdesivir. While there are no antiviral data for remdesivir that show activity against 2019-nCoV at this time, available data in other coronaviruses give us hope,” the company stated.”
  • “The Wuhan Institute submitted the patent application jointly with the Military Medicine Institute of the People’s Liberation Army Academy of Military Science. Researchers with both organizations noted in a paper published in Nature’s Cell Research** this week that both Remdesivir and Chloroquine, used to treat malaria, may be effective in stalling the coronavirus.”
  • “Even if the Wuhan Institute’s application gets authorized, the role is very limited because Gilead still owns the fundamental patent of the drug,” said Zhao Youbin, a Shanghai-based intellectual property attorney at Purplevine IP Service Co. “Any exploitation of the patent must seek approval from Gilead.”
  • “The Wuhan Institute indicated it filed the patent application on January 21, but also noted it would temporarily drop the patent claims if it had the opportunity to collaborate with foreign biopharma companies to battle the epidemic.”
  • China can manufacture Chloroquine and currently wants access to Remdesivir. Bloomberg points out that the country’s decision to seek a patent “instead of invoking the heavy-handed ‘compulsory license’ option that lets nations override drug patents in national emergencies, underscores the delicate balancing act before China as it signals commitment toward intellectual property rights alongside curbing the virus outbreak.”

https://www.biospace.com/article/china-s-wuhan-institute-files-to-patent-the-use-of-gilead-s-remdesivir-for-coronavirus/

** “Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitroWang, M., Cao, R., Zhang, L. et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res (2020). https://doi.org/10.1038/s41422-020-0282-0 , Published Feb 4, 2020

  • “Remdesivir has been recently recognized as a promising antiviral drug against a wide array of RNA viruses (including SARS/MERS-CoV5) infection in cultured cells, mice and nonhuman primate (NHP) models. It is currently under clinical development for the treatment of Ebola virus infection.6 Remdesivir is an adenosine analogue, which incorporates into nascent viral RNA chains and results in pre-mature termination.7 Our time-of-addition assay showed remdesivir functioned at a stage post virus entry (Fig. 1c, d), which is in agreement with its putative anti-viral mechanism as a nucleotide analogue. Warren et al. showed that in NHP model, intravenous administration of 10 mg/kg dose of remdesivir resulted in concomitant persistent levels of its active form in the blood (10 μM) and conferred 100% protection against Ebola virus infection.7 Our data showed that EC90 value of remdesivir against 2019-nCoV in Vero E6 cells was 1.76 μM, suggesting its working concentration is likely to be achieved in NHP. Our preliminary data (Supplementary information, Fig. S2) showed that remdesivir also inhibited virus infection efficiently in a human cell line (human liver cancer Huh-7 cells), which is sensitive to 2019-nCoV.2
  • “Chloroquine, a widely-used anti-malarial and autoimmune disease drug, has recently been reported as a potential broad-spectrum antiviral drug. Chloroquine is known to block virus infection by increasing endosomal pH required for virus/cell fusion, as well as interfering with the glycosylation of cellular receptors of SARS-CoV.
  • “Our time-of-addition assay demonstrated that chloroquine functioned at both entry, and at post-entry stages of the 2019-nCoV infection in Vero E6 cells (Fig. 1c, d). Besides its antiviral activity, chloroquine has an immune-modulating activity, which may synergistically enhance its antiviral effect in vivo. Chloroquine is widely distributed in the whole body, including lung, after oral administration. The EC90 value of chloroquine against the 2019-nCoV in Vero E6 cells was 6.90 μM, which can be clinically achievable as demonstrated in the plasma of rheumatoid arthritis patients who received 500 mg administration. Chloroquine is a cheap and a safe drug that has been used for more than 70 years and, therefore, it is potentially clinically applicable against the 2019-nCoV.”
  • “Our findings reveal that Remdesivir and Chloroquine are highly effective in the control of 2019-nCoV infection in vitro. Since these compounds have been used in human patients with a safety track record and shown to be effective against various ailments, we suggest that they should be assessed in human patients suffering from the novel coronavirus disease.”

https://www.nature.com/articles/s41422-020-0282-0

“Antiviral Drug Remdesivir By Gilead: Most Effective For Treating 2019-nCoV Coronavirus According To Study Trials Published Last Week In NEJM Journal” – Thailand Medical News Feb 02, 2020

  • “Already at the start of the coronavirus outbreak in late December 2019, Chinese medical researchers and doctors were already treating coronavirus infected patients with a HIV antiviral called Aluvia, also known as Kaletra, which is a combination of lopinavir and ritonavir and is produced by pharmaceutical company AbbVie. simply goggle online and you can see that many medical sites were already talking about the usage of this drug for coronavirus since early January 2020.”

https://www.thailandmedical.news/news/antiviral-drug-remdesivir-by-gilead:most-effective-for-treating-2019-ncov-coronavirus-according-to-study-trials-published-last-week-in-nejm-journal

Remdesivir’s value towards fighting Ebola – There are apparently better drug candidates.

“Monoclonal Antibody Therapy for Ebola Virus Disease” – By Myron M. Levine, M.D., D.T.P.H, N Engl J Med 2019; 381:2365-2366, DOI: 10.1056/NEJMe1915350, Published Dec 12, 2019

  • “After 681 patients had been enrolled in four treatment centers in the provinces of North Kivu and Ituri, the data and safety monitoring board conducted an interim analysis and, on the basis of the results, recommended that no additional patients be assigned to the remdesivir or ZMapp groups because REGN-EB3 and MAb114 showed significantly superior efficacy in preventing death.”

https://www.nejm.org/doi/full/10.1056/NEJMe1915350

Chloroquine – Wikipedia

Antiviral

  • “As well as its anti-malaria action, chloroquine appears to have some antiviral effects, though its comparatively low potency and side effects have made it difficult to integrate into clinical practice. It is in trials as an antiretroviral for HIV-1/AIDS and is being considered in pre-clinical models as a potential agent against chikungunya fever. In late January 2020 during the 2019–20 coronavirus outbreak, Chinese medical researchers stated to the media that in exploratory research considering a selection of 30 drug candidates, three of them, remdesivir, chloroquine and lopinavir/ritonavir, seemed to have “fairly good inhibitory effects” on the coronavirus 2019-nCoV at the cellular level. Requests to start clinical testing were submitted.  On 19 February 2020, preliminary results found that chloroquine may be effective and safe in treating COVID-19 associated pneumonia. There is evidence to indicate the efficacy of chloroquine phosphate against SARS-CoV-2 in vitro, on Vero cells. Brand names include Chloroquine FNA, Resochin, and Dawaquin. Chloroquine was discovered in 1934 by Hans Andersag and coworkers at the Bayer laboratories, who named it “Resochin”

https://en.wikipedia.org/wiki/Chloroquine

Gilead Science Inc. Investor-focused data:

  • “Vision: To advance therapeutics against life-threatening diseases worldwide.”
  • “Mission: To discover, develop and commercialize innovative therapeutics in the areas of unmet medical needs that improve patient care.”

https://www.gilead.com/

Stock Quote

  • NASDAQ: GILD
  • $69.36 -3.3 (-4.54%)
  • Volume: 33,804,800

Feb 28, 2020 4:00 PM EST

http://investors.gilead.com/

Data as of Feb 28, 2020:

  • Change: -3.3 (-4.54%)
  • Volume 33,804,800
  • Today’s Open $70.17
  • Previous Close $72.66
  • Today’s High $71.08
  • Today’s Low $66.63
  • 52 Week High $78.88
  • 52 Week Low $60.89

http://investors.gilead.com/stock-information/stock-quote-chart

“Investor Calendar: Gilead Sciences at the Cowen 40th Annual Health Care Conference: Mar 2, 2020 at 12:00 PM EST”

http://investors.gilead.com/events/event-details/gilead-sciences-cowen-40th-annual-health-care-conference

  • “$90.1B Market Cap (as of 2/7/2020)”

“4Q19 FINANCIALS:”

  • “PRODUCT SALES $5.8B”
  • “NON-GAAP EPS $1.30”
  • “OPERATING CASH FLOW $2.6B”

http://investors.gilead.com/static-files/bc15c89c-f396-427a-bfe3-54dda82219c1

“Cash, Cash Equivalents and Marketable Debt Securities As of December 31, 2019, Gilead had $25.8 billion of cash, cash equivalents and marketable debt securities compared to $31.5 billion as of December 31, 2018. During 2019, Gilead generated $9.1 billion in operating cash flow, paid $5.6 billion in connection with the global research and development collaboration agreement with Galapagos and equity investments in Galapagos, repaid $2.8 billion of principal amount of debt, paid cash dividends of $3.2 billion and utilized $1.7 billion on stock repurchases.”

http://investors.gilead.com/financial-information/quarterly-earnings

“10K: Annual report which provides a comprehensive overview of the company for the past year – Feb 25, 2020”

  • “We sell and distribute most of our products in the United States exclusively through the wholesale channel. Our product sales to three large wholesalers, AmerisourceBergen Corporation, Cardinal Health, Inc. and McKesson Corporation, each accounted for more than 10% of total revenues for each of the years ended December 31, 2019, 2018 and 2017. On a combined basis, in 2019, these wholesalers accounted for approximately 87% of our product sales in the United States and approximately 64% of our total worldwide revenues. We sell and distribute our products in Europe and countries outside the United States where the product is approved, either through our commercial teams, third-party distributors or corporate partners.”
  • “Our Manufacturing Facilities We own or lease manufacturing facilities to manufacture and distribute certain products and API for clinical and/or commercial uses. These facilities are located in Foster City, San Dimas, La Verne, Oceanside and El Segundo, California; Dublin and Cork, Ireland; Hoofddorp, Netherlands; and Edmonton, Canada.”
  • “Foster City, California: We conduct process chemistry research and formulation development activities, manufacture API and drug product for our clinical trials and oversee our third-party contract manufacturers.”
  • “San Dimas and La Verne, California: We manufacture AmBisome and also package and label the majority of our commercial products for distribution to the Americas and Pacific Rim.”
  • “Oceanside, California: We utilize the facility for clinical manufacturing and process development of our biologics candidates.”
  • “El Segundo, California: We utilize the facility for clinical and commercial manufacturing and processing of Yescarta.”
  • “Cork and Dublin, Ireland: We utilize the Cork facility for commercial manufacturing, packaging and labeling of our products. We also perform quality control testing, labeling, packaging and final release of many of our products for distribution to the European Union and other international markets.  The Dublin facility is also responsible for distribution activities for our products.”
  • “Edmonton, Canada: We conduct process chemistry research and scale-up activities for our clinical development candidates, manufacture API for both investigational and commercial products and conduct chemical development activities to improve existing commercial manufacturing processes.”
  • “Hoofddorp, Netherlands: We utilize the facility for commercial manufacturing and processing of Yescarta.”

“SELECTED QUARTERLY FINANCIAL INFORMATION (UNAUDITED) (in millions, except per share amounts)

2019 Total Revenues:

1st Quarter        2nd Quarter       3rd Quarter    4th Quarter

$ 5,281                $ 5,685                $ 5,604               $ 5,879

Gross profit on product sales

$ 4,243               $ 4,607                $ 4,481               $ 4,113

 Net income (loss)(1)(2)

$ 1,968               $ 1,875                $ (1,168)               $ 2,689”

http://investors.gilead.com/financial-information/sec-filings

Update Feb 28, 2020:

In today’s blog update I’m speculating that the world’s refugee crisis is about to get a lot worse due to the Coronavirus. I’m also trying to read between the lines on Dr. Michael Ryan’s, World Health Organization’s (WHO’s), recent comments regarding whether COVID-19 should be classified as a pandemic.

Currently there are about 70.8 million displaced refugees across the globe.  Many are housed or huddled in shanty-like tent cities with poor sanitation; essentially breeding grounds for all types of diseases;  now throw COVID-19 into that mix.  Countries like Turkey and Greece will have enough difficulty dealing with their own citizens’ health issues that they will no longer care if the EU, NATO or the UN is angry at them for allowing their borders to become porous. At which point, Turkey and Greece will allow (push) the refugees to start heading to the exits: towards the rest of Europe.  Refugees will be heading to whichever country they feel will provide their families with the best healthcare – the best chance of survival – the best chance for a future! The same scenario will likely play out across the world, everywhere there are two adjacent countries and one of those two countries has a much better healthcare system than its neighbor. Consequently, I expect the U.S. will militarize its southern border within a month and President Trump will utilize rarely used presidential powers, enacted due to the crisis, to get it done!

The second part of today’s blog focuses on this statement by Dr. Michael Ryan, Executive Director of WHO’s health emergencies program — made while discussing WHO’s recent risk-level increase.: “If we say there’s a pandemic of coronavirus, we’re essentially accepting that every human on the planet will be exposed to that virus.” The WHO has declared Pandemics in the past with infection rates of less than 25%; so why would Dr. Ryan make a statement even remotely suggesting that the exposure/infection rate would have to equal 100% before WHO declares this a pandemic?! If the World Health Organization actually believes that COVID-19 will reach 100% infection rates, with current low estimates on COVID-19’s mortality rates at 1 to 2%, with a current global population of 7.8 billion, than we’re looking at possibly 78 to 156 million dead. I hope it was just a stupid comment by Dr. Ryan. The WHO needs to get off the fence and declare this a pandemic!

