Coronavirus Tidbits #66 7/15/20

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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.

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

News 

The administration has ordered hospitals to bypass the CDC in reporting data.

Now they are to send all coronavirus patient information to a central database in Washington, controlled by the regime.

Want to prove that cases are falling and all is well??? Now they will control the data and only report what they want. I’m sure everything will be rosy before the election.

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COVID-19 can be transmitted in the womb, reports pediatric infectious disease journal

Case study provides evidence of intrauterine transmission of SARS-CoV-2 from mother to infant

July 10, 2020 – A baby girl in Texas – born prematurely to a mother with COVID-19 – is the strongest evidence to date that intrauterine (in the womb) transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can occur, reports The Pediatric Infectious Disease Journal,

https://www.eurekalert.org/pub_releases/2020-07/wkh-ccb071020.php

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The two largest school districts in California, Los Angeles and San Diego, announced today they will begin the 2020-21 school year online.

This is a sound response to the uncontrolled Covid in their state now.

Orange County has drunk the Kool Aid, not only reopening schools but the Board of Ed is planning on doing so without masking or social distancing, saying (incorrectly) that masking may be harmful to the kids.

https://www.latimes.com/california/story/2020-07-13/orange-county-board-of-education-recommends-no-masks-social-distancing-when-schools-reopen

Fortunately, some of the school districts are not going to follow the BOE’s nonsense.

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Texas hospitals are running out of drugs, beds, ventilators and even staff.

Many hospitals are no longer accepting transfer patients in order to maintain space for a surge that’s expected to come. In some parts of Texas, the surge is already here.

So much for Gov Greg Abbott’s hurry to reopen against medical advice.

https://www.texastribune.org/2020/07/14/texas-hospitals-coronavirus/?

Diagnostics:

still an incredible, negligent lack of accurate testing.

Drugs:

A glimmer of good news re Tocilizumab!

Rheumatoid arthritis drug tied to fewer deaths in COVID patients

Two new studies have revealed that the rheumatoid arthritis drug tocilizumab is associated with lower death rates in COVID-19 patients receiving mechanical ventilation. Tocilizumab blocks interleukin-6 (IL-6), an inflammatory protein involved in a potential “cytokine storm” that can lead to respiratory failure in coronavirus patients.

In the first single-center observational study, published late last week in Clinical Infectious Diseases, University of Michigan at Ann Arbor researchers found that tocilizumab was linked to a 45% reduction in risk of death (hazard ratio [HR], 0.55 (95% confidence interval [CI], 0.33 to 0.90) and improved status after adjusting for propensity score inverse probability weighting (IPTW).

In the second study, researchers in Milan found that tocilizumab halved the death rate of coronavirus patients compared with standard care but lengthened hospital stays, according to a study last week in the Journal of Infection.

https://www.cidrap.umn.edu/news-perspective/2020/07/rheumatoid-arthritis-drug-tied-fewer-deaths-covid-patients

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Global vaccine plan may allow rich countries to buy more

(AP) — Politicians and public health leaders have publicly committed to equitably sharing any coronavirus vaccine that works, but the top global initiative to make that happen may allow rich countries to reinforce their own stockpiles while making fewer doses available for poor ones.

Devices:

Mounting evidence that masks protect the wearer:

Breathing in a smaller amount of virus may lead to no disease or far more mild infection than a larger “dose.” Dr. Monica Gandhi, UCSF Prof

study published in 2015 gave healthy volunteers varying doses of a flu virus; those who got higher doses got sicker, with more coughing and shortness of breath, Gandhi said.

There’s more evidence that masks can be protective — even when wearers do become infected. She cited an outbreak at a seafood plant in Oregon where employees were given masks, and 95% of those who were infected were asymptomatic.

Gandhi also cited the experience of a cruise ship that was traveling from Argentina to Antartica in March when the coronavirus infected people on board, as documented in a recent study. Passengers got surgical masks; the crew got N95 masks.

But instead of about 40% of those infected being asymptomatic — which is what would normally be expected — 81% of those testing positive were asymptomatic, and the masking may have helped reduce the severity of disease in people on board, Gandhi said.

The protective effects are also seen in countries where masks are universally accepted for years, such as Taiwan, Thailand, South Korea and Singapore. “They have all seen cases as they opened … but not deaths,” Gandhi said.

The Czech Republic moved early to require masks, issuing an order in mid-March, Gandhi said; that’s about three months before Gov. Gavin Newsom did so statewide in California. But in the Czech Republic, “every time their cases would go up …their death rate was totally flat. So they didn’t get the severe illness with these cases going on.”

https://www.latimes.com/california/story/2020-07-14/evidence-mounts-that-masks-help-lower-your-exposure-to-the-coronavirus

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More evidence of masks protecting the wearer, too.

2 Stylists Had Coronavirus, but Wore Masks. 139 Clients Didn’t Fall Sick. They also wore masks. Patrons and stylists alike had worn masks for the duration of almost all the encounters documented by the study–most were cloth or surgical masks.

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visualization of masks preventing aerosol/droplet spread

and then glow germ showing why it is important to stop droplets

Epidemiology/Infection control:

Great DataViz:

See more at https://91-divoc.com/pages/covid-visualization/

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Filling middle seats on airplanes doubles the risk of catching COVID-19, according to an MIT study

https://www.businessinsider.com/middle-seats-flights-coronavirus-risk-study-2020-7

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Hong Kong “reported ***41 cases, a record high***” — they’ve closed schools again and Disneyland closing again. 

