Coronavirus Tidbits #34 4/16/20

Announcements:

First, there is now a Resources Page here for the most commonly asked questions I'm getting.

Tidbits will likely be a bit shorter and a little less frequent for the next little bit. I have been immersed in it and I need to spend a little more time on self-care, which for me means seeing the spring flowers emerge and digging in the dirt. Pesach is always a bit rough anyway, so I will turn to more nature.

Happy to continue to answer your questions/concerns as best I can, so don't be shy about that.

 

New post:

Should You Self-Isolate For COVID-19 Coronavirus If You Can’t Smell?

Honored to be giving the Keynote address at the Yom HaShoah Interfaith Commemoration in Providence, RI on Mon, April 20

News:

On Trump's decision to halt US funding to the World Health Organization (WHO).

Professor Peter Piot, Director of the London School of Hygiene & Tropical Medicine, said:

"The COVID-19 pandemic is the greatest global health challenge facing our societies and economies for more than 100 years. At this critical moment in our history we must stick together. Solidarity is crucial to defeating this virus.

We need the World Health Organization now more than ever. Its technical expertise, guidance and leadership is supporting countries to implement optimum science-based strategies to prevent and control COVID-19, and will catalyse global action against future health emergencies.

WHO also continues to be on the frontlines of other public health emergencies such as the Ebola outbreak in the Democratic Republic of the Congo. For many communities around the world, especially in low and middle income countries, their vital programmes are an essential lifeline.

Halting funding to the WHO is a dangerous, short-sighted and politically motivated decision, with potential public health consequences for all countries in the world, whether they are rich or poor.

COVID-19 does not respect borders, and WHO’s support to countries’ responses around the globe, especially the most vulnerable, is more crucial than ever.

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What happens when the food supply is disrupted by a pandemic?

A good explainer: https://civileats.com/2020/04/15/food-distribution-101-what-happens-when-the-food-supply-is-disrupted-by-a-pandemic/

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And more about our meat supply and how we treat animals: https://www.businessinsider.com/sick-workers-closures-hit-meat-suppliers-sparking-shortage-fears-2020-4

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Fearing deportation, many immigrants at higher risk of Covid-19 are afraid to seek testing or care

Public Charge rule tightly limits noncitizens’ use of government programs, has left many immigrants increasingly afraid to seek any public services, including medical care, because they fear doing so could lead to deportation or prevent them from receiving permanent residency in the future.

While this is waived for Covid19, many are unaware of that.

In LA: 1 in 3 residents of the county is foreign-born and 1 in 5 is either undocumented or living with someone who is undocumented.

This whole STAT article is worth a read re social justice and disparities.

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Collateral damage likely as Polio and Measles vaccination campaigns are halted.

https://www.washingtonpost.com/opinions/global-opinions/prepare-for-collateral-damage-as-devastating-as-the-virus/2020/04/16/92231254-7f41-11ea-8013-1b6da0e4a2b7_story.html

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Bad news as more people who tested positive again for COVID-19 after making full recoveries in Korea

Korean CDC recommending cured patients self-quarantine for another 14 days.

It's not clear whether relapse cases originate from a new exposure or from re-infection from virus not cleared after initial infection and harbored somewhere in the body. So some percentage of a population is susceptible to re-infection either because of lack of a protective immune response to the initial strain of coronavirus or re-infected by a different strain of coronavirus circulating in a population.

In other bad news, cases in Singapore are rising again...mostly in workers in a dorm.

But overall, Singapore and Hong Kong's strategy of "suppression and lift" has been working. They fought outbreaks through aggressive testing, isolating infected people, and tracing and quarantining their contacts. For everyone else, it was almost business as usual, with a bit of social distancing.

Diagnostics:

still an incredible, negligent lack of testing.

Abbott's test

Remember that revolutionarily fast bedside #Covid19 test from Abbott? Answers in minutes? It's generating false negative results if the samples are put in a virus transport media. https://www.statnews.com/2020/04/16/rapid-coronavirus-test-commonly-used-in-u-s-may-miss-infections-in-some-situations/

Cepheid's test requires that media be used.

So docs/RNs will need explicit instructions for each site.

We still don't really know the sensitivity of the tests.

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swab test missing 30% to 50% of cases. Should US be doing chest CAT scans like China did?

chest CT found 97% of Covid-19 infections.

If tests are the first leg of an exit strategy, as the Johns Hopkins Center for Health Security said in a plan released for reopening the U.S. economy, then incorrectly “clearing” 30% of those who are tested will doom any exit plan. They could be cleared to return to work when they’re actually infectious, and — even worse — those they encounter and potentially expose to the virus would not be identified and quarantined.

Drugs:

Remdesivir is still looking promising, but the "studies" have not been controlled and are mostly compassionate use (i.e., last ditch effort).

Devices:

see diagnostics

Epidemiology/Infection control:

44% of secondary Covid-19 case-patients were infected BEFORE the index patient experienced symptoms. Study from China

infectiousness peaked 0 to 2 days before symptoms appeared, and 46% to 55% of transmissions occurred in the presymptomatic period.

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Simply speaking could transmit coronavirus, new study suggests.

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Leadership: Angela Merkel explains how growth in coronavirus cases occurs: 

Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Politics:

All the President's men:

Caputo, who moved to Moscow in 1990s, was Putin’s image maker, worked for Gasprom, & is close pals with Stone & Manafort, spent last year promoting the Kremlin’s 2016 election Ukraine conspiracy and nonsense about Bidens, in coordination w/ Russian agent Telizhenko. But now...

Secr Alazar: "I’m delighted to have Michael Caputo join our team at @HHSGov as our Assistant Secretary for Public Affairs, especially at this critical time in our nation’s public health history."

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FEMA gave a $55,000,000 no-bid contract to a bankrupt company with no employees for N95 masks – which they don't make or have – at 7x the cost others charge.

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Leadership:

New Zealand Prime Minister @jacindaardern announces she and other ministers will take a 20% pay cut for six months to show solidarity with those affected by the Covid-19 outbreak

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Intelligence community compromised: @RepAdamSchiff tells @DavidCornDC that “we cannot count on the intelligence community to speak truth to power, to inform the Congress and the American people about what we’re seeing in terms of Russian interference" under a Trump administration. https://t.co/EknrzAE44j

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While Trump wants to cut funding for WHO...

 

Feel good du jour:

Boy sees bruised faces of HCWs from their masks, creates 3-D printed solution to give them

https://www.washingtonpost.com/lifestyle/2020/04/16/nurses-doctors-are-posting-photos-their-faces-bruised-by-masks-boy-stepped-help/

Comic relief:

Bits of beauty:


 

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