 “Turkey Says It Has No Choice But to ‘Loosen’ Stance on Refugees” – By Firat Kozok, Bloomberg.com, Published Feb 28, 2020

  • “(Bloomberg) — Turkey is pressed by developments in Syria’s Idlib and has no choice but to “loosen” its policy of preventing refugees from travelling on to Europe, President Recep Tayyip Erdogan’s communications director Fahrettin Altun told reporters in Ankara.“If Idlib falls, then millions of Syrian refugees will try to escape to Turkey and Europe. Turkey no longer has the possibility to provide resources for and help these people,” Altun said.””

https://www.bloombergquint.com/politics/turkey-says-it-has-no-choice-but-to-loosen-stance-on-refugees

https://www.unhcr.org/en-us/data.html

https://en.wikipedia.org/wiki/National_Emergencies_Act#Emergency_powers

WHO raises coronavirus threat assessment to its highest level: ‘Wake up. Get ready. This virus may be on its way’- By Berkeley Lovelace Jr., CNBC.com, Published Feb 28, 2020.

  • Dr. Michael Ryan, Executive Director of WHO’s health emergencies program. : “If we say there’s a pandemic of coronavirus, we’re essentially accepting that every human on the planet will be exposed to that virus.”

https://www.cnbc.com/2020/02/28/who-raises-risk-assessment-of-coronavirus-to-very-high-at-global-level.html

Update: Feb 27, 2020

Today’s blog update details the following: 1) Guangdong, China health authorities report “14% of patients recovered from coronavirus and discharged from hospitals were found positive for the virus” in their stool samples**, despite being asymptomatic on lung CTs, throat and nose swabs and having an absence of fevers. 2) A group of noted Epidemiologists and Virologists have submitted a paper advising “genomic evidence does not support the idea that SARS-CoV-2 is a laboratory construct” (not man-made / engineered in a lab); however, they also stated they did not have conclusive evidence to rule it out.  Additionally they advised, “if SARS-CoV-2 pre-adapted in another animal species then we are at risk of future re-emergence events even if the current epidemic is controlled”. 3) Media outlets are revealing that a Japanese woman in her 40s has contracted the Coronavirus for a second time — or has had a re-emergence of her initial infection.  Dr. Philip Tierno Jr., Professor of Microbiology and Pathology at NYU School of Medicine. advised ““much remains unknown about the virus. I’m not certain that this is not bi-phasic, like anthrax,” meaning the disease appears to go away before recurring.  Dr. Zhan Qingyuan, director of pneumonia prevention and treatment at the China-Japan Friendship Hospital, said even people who have recovered may not be immune to the virus. “For those patients who have been cured, there is a likelihood of a relapse,” He added, “Viruses can also mutate quickly, so immunity to one strain doesn’t guarantee immunity to another.” 4) Japan’s PM Abe is taking significant steps in his country’s response to the outbreak by having all Japanese schools closed, starting Monday, until late March.  I’m guessing the closures will be extended for a much longer period.  Time to research how your kids can go to school online!  Also of note, Mitsubishi tells all 3800 employees in Japan to stay home and work remotely for the next two weeks.

** The U.S. Coronavirus test kits are serology (blood, serum) test kits.

https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html

“Guangdong: 14% of patients recovered are healthy coronavirus carriers again” – By Wang Zhicheng, AsiaNews.com, Published Feb 26, 2020

  • “Beijing (AsiaNews) – 14% of patients recovered from coronavirus and discharged from hospitals were found positive for the virus in the following checks. In a press conference held yesterday, Guangdong health authorities said it is still unknown why this occurs. In any case, this aspect makes control over the epidemic even more complicated.”
  • “According to the protocol of the National Health Commission, a patient can be discharged from the hospital if the throat and nose swabs are negative twice; if the computed tomography (CT) scan of the lungs reveals no lesions; if there are no obvious feverish states.”
  • “The protocol suggests that former patients take care of their health and avoid outdoor activities for at least 14 days, subjecting themselves to further analysis. It turned out that many of the recovered patients still have the virus in their body, particularly in the stool. Until now the protocol did not list the patient’s stool analysis.”

http://www.asianews.it/news-en/Guangdong:-14-of-patients-recovered-are-healthy-coronavirus-carriers-again-49398.html

“New Paper Adds Support to Covid-19’s Natural Origins” – Flynn Murphy, Caixin.com, Published Feb 25, 2020

  • “New research from a group of five respected global scientists has concluded the Covid-19 coronavirus that began in China and is now spreading around the world contains at least two genetic clues that indicate it was probably created in nature — and not in a lab.”
  • “The latest research paper (hyperlink is below) came from an international team of specialists from various fields related to virology: W. Ian Lipkin, Kristian G. Andersen, Andrew Rambaut, Edward C. Holmes and Robert F. Garry. Like much research about the virus, the paper has yet to be peer reviewed. Following their analysis of the genomes of different coronaviruses, the group pointed out the new virus has at least two special features that appear to show it (likely) wasn’t made in a laboratory or deliberately engineered.”
  • “Furthermore, engineering such a virus would likely have left genetic evidence in the form of a “previously used virus backbone,” the researchers wrote. That was not the case with the SARS-CoV-2.”
  • “Based on these genetic clues, there are two likely ways the new virus was produced, the team said. One is through a natural selection process in animals before it was passed to humans, and the other was through a natural selection process after the first humans were infected.”
  • “They said finding the latent host as well as the earliest infection from the seafood market where the outbreak may have begun would yield more valuable information about the virus’s source. However, experts say most of evidence involving the latter has been destroyed. The group also pointed out that the question of whether the virus came from the older SARS virus is a good topic for future exploration.”

http://en.caixin.com/2020-02-25/101520296.html

The Proximal Origin of SARS-CoV-2” – Virological.org, Published Feb 17, 2020

Conclusions:

  • “In the midst of the global COVID-19 public health emergency it is reasonable to wonder why the origins of the epidemic matter. A detailed understanding of how an animal virus jumped species boundaries to infect humans so productively will help in the prevention of future zoonotic events. For example, if SARS-CoV-2 pre-adapted in another animal species then we are at risk of future re-emergence events even if the current epidemic is controlled. In contrast, if the adaptive process we describe occurred in humans, then even if we have repeated zoonotic transfers they are unlikely to take-off unless the same series of mutations occurs. In addition, identifying the closest animal relatives of SARS-CoV-2 will greatly assist studies of virus function. Indeed, the availability of the RaTG13 bat sequence facilitated the comparative genomic analysis performed here, helping to reveal the key mutations in the RBD as well as the polybasic cleavage site insertion.”
  • “The genomic features described here may in part explain the infectiousness and transmissibility of SARS-CoV-2 in humans. Although genomic evidence does not support the idea that SARS-CoV-2 is a laboratory construct, it is currently impossible to prove or disprove the other theories of its origin described here, and it is unclear whether future data will help resolve this issue. Identifying the immediate non-human animal source and obtaining virus sequences from it would be the most definitive way of revealing virus origins. In addition, it would be helpful to obtain more genetic and functional data about the virus, including experimental studies of receptor binding and the role of the polybasic cleavage site and predicted O-linked glycans. The identification of a potential intermediate host of SARS-CoV-2, as well as the sequencing of very early cases including those not connected to the Wuhan market, would similarly be highly informative. Irrespective of how SARS-CoV-2 originated, the ongoing surveillance of pneumonia in humans and other animals is clearly of utmost importance.”

http://virological.org/t/the-proximal-origin-of-sars-cov-2/398

“Woman treated for Coronavirus again tests positive” – NHK World-Japan, Published Feb 26, 2020

  • “Officials of Osaka Prefecture, western Japan, say a woman in her 40s, who had been treated for symptoms of the new coronavirus and left hospital early this month, has again tested positive.  The woman is a tour guide living in the city of Osaka. She was on a bus carrying tourists from Wuhan, China, in mid-January, and tested positive on January 29. The woman was discharged from a local medical institution on February 1, and was confirmed as virus-free on February 6. But on February 19, she felt throat and chest pain. After several visits to the doctor, she was tested a week later and tested positive again.”
  • “The woman reportedly wore a mask and stayed at home after leaving the medical institution. She did not go to work and had no close contact with anyone. She is now hospitalized in the prefecture. Prefectural officials believe that either viruses that remained in the woman multiplied, or the woman was re-infected. An expert on infectious diseases at Osaka University says people who are infected develop antibodies, so they can usually avoid re-infection by the same virus. However, if there had not been enough antibodies, that individual could have been prone to re-infection or viruses that had been undetected in the body could have multiplied.”

https://www3.nhk.or.jp/nhkworld/en/news/20200227_12/

People could get the novel coronavirus more than once, health experts warn — recovering does not necessarily make you immune” -Holly Secon, Business Insider, Published Feb 3, 2020

  • Zhan Qingyuan, director of pneumonia prevention and treatment at the China-Japan Friendship Hospital, said even people who have recovered may not be immune to the virus. “For those patients who have been cured, there is a likelihood of a relapse,” he said in a briefing on Friday. “The antibody will be generated; however, in certain individuals, the antibody cannot last that long.”
  • “A risk of reinfection:  The larger coronavirus family includes the viruses that cause SARS, MERS, and the common cold. Most coronaviruses cause mild to moderate upper-respiratory infections, and many — including the new strain — spread to people from animals.
  • “When a virus enters a human body, it tries to attach to and take over host cells. In response, our immune systems produce antibodies: proteins that recognize and remove viruses. That’s how humans become immune to certain illnesses. Children that have contracted chickenpox, for example, are immune to the disease as adults. Vaccines are another way to develop immunity.”
  • “With many infectious diseases, a person can develop immunity against a specific strain after exposure or infection,” Amira Roess, a professor of Global Health and Epidemiology at George Mason University, told Business Insider. “Often, that person will not get sick again upon subsequent exposure to it. Regarding this specific strain of coronavirus, scientists are working to answer this question.”
  • “Doctors and virologists don’t yet know enough about the Wuhan coronavirus to say whether humans develop full immunity after they’ve contracted the illness. According to Zhan, doctors aren’t sure that the antibodies patients develop are strong or long-lasting enough to keep them from contracting the disease again. Viruses can also mutate quickly, so immunity to one strain doesn’t guarantee immunity to another.”

https://www.businessinsider.com/wuhan-coronavirus-risk-of-reinfection-2020-2?utm_source=yahoo.com&utm_medium=referral

“PM Abe asks all of Japan schools to close over coronavirus” – Daniel Leussinik, Rocky Swift, Reuters.com, Published Feb 26, 2020

(Reuters ran the story about the re-infection as a sub-heading under the school closing story)

  • “A woman working as a tour bus guide was reinfected with the coronavirus, testing positive after having recovered from an earlier infection, Osaka’s prefectural government said. Her case, the first known of in Japan, highlighted how much is still unknown about the virus even as concerns grow about its global spread.”
  • “Though a first known case for Japan, second positive tests have been reported in China – one on Feb. 21 – where the disease originated late last year.”
  • “Once you have the infection, it could remain dormant and with minimal symptoms, and then you can get an exacerbation if it finds its way into the lungs,” said Philip Tierno Jr., Professor of Microbiology and Pathology at NYU School of Medicine.
  • “Tierno said much remains unknown about the virus. “I’m not certain that this is not bi-phasic, like anthrax,” he said, meaning the disease appears to go away before recurring. Asked to comment on prospects for the Olympic Games going ahead this summer, Tierno said, “The Olympics should be postponed if this continues … There are many people who don’t understand how easy it is to spread this infection from one person to another.”
  • “TOKYO (Reuters) – Japan’s entire school system, from elementary to high schools, will be asked to close from Monday until spring break late in March to help contain the coronavirus outbreak, Prime Minister Shinzo Abe said on Thursday.”
  • “This coming week or two are an extremely important period,” Abe told a coronavirus task force.  Prioritizing children’s’ health and safety above everything else, we will ask all the elementary, junior high and high schools across Japan to temporarily close from March 2 to spring break.”
  • “The Japanese school year ends in March, with spring vacation usually starting the last week of the month. Abe’s sudden announcement about schools set off a flurry of worries on social media among parents now scrambling to arrange childcare.”
  • “The number of cases in Japan rose on Thursday to more than 200, up from the official tally of 186 late on Wednesday. On the main northern island of Hokkaido, 15 new cases, including two children under the age of 10, were confirmed. (This virus is not just a concern for adults with chronic conditions) The cases reported in Japan do not include 705 reported from an outbreak on the Diamond Princess cruise liner that was quarantined off Tokyo earlier this month.”
  • The government has urged that big gatherings and sports events be scrapped or curtailed for two weeks to contain the virus while pledging that the 2020 Summer Olympics will go ahead in Tokyo. (It’s more likely, the Olympics will be postponed) But its handling of the virus has drawn increasing criticism, including from opposition politicians.”
  • ”Japan’s biggest trading group, Mitsubishi Corp, said it was telling all of its 3,800 staff in the country to work from home for two weeks starting Friday.”

https://www.reuters.com/article/us-china-health-japan-idUSKCN20L0BI

Update Feb 26, 2020:

Today’s blog update introduces readers to the website Biocentury.com and identifies 37 companies and academic groups that are currently pursuing vaccine development programs for COVID-19. In reviewing these select article excerpts, it should become apparent to the reader that finding an effective working vaccine will require a monumental global effort and a significant amount of time to achieve.  Also introduced in today’s blog is the term ADE (Antibody-Dependent Enhancement): ADE is aproblem for many respiratory virus vaccines, in which the vaccine can cause a paradoxical worsening after virus infection”.