Despite >15,300 daily Covid cases in Florida, Disney World is opening up

This will endanger the entire country and any sane leadership would prohibit it.

Someone made this perfect response. Turn the volume on for this one:

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Risk assessments:

For Allegany County, which has a relatively low number of infections, the risk that one (or more) individuals are infected with #COVID19 in gathering of only 25 people is 5%

 

Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Politics:

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Trump is insisting that schools reopen in the fall, despite all the evidence that it is not safe.

A briefing packet for federal emergency response teams said fully reopening schools and universities presented the “highest risk” for coronavirus spread, whereas virtual-only classes would be the lowest risk

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Anderson Cooper: “Jim, is there *anyone* left in the administration who shakes their head when they hear the president rambling in the Rose Garden?” Jim Acosta: “No, Anderson, we are down to Kool-Aid drinkers and next of kin.”

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This week, Trump and his attack dogs focus their attention on Dr. Fauci.

The rift between Fauci, the director of the National Institute of Allergy and Infectious Diseases, and President Donald Trump widened last week after Fauci told the Financial Times in an interview that he hasn’t seen Trump at the White House since early June and hasn’t briefed him on the pandemic in at least two months.

Past directors of the CDC also criticized the Trump administration of dismissing advice from public health officials in a separate op-ed published in The Washington Post on Tuesday. Four former CDC directors wrote that the U.S. faces “two opponents” in its efforts to reopen the country: Covid-19 and politicians and others attempting to undermine the CDC.

The rebuke from the former directors come after Trump and Education Secretary Betsy DeVos spent days pressuring schools to reopen amid a surge in Covid-19 cases nationwide. Trump threatened to withhold federal funding from states that don’t reopen their schools.

Vice President Mike Pence confirmed on Wednesday that the Trump administration is looking to the upcoming phase four coronavirus relief bill as a potential way to exert leverage over schools.

https://www.cnbc.com/2020/07/14/top-infectious-disease-experts-lend-support-to-fauci-after-white-house-attacks.html

Peter Navarro, Trump’s trade advisor, escalated saying:  “Dr. Anthony Fauci has a good bedside manner with the public, but he has been wrong about everything I have interacted with him on” and ends with a warning of “skepticism and caution” about anything Fauci says.

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Public health experts have leaped to Fauci’s defense on Twitter, noting that Fauci is one of the most respected health experts in the world, having worked for six presidents and researched HIV/AIDS, Ebola, Zika and a variety of other infectious diseases.

“When studies show that, opposite from SARS & MERS, COVID19 is most infectious soon after infection & less infectious later, we recognize asymptomatic transmission and importance of masks,” tweeted Tom Frieden, the former director of the CDC.

“That’s called science, not a mistake. The real, deadly mistake is not listening to science.”

Ashish Jha, director of the Harvard Global Health Institute, tweeted, “His track record isn’t perfect. It’s just better than anyone else I know. Sidelining Dr. Fauci makes the federal response worse. And it’s the American people who suffer.”

Feel good du jour:

Baltimore students are making face shields for essential workers

and getting $1/shield

https://www.wdsu.com/article/rewarding-summer-job-baltimore-students-make-face-shields-at-home-for-essential-workers/33315435

Comic relief:

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Perspective:

Slow Medicine: COVID-19 Exposes What’s Wrong With U.S. Healthcare

— Nations that effectively implemented simple public health measures have fared much better

Despite all the technological investment in the U.S., COVID-19 rates have been among the highest in the world. In contrast, nations that have effectively implemented the simple public health measures — such as Japan, Taiwan, Hong Kong, and Iceland — have fared much better. While there are many potential explanations for these discrepancies, at least part of the reason may be the contrasting responses to the pandemic. Growing evidence now supports the value of simple measures, including masksdistancing, and hygiene.

The divergent responses between the U.S. and other nations is far from unique to COVID-19. Rather, it is emblematic of how the U.S. approach to healthcare differs from that in many other nations. Compared to other countries, the U.S. offers substantially more high-tech, aggressive care — more advanced imaging studies; more invasive procedures, such as coronary artery bypass surgery; and more novel pharmacotherapies and medical devices.

Yet at the same time, the U.S. healthcare system fails to provide many basic services. U.S. patients frequently fail to receive evidence-based preventive care, counseling, and chronic disease management. Palliative care is markedly underutilized. And U.S. patients, particularly those of low socioeconomic status, face substantial barriers accessing primary care and mental health services.

The net result is that despite the aggressive approach to care, health outcomes in the U.S. — such as life expectancy and maternal and infant mortality rates — are mediocre, while U.S. patients commonly experience frustration and dissatisfaction with the care they receive, suffer high rates of misdiagnosis, and experience alarming health disparities.

https://www.medpagetoday.com/blogs/slowmedicine/87421?

Michael Hochman, MD, MPH, directs the Gehr Center for Health Systems Science at the University of Southern California’s Keck School of Medicine.

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Watch this great interview w science writer Ed Yong–he nails what is going on and prospects for a Covid19 vaccine.

Bits of beauty:

 

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