“WHO mapping out COVID-19 vaccines – – Who is creating a roadmap to develop covid-19 vaccines” – By Steve Usdin, Washington Editor, Biocentury.com, Published Feb 14, 2020

  • “Scientists from biopharma companies, universities and regulatory agencies met at the WHO Feb. 11-12 to draw a roadmap for the development of vaccines to protect against COVID-19 amid a rapidly shifting terrain.”
  • “While knowledge about the disease is limited and changing daily, vaccine development is moving at an unprecedented pace. Priorities out of the WHO meeting include drafting a target product profile (TPP), designing a master protocol to test multiple vaccine candidates in parallel, and coordinating international work on animal models and standards, scientists who attended the meeting told BioCentury (see “Designing a Master Protocol for 2019-nCoV Outbreak”).”
  • “The meeting, which considered a range of R&D issues in addition to vaccine development, was co-sponsored by WHO and the Global Research Collaboration for Infectious Disease Preparedness (GloPID-R). The vaccine working group was chaired by Philip Krause, deputy director of the Office of Vaccines Research and Review at FDA’s Center for Drug Evaluation and Research.”
  • “There was a lot of debate about the preclinical work that must be done to support a Phase I study.  Usually it takes two years to design and conduct multiple animal studies to assess toxicity and immunogenicity. That’s being compressed into weeks,” Gregory Glenn, president for R&D at Novavax Inc. (NASDAQ:NVAX), told BioCentury. “We probably need to have some standardized assays so that everybody is using the same measuring stick for claims” about their vaccine candidates.”
  • There’s a consensus on the path forward, and the consensus is also that a lot of work needs to be done to get us there,” Johan Van Hoof, global therapeutic area head for infectious diseases and vaccines at the Janssen unit of Johnson & Johnson, told BioCentury.”
  • There was complete agreement that we’re not trying to prevent infection and we shouldn’t expect that,” said Glenn, who went even further, arguing that complete protection against disease symptoms is not necessary. “If you could decrease hospitalizations by 70%, that would be a massive, massive improvement.”

Vaccine progress:

  • “At least 37 companies and academic groups, including 25 in China, have announced COVID-19 vaccine development programs (see Table: “COVID-19 Vaccine Development Programs”).”
  • “Janssen told BioCentury it hopes to start a Phase I clinical study of a COVID-19 vaccine candidate within approximately 8-12 months. It is using the same recombinant adenovirus (rAdV) vector platform that was the basis for an investigational Ebola vaccine that is being administered in the Democratic Republic of the Congo and Rwanda, and for several investigational vaccines that are under development. Janssen has created seven constructs and has started testing them in mice, Van Hoof said.”
  • “Moderna Inc. (NASDAQ:MRNA) is preparing its mRNA-1273 mRNA COVID-19 for a Phase I trial that its collaborator, NIH’s National Institute for Allergy and Infectious Diseases, will conduct. CEPI has provided funding through Phase I. The first clinical batch of mRNA-1273, including fill and finishing of vials, was completed on February 7, Moderna told BioCentury. “This mRNA vaccine was designed and manufactured in 25 days and is undergoing analytical testing prior to release to the NIH for use in their planned Phase I clinical trial in the U.S.””
  • “The prospects for Codagenix Inc. to bring a COVID-19 vaccine to market were boosted last week by its announcement of a collaboration with the Serum Institute of India Pvt. Ltd. to co-develop a live attenuated vaccine.  “The Serum Institute, one of the world’s largest manufacturers of vaccines, will provide milestone-based funding of preclinical and clinical development, Codagenix CEO J. Robert Coleman told BioCentury.” “If Codagenix develops a successful vaccine, the Serum Institute has committed to manufacture it, Coleman said.  Codagenix is developing a COVID-19 vaccine using its computationally designed live attenuated virus technology.”
  • “Texas Children’s Hospital Center for Vaccine Development at Baylor College of Medicine is working on two candidate vaccines for COVID-19. One is a SARS vaccine candidate “which is predicted to confer cross-protection against” COVID-19, Maria Elena Bottazzi, co-director of the Texas Children’s Hospital Center for Vaccine Development – Product Development Partnership (PDP), told BioCentury.  The SARS vaccine “has completed cGMP manufacturing and could move into clinical trials quickly,” said Peter Hotez, co-director of the Texas Children’s PDP and dean of the National School of Tropical Medicine. The team is seeking partners and funding for both programs.  The vaccines minimize or prevent antibody-dependent enhancement (ADE), a “problem for many respiratory virus vaccines, in which the vaccine can cause a paradoxical worsening after virus infection,” Hotez said. “ADE also occurs with some virus constructs of SARS and is therefore a potential safety problem with coronavirus vaccines.”
  • “Vaxart Inc. (NasdaqGS:VXRT) is developing an oral recombinant COVID-19 vaccine that would be administered by tablet.  Like the company’s other investigational vaccines, its COVID-19 vaccine uses an adenovirus type 5 (Ad5) vector to carry genes coding for an antigen and an adjuvant to the mucosa of the small intestine, Vaxart CEO and chairman Wouter Latour told BioCentury.  Vaxart’s vaccines differentiate themselves by providing a “really robust mucosal response” that could be particularly important for a disease like COVID-19 that affects the respiratory system, Latour said. Vaxart will need external funding or collaboration to bring its vaccine past preclinical studies, he said.”

Table: COVID-19 vaccine development programs:

  • “Listed below are the companies and academic groups that have announced programs to develop new vaccines for COVID-19 (2019-nCoV) acute respiratory disease as of Feb 14. The majority of the vaccine programs are being developed by China-based groups. Ongoing programs include live attenuated, inactivated, protein-based, viral vector and DNA and RNA vaccines. Source: China Association for Vaccines, group websites”
Company/group Country Organization type
Johnson & Johnson U.S. Pharma/big biotech
AIM Vaccine China Biotech
Applied DNA Sciences; Takis Biotech U.S.; Italy Biotech
Beijing Biological Products Institute (Sinopharm) China Biotech
Beijing Sanroad Biological Products  China Biotech
CanSino Biologics China Biotech
Changchun Zhuoyi Biological  China Biotech
China National Biotech Group (Sinopharm) China Biotech
Chongqing Zhifei Biological Products China Biotech
Codagenix; Serum Institute of India U.S.; India Biotech
CureVac Germany Biotech
ExpreS2ion Biotech Holding Denmark Biotech
GeoVax Labs; BravoVax U.S.; China Biotech
Hualan Biological Engineering China Biotech
iBio; Beijing CC-Pharming U.S.; China Biotech
Inovio Pharmaceuticals; Beijing Advaccine Biotechnology U.S.; China Biotech
Liaoning Chengda Biotechnology  China Biotech
Minhai Biotechnology  China Biotech
Moderna U.S. Biotech
Novavax U.S. Biotech
Royal (Wuxi) Bio-pharmaceutical China Biotech
Shenzhen Kangtai Biological Products China Biotech
Sichuan Clover Biopharmaceuticals China Biotech
Sinovac Biotech China Biotech
Stermirna Therapeutics; Tongji University China Biotech
Vaxart U.S. Biotech
Walvax Biotechnology China Biotech
ZhongKe Biopharm China Biotech
Zhongyi Anke Biotechnology China Biotech
Zydus Cadila India Biotech
Sichuan University State Key Laboratory of Biotherapy; Zhejiang Teruisi Pharmaceutical; Chengdu National GLP Center; Sichuan Provincial People’s Hospital; Chengdu Institute of Biological Products  (Sinopharm) China Biotech; Academic
Stermirna Therapeutics; Tongji University China Biotech; Academic
Baylor College of Medicine; University of Texas Medical Branch; New York Blood Center; Fudan University U.S.; China Academic
Imperial College London U.K. Academic
Institute of Medical Biology, Chinese Academy of Medical Sciences China Academic
Oxford University U.K. Academic
University of Queensland Australia Academic
University of Saskatchewan Canada Academic

https://www.biocentury.com/article/304456

  • “Antibody-dependent enhancement (ADE) occurs when non-neutralizing antiviral proteins facilitate virus entry into host cells, leading to increased infectivity in the cells. Some cells do not have the usual receptors on their surfaces that viruses use to gain entry. The antiviral proteins (i.e., the antibodies) bind to antibody Fc receptors that some of these cells have in the plasma membrane. The viruses bind to the antigen binding site at the other end of the antibody. ADE is common in cells cultured in the laboratory, but rarely occurs in vivo except for dengue virus. This virus can use this mechanism to infect human macrophages, causing a normally mild viral infection to become life-threatening”

https://en.wikipedia.org/wiki/Antibody-dependent_enhancement

Update: Feb 25, 2020:

Today’s blog update focuses on larger businesses (corporations) and supply chain management.  The referenced Wall Street Journal article discusses a brief outline on how (larger – International) businesses can try to mitigate the impending revenue / profit losses coming from the evolving Coronavirus outbreak.  The selected article excerpts identify some good starting points; I suggest that every business. large and small, build on Dr. Sheffi’s outline, and expand their business plans according to their own desired objectives, funding and respective situations.

This part here is my personal perspective:  All consumer-oriented businesses that hope to survive the next six months to three ? years should be re-writing their business plans to consider a different type of consumer –-  A consumer that avoids unnecessary exposure to the outside world; one who prefers to shop online, prefers to pick-up their groceries, or better yet have them delivered; one who works from home remotely; and one who has limited or restricted geographic mobility.

“Commentary: Supply-Chain Risks From the Coronavirus Demand Immediate Action – WSJ.com, Published Feb 18, 2020

  • MIT’s Yossi Sheffi writes that the unknown potential impact of the virus shouldn’t stop companies from acting quickly to minimize short- and long-term impact on their operations”
  • “Faced with so many unknowns, companies should take sensible “just in case” steps to prepare for the effects of the coronavirus.”
  • “1. Set up a central emergency management center. At this point it can be virtual but should include a clear roster of participants with clear decision-making rules in case of a pandemic.”
  • “2. Review the company’s product portfolio and the customer base in order to set priorities. If capacity is reduced, there will need to be rules for which products should be built and which customers should be supplied first.”
  • “3. Review suppliers. Who makes critical parts? Are there alternate sources? What is the suppliers’ inventory status?”
  • “4. Plan for operating to maximize cash flow rather than profits.”
  • “5. Maintain communications with federal and local authorities, as well as Chinese and other Southeast Asian friends and colleagues on the ground.”
  • “Hoping for the best while preparing for the worst may not seem like a rigorous business approach to the crisis. But given our lack of knowledge, it is the most prudent strategy for managing risk.”

“Yossi Sheffi is director of the Massachusetts Institute of Technology’s Center for Transportation and Logistics. He is the author of two books on supply-chain risk management, “The Resilient Enterprise” and “The Power of Resilience.”

https://www.wsj.com/articles/commentary-supply-chain-risks-from-the-coronavirus-demand-immediate-action-11582054704

https://en.wikipedia.org/wiki/Yossi_Sheffi

Update: Feb 24, 2020:

Today’s blog update provides a brief history for the use of cordon sanitaires (quarantines), and reverse cordon sanitaires (self-imposed or voluntary quarantines).   I have three central points I hope the reader will take away and mull on: first, I think it’s too late now to stop the spread at international borders – we can only slow it; second, it may not be too late to implement cordon sanitaires or reverse cordon sanitaires at the state, county or city level; third, discussions and planning on how to feed and provide medical care for people in such contingencies needs to start now.  Also included in today’s post is a brief weblink excerpt describing Remdesivir, an anti-viral drug, with potential capabilities of inhibiting the Coronaviruses from replicating cell bodies.    

Cordon sanitaire – Wikipedia

  • “A cordon sanitaire, French for “sanitary cordon”) is the restriction of movement of people into or out of a defined geographic area, such as a community. The term originally denoted a barrier used to stop the spread of infectious diseases, and may be used interchangeably with the term “quarantine“. The term cordon sanitaire dates to 1821, when the Duke de Richelieu deployed French troops to the border between France and Spain, allegedly to prevent yellow fever from spreading into France.”
  • “A cordon sanitaire is generally created around an area experiencing an epidemic or an outbreak of infectious disease, or along the border between two nations. Once the cordon is established, people from the affected area are no longer allowed to leave or enter it. In the most extreme form, the cordon is not lifted until the infection is extinguished. Traditionally, the line around a cordon sanitaire was quite physical; a fence or wall was built, armed troops patrolled, and inside, inhabitants were left to battle the affliction without help. In some cases, a “reverse cordon sanitaire” (also known as protective sequestration) may be imposed on healthy communities that are attempting to keep an infection from being introduced. Public health specialists have included cordon sanitaire along with quarantine and medical isolation as “nonpharmaceutical interventions” designed to prevent the transmission of microbial pathogens through social distancing.”
  • “The cordon sanitaire is rarely used now because of our improved understanding of disease transmission, treatment and prevention. It remains a useful intervention under conditions in which: 1) the infection is highly virulent (contagious and likely to cause illness); 2) the case fatality rate is very high; 3) treatment is nonexistent or difficult; and 4) there is no vaccine, or other means of immunizing large numbers of people (such as needles or syringes) are lacking.”  (Note: the current Coronavirus, COVID-19, meets all four requirements)

Historical examples:

  • “17th century: In May 1666, the English village of Eyam famously imposed a cordon sanitaire on itself after an outbreak of the bubonic plague in the community. During the next 14 months almost eighty percent of the inhabitants died. A perimeter of stones was laid out surrounding the village and no one passed the boundary in either direction until November 1667, when the pestilence had run its course. Neighboring communities provided food for Eyam, leaving supplies in designated locations along the boundary cordon and receiving payment in coins “disinfected” by running water or vinegar.”
  • “19th century: In 1899 an outbreak of the plague in Honolulu was managed by a cordon sanitaire around the Chinatown district. In an attempt to control the infection, a barbed wire perimeter was created and people’s belongings and homes were burned.”
  • “During the San Francisco plague of 1900–1904 San Francisco’s Chinatown was subjected to a cordon sanitaire. The San Francisco plague of 1900–1904 was an epidemic of bubonic plague centered on San Francisco‘s Chinatown. It was the first plague epidemic in the continental United States. The epidemic was recognized by medical authorities in March 1900, but its existence was denied for more than two years by California’s Governor Henry Gage. His denial was based on business reasons, to protect the reputations of San Francisco and California and to prevent the loss of revenue due to quarantine.”  (Likely, the same reasons today’s world leaders are still slow to react!)
  • “20th century:
  • “The 1918 flu pandemic spread so rapidly that, in general, there was no time to implement cordons sanitaires. However, to prevent an introduction of the infection, residents of Gunnison, Colorado isolated themselves from the surrounding area for two months at the end of 1918. All highways were barricaded near the county lines. Train conductors warned all passengers that if they stepped outside of the train in Gunnison, they would be arrested and quarantined for five days. As a result of this protective sequestration, no one died of influenza in Gunnison during the epidemic.
  • In late 1918, Spain attempted unsuccessfully to prevent the spread of the Spanish flu by imposing border controls, roadblocks, restricted rail travel, and a maritime cordon sanitaire prohibiting ships with sick passengers from landing, but by then the epidemic was already in progress.” (I think we’re already seeing that we’re past the point of stopping the spread of the current Coronavirus across most national borders; however, it’s not too late to consider implementing reverse cordon sanitaires at state (province) or county levels.  Keeping in mind all the significant issues involved in feeding and caring for isolated communities.)
  • “21st century:

“During the 2003 SARS outbreak in mainland China, Hong Kong, Taiwan, and Singapore, large-scale quarantine was imposed on travelers arriving from other SARS areas, work and school contacts of suspected cases, and, in a few instances, entire apartment complexes where high attack rates of SARS were occurring. In China, entire villages in rural areas were quarantined and no travel was allowed in or out of the villages. One village in Hebei Province was quarantined from April 12, 2003 until May 13. Tens of thousands of individuals fled from areas when they learned of an impending cordon sanitaire, thereby possibly spreading the epidemic.” (Sounds familiar – five million Wuhan residents departed the city for Chinese New Year holidays and also to avoid the publicly announced quarantine start date.)

  • “During the 2003 SARS outbreak in Canada, “community quarantine” was used to successfully reduce transmission of the disease.”

https://en.wikipedia.org/wiki/Cordon_sanitaire

More details on Canada’s 2003 SARS community quarantine follow:

  • “Quantifying the impact of community quarantine on SARS transmission in Ontario: estimation of secondary case count difference and number needed to quarantine” BMC Public Health. 2009; 9: 488. Published online 2009 Dec 24. doi: 10.1186/1471-2458-9-488
  • Quantitative estimates of quarantine impact: We estimated that use of community quarantine in the 2003 Ontario SARS outbreak reduced transmission to one third, with an absolute difference of 0.13 secondary cases per index case under quarantine, relative to not quarantined by symptom onset.”
  • “Challenges in interpretation and communication: Measures to restrict close contact probably made an important contribution to the control of SARS outbreaks.  Transmission patterns for influenza however, make it less likely that contact tracing and quarantine would be fast enough to avoid transmission which is greatest in the earliest stage of infection.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2808319/

“Nonpharmaceutical Interventions for Pandemic Influenza, International Measures” – World Health Organization Writing Group, Emerg Infect Dis. 2006 Jan; 12(1): 81–87. doi: 10.3201/eid1201.051370

  • “Abstract: Screening and quarantining entering travelers at international borders did not substantially delay virus introduction in past pandemics, except in some island countries, and will likely be even less effective in the modern era. Instead, WHO recommends providing information to international travelers and possibly screening travelers departing countries with transmissible human infection. The principal focus of interventions against pandemic influenza spread should be at national and community levels rather than international borders.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291414/

Remdesivir:

“An experimental antiviral medication might help fight the new coronavirus” – Theverge.com, Nicole Wetsman, Published Feb 4, 2020

  • Remdesivir was developed by the pharmaceutical company Gilead (NASDAQ: GILD) as a treatment for Ebola. It’s a broad-spectrum antiviral drug, and it blocks the activity of a protein that helps coronaviruses make copies of themselves. Research groups identified the drug as a potential candidate for the treatment of coronaviruses in the aftermath of the 2012 MERS outbreak, when another new coronavirus spread through the Middle East. In cell models, it blocks the activity of MERS, SARS (a 2002 coronavirus), and other coronaviruses that are found in bats.”
  • “Another clinical trial, of a combination of two anti-HIV drugs, is also underway in a Chinese hospital. Chinese experts recommended that the two drugs, lopinavir and ritonavir, be given to coronavirus patients. They’ve also helped a handful of coronavirus patients in Thailand — including a 70-year-old woman, according to Thai doctors.”  (Just a guess, but this data makes me suspect there may be some truth to the possibility that the virus was man-made – see Feb 20, 2020 blog update)  

https://www.theverge.com/2020/2/4/21122327/coronavirus-experimental-medication-treatment-wuhan-china-gilead-hiv

Update: Feb 23, 2020:

Today’s blog update provides select excerpts from a recent 28-day medical observational cohort (study) of 52 critically ill patients treated for SARS-CoV-2 (Coronavirus) pneumonia in Wuhan, China from Dec 2019 to Jan 2020.  I cherry-picked the data in the study that I thought was most important and relisted it here; however, if you need more context or specifics than I highly recommend reading the full article at the referenced link at the end of today’s post.  The three things I took away from the study is first, that 32 of the 52 critically-ill patients died, and three patients were still on ventilators at the end of the 28 day study.  Second, if you’re an older (64+), male, and you have a chronic medical illness (worse, if its cerebrovascular in nature), and you contract SARS CoV-2, and you end up on a mechanical ventilator in ICU… then your expected survival rate is apparently 50% or less.  Third, the doctors (study authors) postulated that “the (SARS-CoV-2) mortality rate would be higher after 28 days than that seen (in previous studies) in patients with MERS-CoV”.**

** “Middle East respiratory syndrome coronavirus (MERS-CoV) – The Kingdom of Saudi Arabia” – WHO – Published Feb 24, 2020 (added to blog on Feb 24, 2020)

** “From 2012 until 31 January 2020, the total number of laboratory-confirmed MERS-CoV infection cases reported globally to WHO is 2519 with 866 associated deaths.”

Strange side-note, same article: “Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.” (Do people actually drink camel urine?)

https://www.who.int/csr/don/24-february-2020-mers-saudi-arabia/en/

Two quick Wikipedia links to assist with virus and pneumonia (ARDS) background:

https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_coronavirus_2

https://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome

“Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study” –  www.thelancet.com/respiratory   Published online February 21, 2020   https://doi.org/10.1016/S2213-2600(20)30079-5

  • Contributors: “Department of Critical Care Medicine (X Yang MD, Y Yu MD, J Xu MD, Prof H Shu MD, Prof H Liu MD, Y Wu MD, Y Wang MD, S Pan MD, Prof X Zou MD, Prof S Yuan MD, Prof Y Shang MD), Institute of Anesthesiology and Critical Care Medicine (X Yang, Y Yu, J Xu, Prof H Shu, Prof H Liu, Y Wu, Y Wang, S Pan, Prof X Zou, Prof S Yuan, Prof Y Shang), Union Hospital, and Department of Critical Care Medicine, Tongji Hospital (Prof M Fang MD), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Jin Yin-tan Hospital, Wuhan, China (X Yang, Prof J Xia MD, Prof H Liu, Prof T Yu MD, Prof Y Shang); Department of Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Hubei, China (L Zhang MD); and Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China (Prof Z Yu MD)”

SUMMARY:

  • Background: An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia.”
  • Methods: In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2 related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation.”
  • Findings: Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. 32 (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3–11) days for non-survivors. Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients.
  • Interpretation: The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1–2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced.”
  • Results: Of the 20 patients who survived, eight patients were discharged. Three patients were still on invasive ventilation at 28 days, including one patient who was also on ECMO. One patient was on non-invasive ventilation, two were using high-flow nasal cannula, and six were using common nasal cannula.”
  • “Discussion: Like SARS-CoV and Middle Eastern respiratory syndrome (MERS)-CoV, SARS-CoV-2 is a coronavirus that can be transmitted to humans, and these viruses are all related to high mortality in critically ill patients. However, the mortality rate in patients with SARS-CoV-2 infection in our cohort is higher than that previously seen in critically ill patients with SARS. In a cohort of 38 critically ill patients with SARS from 13 hospitals in Canada, 29 (76%) patients required mechanical ventilation, 13 (43%) patients had died at 28 days, and six (16%) patients remained on mechanical ventilation. 17 (38%) of 45 patients and 14 (26%) of 54 patients who were critically ill with SARS infection were also reported to have died at 28 days in a Singapore cohort13 and a Hong Kong cohort, 14 respectively. The mortality rate in our cohort is likely to be higher than that seen in critically ill patients with MERS infection. In a cohort of 12 patients with MERS from two hospitals in Saudi Arabia, seven (58%) patients had died at 90 days. Since the follow-up time is shorter in our cohort, we postulate that the mortality rate would be higher after 28 days than that seen in patients with MERS-CoV.”
  • “The fundamental pathophysiology of severe viral pneumonia is severe ARDS. Men and people of an older age (>65 years) are more likely to develop ARDS than women or those of a younger age. Therefore, it is reasonable that the mortality at 28 days of severe SARS-CoV-2 pneumonia is similar to the mortality of severe ARDS, which is near 50%.  Patients with a history of cerebrovascular disease are at increased risk of becoming critically ill or dying if they have SARS-CoV-2 infection.”
  • In our cohort, fever is the most common symptom in patients with SARS-CoV-2 pneumonia, which is in accordance with previous studies, but not all patients had fever. We also found that fever was not detected at the onset of illness in six (11·5%), and that it was in fact detected 2–8 days later. The delay of fever manifestation hinders early identification of patients infected with SARS-CoV-2—if patients are asymptomatic identification of suspected cases is more difficult. The median duration from onset of symptoms to radiological confirmation of pneumonia was 5 (3–7) days, meaning that early or repeated radiological examinations are useful in screening patients with SARS-CoV-2 pneumonia. As for laboratory tests, lymphocytopenia occurred in more than 80% of critically ill patients in our cohort. Mechanical ventilation is the main supportive treatment for critically ill patients.”
  • “Nearly half of the patients were given antiviral agents, and more than half were given intravenous glucocorticoids. Patients treated with lopinavir were from an ongoing clinical trial registered on Chinese Clinical Trial Registry (ChiCTR2000029308). Remdesivir was given to the first patients with SARS-CoV-2 pneumonia in the USA.4 Trials on remdesivir are about to recruit both mild to moderate patients (NCT04252664) and severe patients (NCT04257656) infected with SARS-CoV-2. Although, intravenous glucocorticoids were commonly used in patients with severe SARS or MERS pneumonia, their efficacy remains controversial and their use to treat SARS-CoV-2 infection is also controversial. An ongoing clinical trial (NCT04244591) might shed some light on the safety and efficacy of these drugs as treatment.”   (Note: the Feb 13, 2020 blog update here discussed glucocorticoids, neutrophilia, and the use of ventilators in a prior, smaller – 38 person, coronavirus study).**

** Jason Gale, Senior Editor at Bloomberg.com has a recent related article out:  ttps://www.bloomberg.com/news/articles/2020-02-23/coronavirus-patients-long-ventilator-stays-strain-hospitals

  • “The data in this (52 person) study permit a preliminary assessment of the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia. Further studies are still needed.”

https://www.thelancet.com/pb-assets/Lancet/pdfs/S2213260020300795.pdf

Update Feb 22, 2020

The latest World Health Organization (WHO) COVID-19 infection/mortality statistics:

“Globally 77,794 confirmed (599 new)”

“China 76,392 confirmed (397 new) 2348 deaths (109 new)”

“Outside of China 1,402 confirmed (202 new) 28 countries (2 new: Israel & Lebanon) 11 deaths (3 new)”

WHO puts out situation daily situation reports.

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports

Update Feb 21, 2020

Hello,

In today’s blog post I’m highlighting the virus’ emergence in South Korea and relaying my opinion that we may be on the verge of a Sea Change (profound transformation) in our current way of life. The Sea Change I’m anticipating is that humanity will, in response to the spreading contagion, begin to avoid any and all human clustering, mass gathering events, activities and locales such as: hospitals, sporting events, church gatherings, town halls, concerts, large food markets, all schooling settings, mass transport (buses, trains, airplanes, ships), work facilities, campuses, bars and restaurants, military barracks and polling stations… the list is endless.   People will be afraid to be around other humans outside of their immediate families and their close-knit social circles.  This Sea Change would/will likely last as long as the virus remains a significant presence around the globe; for however long it takes to develop a viable vaccine!  Obviously, this would have a significant impact on so many aspects of our daily lives. Global financial markets will take a major hit and could possibly collapse!  I know this all sound like gloom and doom, and maybe what I’m describing is just a worse-case scenario.  I just can’t understand why it appears the world, especially the U.S., is not taking this issue more seriously.

In the following referenced article, I find significance in the scale of the lock-down of Daegu, South Korea – 2.5 million people, and also in the “super-spreading event”, 400 people infected in a South Korean church.  South Korea is the next canary in the coal mine proving that the virus will not be mainly contained to China. The Super-spreading church event highlights my main point of today’s blog focus: communal environments will feed the virus’ growth. I also see significance in the spread of the virus in China’s prison systems for the same reason.  Prisons, like cruise ships, confine humans into close quarters, with increased bodily contact and confined or shared air flow; often in environments that are frequently less than hygienic and consequently conducive to spreading the virus.  For the virus, it’s the equivalent of shooting fish in a barrel.

Coronavirus Kills Young Wuhan Doctor As Hundreds Infected In China’s Prisons – Theguardian.com, L. Kuo & R. Ratcliffe, Published Feb 21, 2020

South Korea: 

  • “In South Korea, prime minister Chung Se-kyun said the country was entering an emergency phase following a surge in infections that has been linked to a controversial church.  Mass gatherings have been banned, and all kindergartens and libraries closed in Daegu, a city that is home to 2.5 million people and lies two hours from Seoul. Soldiers in the city have also been forbidden from leaving their barracks after several military personnel tested positive.” (This strategy with the military is analogous to the failed strategy with the cruise ships. It will backfire! Put the healthy non-infected soldiers to work in the cities, or send them home, subject to recall. If they’re potentially infected – isolate them from one another in tents or rooms, just don’t leave them crammed together in confined areas!)
  • “A further 52 new cases were reported by officials on Friday, bringing the national total of confirmed patients to 156. Most are concentrated in Daegu, where a wave of infections have been linked to a 61-year-old woman, known as “Patient 31”. The patient is reported to have attended a church, an incident health officials have described as a “super-spreading event.”
  • “On Friday, the city’s streets were mostly deserted, as people were urged to stay at home and wear masks, even indoors. Military medical staff are also being deployed to Daegu and neighbouring Cheongdo county, and isolation facilities are being created.” 
  • “It’s like someone dropped a bomb in the middle of the city,” resident Kim Geun-woo, 28, told Reuters by telephone. “It looks like a zombie apocalypse.”
  • “Prime Minister Chung Sye-kyun said that while previous efforts had been focused on stopping the illness entering the country, officials were now concentrating on preventing the illness from spreading further in communities.

China:

  • “On Friday, Hubei province revised its number of newly confirmed cases to add 220 infections from the province’s prison system. Officials did not say when those infections took place but said that a total of 271 cases, of which 51 had already been counted, had been diagnosed. Of those, 230 were in Wuhan’s women’s prison. The head of the women’s prison has been dismissed.”
  • “In Rencheng prison in the eastern province of Shandong, 200 prisoners and seven guards tested positive as of Thursday, after infections among correctional officers were first detected last week.”
  • “At Shilifeng prison in the southern province of Zhejiang, a total of 34 prisoners have been confirmed to have contracted the virus, including 27 new cases as of Thursday. According to state media, two prison officials have been fired over the incident in Shilifeng. In Shandong, seven prison officials as well as the party secretary for the province’s department of justice have been removed.”
  • “Officials said 2,077 people in Rencheng prison had now been tested. Authorities said they were setting up a specialist hospital and sending inspection teams to other prisons and detention centres.”

https://www.theguardian.com/world/2020/feb/21/coronavirus-kills-wuhan-doctor-hundreds-infected-china-prisons

As of 2018, China has more than a million citizens (legal foreign nationals) residing in South Korea and the U.S. has approximately 230,000.

https://en.wikipedia.org/wiki/Foreigners_in_Korea

Update: Feb 20, 2020:

Today’s update is a controversial one. It feeds a current conspiracy theory that 2019-nCoV (COVID-19) may have been engineered by humans. I don’t know if this is true, but I’m including an abstract of this info in my blog because the author of the article, Dr. Jean-Claude Perez (See link immediately below), appears to be a legitimate researcher/scientist. In his article, Dr. Perez states the Wuhan Coronavirus is “partially synthetic”, “with fragments of the HIV1 retrovirus”.

https://www.researchgate.net/profile/Jean-claude_Perez

Perez, J. “Wuhan nCoV-2019 SARS Coronaviruses Genomics Fractal Metastructures Evolution and Origins.” Preprints2020, 2020020025 (doi: 10.20944/preprints202002.0025.v2). – Version II, Published online Feb 17, 2020

  • “Wuhan nCoV-2019 SARS Coronaviruses Genomics Fractal Metastructures Evolution and Origins “Where there is matter, there is geometry.” Johannes Kepler Jean-claude PEREZ, PhD Maths § Computer Science Bordeaux University, RETIRED interdisciplinary researcher (IBM Emeritus, IBM European Research Center on Artificial Intelligence), 7 avenue de terre-rouge F33127 Martignas Bordeaux metropole France.”
  • “ABSTRACT : The main result of this updated release is the formal proof that 2019-nCoV coronavirus is partially a SYNTHETIC genome. We proof the CONCENTRATION in a small région of wuhan New genome of 3 different régions from HIV1 ENVELOPPE GENE. In this article, we demonstrate that there is a kind of global human hosts adaptation strategy of SARS viruses as well as a strategy of global evolution of the genomes of the different strains of SARS which have emerged, mainly in China, between years 2003 first SARS genomes and the last 2020 nCoV-2019 Wuhan seafood market pneumonia virus isolate Wuhan-Hu-1, complete genome. This global strategy, this temporal link, is materialized in our demonstration by highlighting stationary numerical waves controlling the entire sequence of their genomes. Curiously, these digital waves characterizing the 9 SARS genomes studied here are characteristic whole numbers: the “Fibonacci numbers” (a series of numbers in which each number is the sum of the two preceding numbers. The simplest is the series 1, 1, 2, 3, 5, 8, etc.), omnipresent in the forms of Nature, and which our research for several decades has shown strong links with the proportions of nucleotides in DNA. Here we demonstrate that the complexity and fractal multiplicity of these Fibonacci numerical waves increases over the years of the emergence of new SARS strains. We suggest that this increase in the overall organization of the SARS genomes over the years reflects a better adaptation of SARS genomes to the human host. The question of a link with pathogenicity remains open. However, we believe that this overall strategy for the evolution of the SARS genomes ensures greater unity, consistency and integrity of the genome. Finally, we ask ourselves the question of a possible artificial origin of this genome, in particular because of the presence of fragments of HIV1 retrovirus. KEYWORDS : SARS, Wuhan nCoV-2019, Fibonacci numbers, Fractal genome, Numerical stationary periodic waves, HIV1, synthetic genomes.”

https://www.preprints.org/manuscript/202002.0025/v2

Update Feb 18, 2020:

Information for Laboratories COVID-19 Requests for Diagnostic Panels and Virus – CDC.gov, Published Feb XX, 2020

  • Should I be testing all patients for COVID-19?

“At this time, CDC only recommends diagnostic testing of patients who meet the clinical criteria for a COVID-19 person under investigation (PUI), per Interim Guidelines for Collecting, Handling and Testing Clinical Specimens from Persons Under Investigation (PUIs) for Coronavirus Disease 2019 (COVID-19).”

On Feb 18, 19 and 20, 2020, I clicked on the above Interim Guidelines hyperlink and received this same message: “Oops! We can’t seem to find the page you were looking for. Please try our search or A-Z index.”

Maybe the guidelines are being revised?

“At this time, PUIs are identified as individuals with a history of travel to China or close contact with a person confirmed to have the COVID-19 illness and symptoms of respiratory illness such as cough or shortness of breath.”

https://www.cdc.gov/coronavirus/2019-ncov/lab/tool-virus-requests.html

The proceeding BMJ (British Medical Journal) article follows up on my Feb 16, 2020, blog post related topic: The Patient Queue Conundrum. The article details a novel pilot program recently implemented in the UK, in Jan 2020, to have individuals with suspected COVID-19 infection self-isolate at their homes with follow-up testing through in-home visits by local medical personnel. I found particularly interesting the information that each ambulance requires “up to eight hours” of decontamination after transporting a suspected COVID-19 patient. Logistics, Funding and Manpower will be increasingly significant factors in how we deal with the virus as the spread grows.

“Coronavirus: home testing pilot launched in London to cut hospital visits and ambulance use BMJ 2020;368:m621, Published Feb 14, 2020

  • “People with suspected covid-19 in London are being tested in their homes as part of a pilot that was developed by doctors to stop unnecessary ambulance use and hospital visits. The community testing scheme started at the end of January at North West London NHS Trust and has now been implemented in three other trusts: University College London Hospital, St George’s University Hospital, and Guys and St Thomas’. More than 130 patients have been tested in two weeks.”
  • The home testing initiative was started by Laurence John from the infectious diseases department at Northwick Park Hospital. He told The BMJ that the need for community testing became clear after 25 London ambulances had to be taken out of service in one afternoon to be decontaminated after carrying potential cases to hospital for testing. Decontamination can take an ambulance out of service for up to eight hours.
  • “In the pilot, potential cases are referred from GPs (General Practioners), NHS 111, or local emergency departments to community testing hubs. These cases are then triaged over the phone to ensure that they are well enough to remain at home, they can self-isolate, and their home environment is appropriate for safe personal protective equipment (PPE) protocols.”
  • “A healthcare professional with PPE training is then sent to the person’s home to perform the test within 24 hours of referral. The person is given advice on self-isolation, probable dates of results, what to do in the event of clinical deterioration, and an emergency contact number. They are then phoned with the results and if they are found to be infected, are admitted to hospital.”

https://www.bmj.com/content/368/bmj.m621

Update: Feb 17, 2020:

Why the current 14 day cruise ship quarantines are simply a delay tactic for governments while they ponder their next moves.

The current 14 day cruise ship quarantines are just delay tactics because it appears that governments are failing to isolate the quarantined individuals from one another, and until recently, officials are not removing the individuals from the contaminated environments (the cruise ships). The 14 day quarantine clock effectively resets every time one individual in the group gets infected, it’s a perpetually forward moving wave of infections!

Diagnostic testing helps to a degree. Let’s say hypothetically that officials test every passenger on an infected ship on the assigned 14th day of the quarantine; and let’s say that all the passengers pass the tests, and let’s assume the tests are 100% accurate. Officials would then have to immediately put each passenger through a disinfection process of their bodies, and issue them sterile clothing. All the passengers personal possessions in their rooms would have to be abandoned as contaminated. Now, the newly disinfected passengers would need to be fully suited up (masks, goggles, the works)., and then escorted off the ship to a clean environment to undergo a second disinfection process. Do this for all 2000 – 5000 people on each ship. Quite a logistical undertaking; one I’m guessing is not being implemented. This is why I think the current 14 day quarantines are simply stalling tactics while government officials look for ways to deal with the virus.

Update: Feb 16, 2020:

The Patient Queue Conundrum And Contingency Planning

As noted in the JAMA survey of 138 Wuhan COVID-19 patients (Feb 13, 2020, Blog Update), hospitals can be breeding grounds for contagion: “Presumed human-to-human hospital-associated transmission of 2019-nCoV (COVID-19) was suspected in 41% of patients.”

So, how can we change this? First, we must ensure the established medical hygiene and isolation protocols are being followed consistently. Second, we must change the intake protocols that we currently use to identify and assess emergency (unscheduled) patient treatment.  We can’t continue to queue people in large numbers in hospital emergency rooms. I just watched a short news brief on TV showing dozens of people in a Chinese hospital queued in hospital hallways waiting for assistance; apparently because their emergency room lobby was overflowing. By confining people in large numbers, especially potentially contagious people, to small areas, with limited airflow we’re just facilitating the spread of the virus. Transmission prevention procedures need to be implemented in the early intake stages of assessing patients.  

Individuals who suspect they may have contracted or been exposed to the virus should be instructed to contact their local hospital or clinic by phone, text or email to relay their symptoms and provide their medical history.  The hospital will then need to prioritize the patient’s status and make a triage determination as to whether the person needs immediate medical assistance or whether they can wait and be scheduled for an assessment appointment, preferably within 48 hours.  Most physical assessments should be conducted in secure, sterile environments in buildings or tents that are not part of the main hospital facility; these buildings or tents should be utilized exclusively for the intake assessment process.  Patients need to be assessed away from other patients, family members, and uninvolved medical staff.

Yes, these additional protocol procedures will be a pain, labor intensive and cost lots of money that most hospitals don’t have. Governments will need to foot the bill with emergency funding! Hospital Security will need to be addressed as a priority issue; some people will need to be turned away from emergency rooms. Governments and medical facilities across the globe should also be looking at how they would/will house (number of beds) and treat mass numbers of infected people.  Mortuary services and casualty management will need to emphasized. Emergency agencies like FEMA, and agencies that deal with refugees, should be consulted as they already have well established procedures and protocols for dealing with many of the same pertinent logistical issues.  Governments should be compiling lists of former and retired medically qualified personnel who may voluntarily return to service, when or if called upon

Life under lockdown in China: hospital queues and empty streets The Guardian, Published Jan 24, 2020

“Patients are all anxious and worried,” said Ms Zhang, a nurse in Wuhan, who is pregnant, and who is herself receiving treatment for a low fever. Her elderly mother is believed by doctors to have the new coronavirus, but she has not been given a diagnostic test. Her mother was previously given injections at an outpatient department and sent home. Despite trying several hospitals, none were able to offer a bed.”

“Zhang fears her father could also become ill, as he has developed a fever after visiting the hospital with her mother. On Thursday, she waited for hours to receive treatment herself, and was eventually given an anti-inflammatory injection but told supplies of cephalosporin** had run out.”

“After speaking to the head of department for infected medical staff, she was able to get a bed. “I am a nurse myself, it’s difficult to get myself a bed, for normal people it would be much more difficult. The situation is the same in other hospitals in Wuhan, I heard from friends and relatives who are working in other hospitals here,” she said.”

https://www.theguardian.com/science/2020/jan/24/life-under-lockdown-in-china-hospital-queues-and-empty-streets

** Note: There is no cure or vaccine for the Corona Virus; Cephalosporin (AKA: Cefalosporin) is an antibiotic used to treat secondary bacterial infections (like bacterial pneumonia).

Update: Feb 15, 2020:

I suspect that once the virus fully establishes itself outside of China, in countries that do not have China’s huge military, police force, financial resources, medical personnel, medicine and medical equipment, the virus will spread rapidly. Picture how quickly it would spread in Calcutta, India, or any other similarly densely populated region around the globe. The Spanish Flu occurred in several waves over the span of three to four years (1917-1920), in mutated strains, with varying levels of virulence.

Update: Feb 13, 2020:

This blog update covers findings from a recent Journal of the American Medical Association (JAMA) study of 138 Wuhan, China, patients afflicted with COVID-19. Of note was the 4.3% mortality rate, the suspected 41% hospital-associated transmission rate, and the estimate “that, on average, each patient has been spreading infection to 2.2 other people“. I also included additional weblinks on Neutrophilia, as referenced in the study, and as a follow up to my Feb 11, 2020, post regarding Cytokine Storms. Why doctors treated 45% of the 138 patients with Methylprednisolone puzzles me. Based on the weblinks I read, see below, Methlyprednisolone “weakens the immune system” and increases white blood cell counts, which seems like the last thing you would want to do with someone already displaying high white blood cell counts (Neutrophilia)? Wouldn’t that contribute to the likelihood of cytokine storms?

“Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia (NCIP)  in Wuhan, China” – JAMAnetwork.com, Feb 7, 2020

  • “Findings:  In this single-center case series involving 138 patients with NCIP, 26% of patients required admission to the intensive care unit and 4.3% died. Presumed human-to-human hospital-associated transmission of 2019-nCoV was suspected in 41% of patients.”

“Results:  Of 138 hospitalized patients with NCIP, the median age was 56 years (interquartile range, 42-68; range, 22-92 years) and 75 (54.3%) were men. Hospital-associated transmission was suspected as the presumed mechanism of infection for affected health professionals (40 [29%]) and hospitalized patients (17 [12.3%]). Common symptoms included fever (136 [98.6%]), fatigue (96 [69.6%]), and dry cough (82 [59.4%]). Lymphopenia (lymphocyte count, 0.8 × 109/L [interquartile range {IQR}, 0.6-1.1]) occurred in 97 patients (70.3%), prolonged prothrombin time (13.0 seconds [IQR, 12.3-13.7]) in 80 patients (58%), and elevated lactate dehydrogenase (261 U/L [IQR, 182-403]) in 55 patients (39.9%). Chest computed tomographic scans showed bilateral patchy shadows or ground glass opacity in the lungs of all patients. Most patients received antiviral therapy (oseltamivir, 124 [89.9%]), and many received antibacterial therapy (moxifloxacin, 89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]) and glucocorticoid therapy (62 [44.9%]). Thirty-six patients (26.1%) were transferred to the intensive care unit (ICU) because of complications, including acute respiratory distress syndrome (22 [61.1%]), arrhythmia (16 [44.4%]), and shock (11 [30.6%]). The median time from first symptom to dyspnea was 5.0 days, to hospital admission was 7.0 days, and to ARDS was 8.0 days. Patients treated in the ICU (n = 36), compared with patients not treated in the ICU (n = 102), were older (median age, 66 years vs 51 years), were more likely to have underlying comorbidities (26 [72.2%] vs 38 [37.3%]), and were more likely to have dyspnea (23 [63.9%] vs 20 [19.6%]), and anorexia (24 [66.7%] vs 31 [30.4%]). Of the 36 cases in the ICU, 4 (11.1%) received high-flow oxygen therapy, 15 (41.7%) received noninvasive ventilation, and 17 (47.2%) received invasive ventilation **(4 were switched to extracorporeal membrane oxygenation). As of February 3, 47 patients (34.1%) were discharged and 6 died (overall mortality, 4.3%), but the remaining patients are still hospitalized. Among those discharged alive (n = 47), the median hospital stay was 10 days (IQR, 7.0-14.0).”

///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////The Following is tangential commentary /data on oxygen ventilators and not a part or excerpt of the JAMA Survey. (added on Feb 16 -18, 2020)

** Note: There is not an infinite number of medical (hospital) industry level oxygen ventilators! As the infection rate grows, oxygen ventilation therapy will be prioritized and consequently the mortality rates will increase. A quick search on Microsoft’s Bing for “Oxygen Ventilator Manufacturers” revealed an Alibaba.com excerpt stating “99%” of theses ventilators are produced in China. (The excerpt was on the search page, I didn’t see it on the Alibaba hyperlink pg.). So, if their factories are shut down or only partially manned, what happens to that supply chain? How much stock inventory is already in your home state or country? What if China has already purchased, or commandeered, the existing supply inventories in those Chinese factories?

Excerpt: “You can also choose from free samples, paid samples. There are 2,536 oxygen ventilator suppliers, mainly located in Asia. The top supplying countries or regions are China, Vietnam, and Pakistan, which supply 99%, 1%, and 1% of oxygen ventilator respectively.” (must be fuzzy math – 101% ?)

https://www.alibaba.com/showroom/oxygen-ventilator.html

FDA’s Actions in Response to 2019 Novel Coronavirus at Home and Abroad” – www.FDA.gov , published Feb 14, 2020

  • Active Supply Chain Surveillance: We are keenly aware that the outbreak will likely impact the medical product supply chain, including potential disruptions to supply or shortages of critical medical products in the U.S.”
  • “FDA inspections are used as part of our commitment to the supply chain and are currently continuing as normal except in China consistent with the State Department Travel warning.”

https://www.fda.gov/news-events/press-announcements/fdas-actions-response-2019-novel-coronavirus-home-and-abroad

Oxygen Ventilator Market 2019: Global Size, Industry Share, Outlook, Trends Evaluation, Geographical Segmentation, Business Challenges and Opportunity Analysis till 2024 – Marketwatch.com, Published Oct 2, 2019

  • “Global Oxygen Ventilator market competition by TOP MANUFACTURERS: Koninklijke Philips, Omron Healthcare, Merck, Cipla, GlaxoSmithKline, PARI Medical Holding, Teva Pharmaceutical Industries, AstraZeneca, Beximco Pharmaceuticals.”

https://www.marketwatch.com/press-release/oxygen-ventilator-market-2019-global-size-industry-share-outlook-trends-evaluation-geographical-segmentation-business-challenges-and-opportunity-analysis-till-2024-2019-10-02

https://www.nhlbi.nih.gov/health-topics/ventilatorventilator-support

/////////////////////////JAMA Survey excerpts resume////////////////////////////////////

  • Discussion: This report, to our knowledge, is the largest case series to date of hospitalized patients with NCIP. As of February 3, 2020, of the 138 patients included in this study, 26% required ICU care, 34.1% were discharged, 6 died (4.3%), and 61.6% remain hospitalized. For those who were discharged (n = 47), the hospital stay was 10 days (IQR, 7.0-14.0). The time from onset to dyspnea was 5.0 days, 7.0 days to hospital admission, and 8.0 days to ARDS. Common symptoms at onset of illness were fever, dry cough, myalgia, fatigue, dyspnea, and anorexia. However, a significant proportion of patients presented initially with atypical symptoms, such as diarrhea and nausea. Major complications during hospitalization included ARDS, arrhythmia, and shock. Bilateral distribution of patchy shadows and ground glass opacity was a typical hallmark of CT scan for NCIP. Most critical ill patients were older and had more underlying conditions than patients not admitted to the ICU. Most patients required oxygen therapy and a minority of the patients needed invasive ventilation or even extracorporeal membrane oxygenation.”
  • “The data in this study suggest rapid person-to-person transmission of 2019-nCoV may have occurred. The main reason is derived from the estimation of the basic reproductive number (R0) based on a previous study.15 R0 indicates how contagious an infectious disease is. As an infection spreads to new people, it reproduces itself; R0 indicates the average number of additional individuals that one affected case infects during the course of their illness and specifically applies to a population of people who were previously free of infection and have not been vaccinated. Based on the report, R0 from nCoV is 2.2, which estimated that, on average, each patient has been spreading infection to 2.2 other people.15 One reason for the rapid spread may be related to the atypical symptoms in the early stage in some patients infected with nCoV.”
  • The dynamic profile of laboratory findings was tracked in 33 patients with NCIP (5 non-survivors and 28 survivors). In the non-survivors, the neutrophil count, D-dimer, blood urea, and creatinine levels continued to increase, and the lymphocyte counts continued to decrease until death occurred. Neutrophilia may be related to cytokine storm induced by virus invasion, coagulation activation could have been related to sustained inflammatory response, and acute kidney injury could have been related to direct effects of the virus, hypoxia, and shock. The 3 pathologic mechanisms may be associated with the death of patients with NCIP.”
  • “Until now, no specific treatment has been recommended for coronavirus infection except for meticulous supportive care. Currently, the approach to this disease is to control the source of infection; use of personal protection precaution to reduce the risk of transmission; and early diagnosis, isolation, and supportive treatments for affected patients. Antibacterial agents are ineffective. In addition, no antiviral agents have been found to provide benefit for treating SARS and MERS. All of the patients in this study received antibacterial agents, 90% received antiviral therapy, and 45% received methylprednisolone. The dose of oseltamivir and methylprednisolone varied depending on disease severity. However, no effective outcomes were observed.”
  • Conclusions: In this single-center case series of 138 hospitalized patients with confirmed NCIP in Wuhan, China, presumed hospital-related transmission of 2019-nCoV was suspected in 41% of patients, 26% of patients received ICU care, and mortality was 4.3%.”

https://jamanetwork.com/journals/jama/fullarticle/2761044

JAMA’s Coronavirus Resource Center: https://jamanetwork.com/journals/jama/pages/coronavirus-alert

Wikipedia – Neutrophilia:

  • “Neutrophilia (also called neutrophil leukocytosis or occasionally neutrocytosis) is leukocytosis of neutrophils, that is, a high number of neutrophils in the blood.”
  • Some drugs, such as prednisone, have the same effect as cortisol and adrenaline (epinephrine), causing marginated neutrophils to enter the blood stream.”

https://en.wikipedia.org/wiki/Neutrophilia

Methylprednisolone vs. Prednisone: What’s the Difference?Healthline.com, Published Sep 19, 2018

  • Methylprednisolone and prednisone are very similar drugs. There is a difference in their relative strengths: 8 milligrams (mg) of methylprednisolone is equivalent to 10 mg of prednisone.”

https://www.healthline.com/health/rheumatoid-arthritis/methylprednisolone-vs-prednisone#cost-and-availability

Prednisone, Drugs.com, published May 22, 2019

  • Steroid medication can weaken your immune system, making it easier for you to get an infection. Avoid being near people who are sick or have infections.”

https://www.drugs.com/prednisone.html

Update: Feb 11, 2020:

In reviewing my initial post on this topic, I stand by my initial comments that this is a major global issue (pandemic) with far reaching consequences and that fear of the virus could cause far more casualties than the virus itself. However, two articles that I’ve read this morning, listed immediately below, have made me question my premise that global authorities should not be closing borders. In short, the referenced articles indicate that cytokine storms (cytokine blood level increases) may be associated with nCoV-2019, and other SARS-related viruses, and consequently a healthy immune system may not be a beneficial factor in combating this virus. If that’s the case, then an isolationist strategy may be the only (delaying) viable strategy available!

“Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”The Lancet, Published Jan 24, 2020

  • “Findings

“By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection.”

  • “Added value of this study”

“We report the epidemiological, clinical, laboratory, and radiological characteristics, treatment, and clinical outcomes of 41 laboratory-confirmed cases infected with 2019-nCoV. 27 (66%) of 41 patients had a history of direct exposure to the Huanan seafood market. The median age of patients was 49·0 years (IQR 41·0–58·0), and 13 (32%) patients had underlying disease. All patients had pneumonia. A third of patients were admitted to intensive care units, and six died. High concentrations of cytokines were recorded in plasma of critically ill patients infected with 2019-nCoV (COVID-19).”

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext

“Cytokine release syndrome” – Wikipedia

  • It is believed that cytokine storms were responsible for the disproportionate number of healthy young adult deaths during the 1918 influenza pandemic, which killed 50 to 100 million people. In this case, a healthy immune system may have been a liability rather than an asset. Preliminary research results from Hong Kong also indicated this as the probable reason for many deaths during the SARS epidemic in 2003. Human deaths from the bird flu H5N1 usually involve cytokine storms as well. Cytokine storm has also been implicated in hantavirus pulmonary syndrome.”

https://en.wikipedia.org/wiki/Cytokine_release_syndrome

////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

Initial Blog Posted on: Jan 31, 2020

Instinctive human survival behavior scares me more than the actual virus!  If we, humanity, react to this pandemic with our self-preservation instincts by closing borders, halting trade, locking down transportation routes, staying home from work, and avoiding each other out of fear of the spreading contagion, then global financial markets will fall, global trade will decrease or cease and the pandemic will be the least of our worries, and the resulting casualty rates will be much higher.  If the global food supply chains cease to run effectively, thousands will die from hunger and the ensuing chaotic violence over the limited food and clean water resources that are available.

“Stocks close below sessions highs as virus fears linger” – MSN.com, Published Feb 3, 2020

  • “Mohamed El-Erian, chief economic advisor at Allianz, advised investors to hold off on adding equity exposure at this point.”
  • El-Erian: “The coronavirus is different. It is big. It’s going to paralyze China. It’s going to cascade into the global economy,” El-Erian told CNBC’s “Squawk Box” on Monday. “We should try and resist our inclination to buy the dip.”

https://www.msn.com/en-us/money/markets/stocks-close-below-session-highs-as-virus-fears-linger/ar-BBZvnIY?ocid=spartandhp

“Dow plunges 600 points as coronavirus fears cap turbulent week on Wall Street” – USAToday.com, Published Jan 31, 2020

  • “The coronavirus has infected almost 10,000 people globally, and has prompted the World Health Organization to declare the outbreak a global health emergency.”

https://www.usatoday.com/story/money/2020/01/31/dow-drops-400-points-amid-uncertainty-over-virus-impact/4621772002/

“Wuhan, China, and at least 15 other cities have been quarantined as China attempts to halt the spread of the coronavirus. That’s about 50 million people on lockdown.” – BusinessInsider.com, Published Jan 23, 2020

  • “On January 23, authorities put Wuhan under quarantine – halting all public transportation, including city buses, trains, and ferries. The order prevents any buses or trains from coming into or leaving the city and grounds all planes at the Wuhan airport. Wuhan authorities started to limit car travel the next day as well, The Guardian reported.”

https://www.businessinsider.com.au/wuhan-coronavirus-officials-quarantine-entire-city-2020-1

“Russia closes border with China to prevent spread of the coronavirus” – CNBC.com, Published Jan 30, 2020

  • “Sixteen out of the 25 crossings along the Russian-Chinese border will be closed as of midnight January 31, the decree said, according to the Moscow Times. Russia’s Foreign Ministry said Thursday that it had temporarily suspended the issuing of electronic visas to Chinese nationals.

https://www.cnbc.com/2020/01/30/coronavirus-russia-closes-border-with-china-to-prevent-spread.html

“Exclusive: Emergency Food Supply Company Says Coronavirus Sparks Unprecedented Orders, May Disrupt Supply” – NationalFile.com, Published Jan 28, 2020

  • “Possibly underscoring the seriousness of the outbreak of Coronavirus that is quickly spreading through China, Asia, and beginning to trickle into Western countries, My Patriot Supply told National File that they are seeing the most interest in the company’s history, and that other emergency food supply companies are running out of inventory.”

https://nationalfile.com/exclusive-emergency-food-supply-company-says-coronavirus-sparks-unprecedented-orders-may-disrupt-supply

“Fear and the Three-Day Food Supply” – TobyHemnway.com, Published Nov 2, 2011

  • “Food systems are based much more on flow than they are on storage, and they usually have been. Claiming that our strategy for food delivery is precarious is not thinking in terms of dynamic whole systems, in which flows are far greater than storage—though both are important.”
  • “What makes (one) think that something as unnatural as city limits is the boundary of a city’s food supply? And what kind of catastrophe would limit a city to the food within it?” (one in which the government itself closes down the supply routes – the flow!)

http://tobyhemenway.com/419-fear-and-the-three-day-food-supply-3/

Hemenway’s article advocates against the need for large food storage facilities within major metropolitan cities. I don’t disagree with him; my point is that the flow of food into these cities is extremely vulnerable to interruption by external forces like a government imposed quarantine similar to the one occurring in Wuhan, China. Note: the comments section of his article is also worth a read.

Border restrictions intensify as coronavirus takes root around China and around the globe.” – MSN.com, Published Feb 1, 2020

  • “Bill Bishop, a longtime observer of China, warned that there is a lot more debt in the Chinese economy than in 2002, when it was hit by an outbreak of SARS (severe acute respiratory syndrome), but bounced back.”
  • Bishop: “The financial system is likely to come under extreme pressure in the coming weeks and if the Party cannot get the outbreak under control and restore confidence quickly there is a small but greater than zero chance we could see an economic heart attack alongside this virus,” he warned in his Sinocism newsletter.”

https://www.msn.com/en-us/news/world/border-restrictions-intensify-as-coronavirus-takes-root-around-china-and-across-globe/ar-BBZxAPR?ocid=spartanntp#image=BBZaM5o|16

It’s incredible that if you turn on the news today, this issue is barely getting any video coverage. This pandemic does not only impact China; people need to realize this is a global problem! The media should be asking tough questions of our respective governments on how they would/will handle quarantines, security, transportation and food chain re-supply issues if/when the virus becomes widespread in their own countries.  Everyone is afraid to ask these tough questions because they don’t want to create panic and they don’t want to be viewed as alarmists. I truly hope I’m wrong about all of this; I’d prefer to be thought a fool and an alarmist than to have my speculations become reality.

Conclusions: The proverbial cat (2019-nCoV) is out of the bag, and there’s no putting it back in the bag now. Closing borders will not stop the virus; at this point it’s already out there (here) across the globe. The modern global economy is analogous to the human body; if we start closing off organs and arteries the body will go into shock and will become gravely ill or worse.

A contrarian approach: Let’s meet it head on! Keep borders, cities, trade routes, supply chains, and financial markets open. Isolate or quarantine only those infected, those that are immuno-compromised, the very young, the very old, the medical staff and the caretakers as deemed necessary.  It would/will be a massive undertaking, and it will not stop the virus’ spread, but it will buy us some time while vaccines are developed. To keep trade routes and food supply chains flowing, and financial markets churning, we will need to have a literal army of workers in all these key commerce fields. Furnishing Personal Protective Equipment (PPE) to all these workers will be a start, but there likely will not be enough gear available. Surgical masks won’t cut it; and respirator gear with masks/shields will likely be in short supply. It sounds odd, but it would be pragmatic if governments solicited healthy volunteers to be exposed to the virus. Manning the army of workers with individuals previously infected/exposed to the virus could negate the need for PPE gear for those individuals and possibly expedite the development of the vaccines. Incentivizing volunteers to be infected/exposed would probably work;  I bet $20,000 USD each would work.  I’m sure, some of you reading this think this is all crazy talk; maybe so, but someone needs to be looking at alternatives to just locking it all down and curling up in a ball!  

“Coronaviruses and respiratory masks: what do they really do?” – Sanosil.com, Published Jan ??, 2020

  • “There is already a shortage of respiratory masks in China. But what do they really do? Basically, a distinction must be made between a “proper” breathing mask, e.g. filter class P3, and a mouth and nose protection mask (also known as an operating or surgical  mask).”
  • P3 breathing masks fit snugly around the nose and mouth.  They often have an exhalation valve to protect against excessive soaking. These masks provide ACTIVE protection against virus-containing droplets by trapping the aerosols before they enter the airways. However, only if tightly fitting glasses are worn at the same time to protect the eyes. Such protective masks are necessary if you have to go near sick people (e.g. hospital staff). The protection provided by the breathing mask is only guaranteed if you change diligently and keep your hands clean at the same time.
  • Surgical masks do NOT protect against pathogenic aerosols, as they do not seal tightly.  However, they are not completely useless: many infections with viruses (flu and corona viruses) occur by touching contaminated surfaces such as handles, lift buttons, ATM keyboards, etc. and then reaching into the mouth, nose or eyes. – According to studies, this happens up to 26 times per hour. A mask forms a physical barrier and can thus prevent this path of infection. In addition, a surgical mask protects the surrounding area if a patient wears one, as the aerosols are severely restricted when sneezing and coughing. However, almost the same protection as a surgical mask is offered by any scarf or neckerchief that is tied in front of the mouth and nose – a barrier is also placed between the hands and mucous membranes.”

https://www.sanosil.com/en/disinfectant-against-coronavirus-china-2019-ncov/

NIOSH-Approved N95 Particulate Filtering Facepiece Respirators

https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n95list1.html

https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/respsource3healthcare.html#e

Published by

Proteus

50 something semi-retired introvert with a knack for seeing the bigger picture. Happily married with two adult children. Bachelors degree in Program Management / Project Administration. Career history: Military Investigator, Program Manager, Bank Teller, Motel Manager, Clerk, Security Guard.... Myriad set of interests: Photography, Finances, Nature, LPs (vinyl), Books, and Science.

32 thoughts on “The Potential Impact of COVID-19, AKA: 2019-nCoV, AKA: SARS-CoV-2, AKA: The Novel Coronavirus, on Global Commerce and Food Supply Chains.”

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    at this {website|web site|site|web page} is {really|actually|in fact|truly|genuinely} {marvelous|wonderful|excellent|fabulous|superb}.|
    {Howdy|Hi there|Hi|Hello}, i read your blog {occasionally|from time to time}
    and i own a similar one and i was just {wondering|curious} if you get a lot of
    spam {comments|responses|feedback|remarks}?

    If so how do you {prevent|reduce|stop|protect against} it, any plugin or
    anything you can {advise|suggest|recommend}? I get so much lately
    it’s driving me {mad|insane|crazy} so any {assistance|help|support}
    is very much appreciated.|
    Greetings! {Very helpful|Very useful} advice {within this|in this particular} {article|post}!
    {It is the|It’s the} little changes {that make|which will
    make|that produce|that will make} {the biggest|the largest|the greatest|the most important|the
    most significant} changes. {Thanks a lot|Thanks|Many thanks} for sharing!|
    {I really|I truly|I seriously|I absolutely} love {your blog|your site|your website}..
    {Very nice|Excellent|Pleasant|Great} colors & theme.
    Did you {create|develop|make|build} {this website|this site|this web site|this amazing site} yourself?
    Please reply back as I’m {looking to|trying to|planning to|wanting to|hoping to|attempting to}
    create {my own|my very own|my own personal} {blog|website|site} and {would like to|want
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    {what the|exactly what the|just what the} theme {is called|is named}.
    {Thanks|Many thanks|Thank you|Cheers|Appreciate it|Kudos}!|
    {Hi there|Hello there|Howdy}! This {post|article|blog post} {couldn’t|could not} be written {any better|much better}!
    {Reading through|Looking at|Going through|Looking through} this {post|article} reminds me of my previous roommate!

    He {always|constantly|continually} kept {talking about|preaching about} this.

    {I will|I’ll|I am going to|I most certainly will} {forward|send}
    {this article|this information|this post} to him. {Pretty sure|Fairly certain}
    {he will|he’ll|he’s going to} {have a good|have a very good|have
    a great} read. {Thank you for|Thanks for|Many thanks for|I appreciate you for} sharing!|
    {Wow|Whoa|Incredible|Amazing}! This blog looks {exactly|just} like my
    old one! It’s on a {completely|entirely|totally} different {topic|subject} but it has pretty much the same {layout|page layout} and design. {Excellent|Wonderful|Great|Outstanding|Superb} choice of colors!|
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    I {looked|checked} {on the internet|on the web|on the net} {for more info|for more information|to find out more|to learn more|for additional information} about the issue and found {most individuals|most people}
    will go along with your views on {this website|this
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    {Hi|Hello|Hi there|What’s up}, I {log on to|check|read} your {new stuff|blogs|blog} {regularly|like every week|daily|on a regular basis}.
    Your {story-telling|writing|humoristic} style is {awesome|witty}, keep {doing what you’re doing|up the good work|it up}!|
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    I {always|constantly|every time} spent my half an hour to read this {blog|weblog|webpage|website|web site}’s {articles|posts|articles or reviews|content} {everyday|daily|every day|all the time} along
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    My {coder|programmer|developer} is trying to {persuade|convince} me
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    {A person|Someone|Somebody} {necessarily|essentially} {lend a hand|help|assist} to make
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    I {always|all the time|every time} used to {read|study}
    {article|post|piece of writing|paragraph} in news papers but now as I am a user of {internet|web|net} {so|thus|therefore} from now I
    am using net for {articles|posts|articles or reviews|content}, thanks to web.|
    Your {way|method|means|mode} of {describing|explaining|telling} {everything|all|the whole
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    aware of} it, Thanks a lot.|
    {Hi|Hello} there, {I found|I discovered} your {blog|website|web site|site} {by means of|via|by the use of|by way of}
    Google {at the same time as|whilst|even as|while} {searching for|looking for} a {similar|comparable|related} {topic|matter|subject},
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    {I have|I’ve} bookmarked it in my google bookmarks.

    {Hello|Hi} there, {simply|just} {turned into|became|was|become|changed into} {aware of|alert to} your {blog|weblog} {thru|through|via} Google,
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    {I’m|I am} {gonna|going to} {watch out|be careful} for brussels.
    {I will|I’ll} {appreciate|be grateful} {if you|should you|when you|in the event you|in case you|for those who|if you happen to} {continue|proceed} this {in future}.
    {A lot of|Lots of|Many|Numerous} {other folks|folks|other people|people} {will be|shall be|might be|will probably be|can be|will likely be} benefited {from your|out of your} writing.
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    {I am|I’m} curious to find out what blog {system|platform}
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    I’m {experiencing|having} some {minor|small} security {problems|issues} with my
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    Do you have any {solutions|suggestions|recommendations}?|
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    Is this a paid theme or did you {customize|modify} it yourself?
    {Either way|Anyway} keep up the {nice|excellent} quality writing, {it’s|it is} rare to see a {nice|great} blog like this one {these days|nowadays|today}.|
    {I am|I’m} {extremely|really} {inspired|impressed} {with your|together with your|along with your} writing {talents|skills|abilities} {and also|as {smartly|well|neatly} as} with the {layout|format|structure} {for your|on your|in your|to your} {blog|weblog}.
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    {stay|keep} up the {nice|excellent} {quality|high quality} writing, {it’s|it is} {rare|uncommon}
    {to peer|to see|to look} a {nice|great} {blog|weblog} like this one
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    {Hi|Hello}, Neat post. {There is|There’s} {a problem|an issue} {with your|together with your|along with your} {site|web site|website} in {internet|web}
    explorer, {may|might|could|would} {check|test} this?
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    {I’m|I am} not sure where {you are|you’re} getting your {info|information}, but {good|great} topic.

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    1. This is hilarious! For those of you who’ve read my recent blog post on Spamming, I indicated in my writing that Spammers have limited creativity and essentially use wrote text, in which they switch up the dialogue just a bit for each post. It may even be a bot (AI – Artificial Intelligence) doing the minor text alterations, I don’t know. In any case, I received the below listed comment/post from “Smoking CBD vs THC” and the post just confirmed what I had already suspected…the text is designed to be altered by the sender to individualize each comment for the spammer….though in this instance, the spammer was apparently lazy, stoned or remorseful…maybe all three?… and sent the entire unedited version of the comment text options. 🙂

  2. Howdy! I know this is kinda off topic however , I’d figured I’d ask.
    Would you be interested in trading links or maybe guest writing a blog post or vice-versa?
    My blog goes over a lot of the same subjects as yours and I
    think we could greatly benefit from each other.
    If you are interested feel free to send me an email.
    I look forward to hearing from you! Great blog by the way!

    1. Hi, I have no interest in guest-blogging for another website. If someone wishes to guest-blog on this website, I’m open to it; but I’m the final approval authority and your blog post has to be helpful to the general reader (global citizen) and not self-serving. If you want something posted, send it as a comment, written as an article, between quotes, with whatever name you want attribution to. Your post can not be vile, divisive or offensive; it must be geared to help people (humanity). If it passes muster, I’ll post it as an individual post attributed to you. I will not exchange emails and there is no compensation or link exchange involved. If you don’t like the rules, post on your own blog! 🙂

  3. Thank you, I have just been searching for information about this topic for ages and yours is the best I
    have found out till now. But, what in regards to the bottom line?
    Are you certain about the supply?

    1. “In this world nothing can be said to be certain, except death and taxes”. — Benjamin Franklin, in a letter to Jean-Baptiste Leroy, 1789.

      Fortunately, my early (Jan-Feb, 2020) worst-case speculations on COVID-19’s potential impacts to the global food supply chains did not materialize. Yes, the virus is deadly, it will take a huge toll on the world’s populous, and it has changed the way we all live; but, it, or we in our response to it, did not disrupt global food supply chains! Had the virus been more lethal, and had our global healthcare workers and essential (food supply chain) workers not reported to work… things might have turned out much worse.

      It’s important to note, the underlying circumstances that fostered the creation and spread of the virus have not changed; and we’re likely to have more zoonotic viruses develop in the future. Overpopulation, climate change, dwindling natural habitats/forests, and the unsanitary conditions that we raise and slaughter food animals all but guarantee that another pandemic is likely already in the making. For all the brilliance and ingenuity of mankind, we still have this fatal flaw…Unmerited confidence in our own abilities to make things right, after the fact. We ignore the warning signs and we fail to act or react until we’ve gone too far in the wrong direction, and there’s no way to stop our forward momentum.

  4. Unsubscribing or canceling a newsletter (email) notification feed.

    At the top or bottom of each newsletter notification email there should be the word “Unsubscribe”. Click on that to Unsubscribe…its really that easy!

  5. Thanks 🙂 I’m using GoDaddy as a host; the upload speed may be great, but their customer service sucks! I’d research WIX and some of the other top listed hosts.

  6. Hello would you mind stating which blog platform you’re working with?
    I’m going to start my own blog soon but I’m having a tough time selecting between BlogEngine/Wordpress/B2evolution and Drupal.

    The reason I ask is because your design seems different then most blogs and I’m looking for something completely unique.
    P.S My apologies for getting off-topic but I had to ask!

  7. Thanks! The only core message I’m trying to drive home is that people should seek to enlighten themselves by broadening their sources of information and knowledge, outside the standard, mostly subjective (partisan), media channels of Fox and CNN.

  8. I’m trying to see how can you prevent the content from being removed on a youtube video due to copyright. I really just want to see what material can you use so that youtube will not remove the content. Like with music, should you use music from like a CD instead of downloading it from like itunes? Can you give me any suggestions?.

  9. Thanks. It all depends on what you want to do with your blog. If your blog is popular you’ll likely end up going with the paid options to reduce the spam, hacking attempts, etc… You’ll also need more domain memory space, SSL certification, SEO – it gets more time and money intensive. If you just want to express your opinions every now and then, go with a free blog option; if you want to do more with it you’ll end up paying $300 or more each year out of pocket for website/domain maintenance and associated services. Good luck!

  10. Hi,
    I’m crossing my fingers, but I guess I’ve been lucky with WordPress – so far no hackers. I’ve included two blogging websites below that discuss ways to improve your odds of not being hacked:
    http://www.mastermindblogger.com/14-ways-to-prevent-your-wordpress-blog-from-being-hacked/
    https://www.keepthetech.com/2016/09/prevent-blog-from-hackers.html

    This third website discusses blog hosting platforms. If I were unhappy with WP, I’d be checking out WIX and Medium as potential options. Good luck!
    https://www.quicksprout.com/best-blogging-platforms/

  11. With havin so much content and articles do you ever run into any problems of plagorism or copyright infringement? My website has a lot of completely unique content I’ve either written myself or outsourced but it seems a lot of it is popping it up all over the internet without my agreement. Do you know any ways to help reduce content from being ripped off? I’d genuinely appreciate it.

    1. Hi,

      I haven’t had any plagiarism or copyright infringement issues relating to my blog — that I know of. The only suggestion I have is that that you may want to place the following DOJ excerpt in a header or footer on your blog’s title page, with a brief note that you will vigorously pursue legal action against those who plagiarize your works.

      “1847. Criminal Copyright Infringement — 17 U.S.C. 506(a) And 18 U.S.C. 2319”

      “The principal criminal statute protecting copyrighted works is 17 U.S.C. § 506(a), which provides that “[a]ny person who infringes a copyright willfully and for purposes of commercial advantage or private financial gain” shall be punished as provided in 18 U.S.C. § 2319. Section 2319 provides, in pertinent part, that a 5-year felony shall apply if the offense “consists of the reproduction or distribution, during any 180-day period, of at least 10 copies or phonorecords, of 1 or more copyrighted works, with a retail value of more than $2,500.” 18 U.S.C. § 2319(b)(1).
      The 1992 amendments to section 2319 have made it possible to pursue felony level sanctions for violations relating to all types of copyrighted works, including computer software and other works written, stored or transmitted in a digital format, if the other elements of the statute are satisfied. Felony penalties only attach to violations of a victim’s rights of reproduction or distribution in the quantity stated. A misdemeanor shall apply if the defendant does not meet the numerical and monetary thresholds, or if the defendant is involved in the infringement of the other rights bestowed upon the copyright holder, including the right to prepare derivative works, or the right to publicly perform a copyrighted work.
      There are four essential elements to a charge of criminal copyright infringement. In order to sustain a conviction under section 506(a), the government must demonstrate: (1) that a valid copyright; (2) was infringed by the defendant; (3) willfully; and (4) for purposes of commercial advantage or private financial gain. Attempts to infringe are prohibited to the same extent as the completed act. Conspiracies to violate the Act can be prosecuted under 18 U.S.C. § 371. A minority of courts also require that the government prove the absence of a first sale, and refer to this as a fifth element of a section 506(a) offense. However, the majority position is that the absence of a first sale is an affirmative defense. Thus, the government does not need to allege it in the indictment or to present initially evidence to negate the defense. See this Manual at 1854.”

      https://www.justice.gov/archives/jm/criminal-resource-manual-1847-criminal-copyright-infringement-17-usc-506a-and-18-usc-2319

  12. Hi,

    Thanks. I can’t speak to the free option, I’ve never tried it; however, I think for the ease in setting up the website, and the web security services (i.e. decreasing the odds of having your site hacked) it would be well worth the annual out-of-pocket expenses ($200 -$300) for the paid option. I went with WordPress through GoDaddy since that’s where I leased the domain name, but I’ve found that GoDaddy’s customer service platform to be woefully inept. WordPress has been excellent! There are a myriad of site providers like WIX; here’s a link to some additional providers.

    https://www.top10bestwebsitebuilders.com/?bkw=website+builders&bcampid=51906013&bcamp=WB+English&bagid=1178677344036054&bag=website+builder&btarid=kwd-73667454415050%3Aloc-4119&bidm=be&bnet=o&bd=c&bmobval=0&bt=search&utm_source=bing&utm_medium=cpc&utm_term=website+builders&utm_campaign=Bing+CPC+Campaign&c=73667516698467&m=e&k=73667454415050&binterest=&bphysical=109578&bfeedid=&a=B2020&ts=&topic=&upf=&msclkid=b6a2e766b4b6181e182fb98a7ddaa4a5

    God luck! 🙂

  13. Hi, I think the topical content is worthy of presentation on a YouTube channel; however, I honestly don’t know where I’m going with this blog. For now its just a hobby and an outlet for me to pursue my interests in writing and analysis. I’m not sure if either of those interests would make me an entertaining presenter or creator of a YouTube channel. Thanks for the vote of confidence though. 🙂

  14. Thanks, it is a bit time intensive; but I also feel it’s well worth it. Through writing (blogging), posting and comments, we’re broadening our knowledge-base and educating one another. I feel that much of the foundation that underlies the current global trend towards populism, nationalism, racism, etc… stems from the ignorance of the masses and their inability or choice (laziness) not to validate the information they receive from their preferred media sources.

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