21 March 2020 : COVID-19 News

US jumps to third place in total identified cases worldwide with 26,747; Italy closes all non-essential businesses; more states direct citizens to stay at home

It’s day 61 since the first case of coronavirus disease was announced in the United States. Johns Hopkins reports 340 deaths, an increase of 31 percent from yesterday. Identified cases from state departments of health are 24,043, an increase of 37 percent from yesterday. Testing is continuing to ramp up.

The US (26,747) has jumped to third in the world in identified cases, behind China (81,348) and Italy (53,578) in the Johns Hopkins dashboard. On 18 March, we were eighth. However, those numbers do not reflect the relationship between cases and total population of the country (potential cases).

Context: Italy’s case load is 878.3/million; the US is 86.3/million; and China is 58.7/million.

On Saturday, Italy closed all non-essential businesses.

In “I’m not an epidemiologist but…” dissects the social media “influencers” driving conversation around SARS-CoV-2 and coronavirus disease.

Head over to Twitter and search “not an epidemiologist but" if you want to see how prevalent and freewheeling the speculation about COVID-19 has become. As the pandemic has affected lives around the world, it seems like nearly everyone on social media wants to be a public health expert.

Vincent Racaniello, a professor of microbiology and immunology at Columbia University, told BuzzFeed the information available in social media channels is “mostly garbage.”

He said there’s absolutely an incentive on social platforms to constantly be providing updates, but the insatiable need for experts is also due to a lack of leadership from the federal government. “We're getting very little federal guidance,” he said. “There's no pandemic plan.”

Think before sharing: are you lighting a fire or illuminating an insight or correcting bad info?

Local and state officials continue to roll out shelter in place orders.

There’s a tool for that: this epidemic calculator is on GitHub and a hospital system has developed a self-triage tool.

Recommended reading

This is a combo reading/watching recommendation: in 2015 Bill Gates gave a TED talk, We’re not ready for the next epidemic. This GatesNotes essay contains the video as well as additional information, including links to an op-ed for the NYT and an essay in the New England Journal of Medicine.

Recommended watching

78 seconds of banjo balm from Steve Martin

Around the country

All 50 states, the District of Columbia, Guam, Puerto Rico and the US Virgin Islands have identified COVID-19 cases. The 340 known deaths are from 32 states plus the District of Columbia and Puerto Rico, with most from Washington.

The CDC now has a portal page for COVID-19 information: coronavirus.gov. Note that the symptoms page has not been updated to include gastro-intestinal distress, which has been reported in research papers.

New Orleans has one confirmed case for every 1,000 residents. New Orleans had held Mardi Gras celebrations, which bring in more than a million people, just two weeks before identifying its first case. This ProPublica essay is an interview with a local respiratory therapist.

I have patients in their early 40s and, yeah, I was kind of shocked.

Most states are not reporting cases based on age, and those who are do not use the scale scale. Eleven states with 5,272 identified cases show that 31 percent of their patients are younger than 40 years old.

In Washington, Gov. Inslee asked for the U.S.S. Mercy to be dispatch to here to support non-COVID-19 patients. Sen. Patty Murray supports Inslee’s call for a major emergency declaration.

Virginia Mason Hospital has appealed to Gov. Inslee and local officials in Yakima County to issue a stay-at-home order.

Hospital administrators said Saturday indications are the COVID-19 outbreak will overwhelm the city’s remaining hospital unless people put themselves in lockdown, only leaving their home for absolute necessities… If nothing is done, hospital officials said projections estimate the hospital would be overwhelmed by April 8.


Politics, economics and COVID-19

The Dow Jones Industrial Average has dropped 24.54% so far in March. This currently stands as the second-worst decline in history; first place goes to the 30.7% monthly drop in September of 1931.

As medical supplies tighten, caregivers have turned to Twitter and Facebook to appeal for personal protective equipment (PPE).

President Trump: “the throwing away of the masks, being in private business, the throwing away of the masks right away … why aren’t we sanitizing the masks … why aren’t we we have very good ugh liquids for doing this sanitizing the masks and that’s something that they are doing more and more sanitizing the masks”

Global news

The number of affected countries jumped from 29 at the end of February to 179 today. Although early reports tied the outbreak to a seafood (“wet”) market in Wuhan, China, analyses of genomic data suggest that the virus may have developed elsewhere.

A women’s football team that had flown to Honduras to perform charity work was caught in that country’s response to COVID-19. On Friday, the team flew to Charleston, SC, on a C-130, according to the US Southern Command.

A reminder that South Korea kicked off its public health plan at the first sign of coronavirus, unlike the US. South China Morning Press describes this as a phone booth but it makes me think of a transparent confessional!

Case count

Tests are becoming much more widely available. There is a lag between being contagious and showing symptoms. The virus was not created in a lab.

21 March, global

  • Globally: 266,073 confirmed (32,000 new) with 11,184 deaths (1,344 new)

  • Regions of the Americas: 18,877 confirmed (5,606 new) with 235 deaths (57 new)

WHO Situation report, 61

  • Global confirmed: 307,280

  • Total deaths: 13,049

  • Total recovered: 92,376

Johns Hopkins interactive dashboard

21 March, domestic

Nationally* there are a total of 15,219 cases and 201 deaths according to the CDC, (updated Friday 20 March) and 26,747 cases and 340 deaths according to Johns Hopkins (11.50 pm, Pacific) All 50 states plus DC are reporting 24,043 identified cases. View infographic and data online.

*CDC and Johns Hopkins data include Puerto Rico, Guam, and US Virgin Islands

What you can do

  1. Stay home when sick. 

  2. Stay home as much as possible, period. 

  3. Avoid crowded places.

What do to when you or a loved one feels sick

Digestive problems may be a symptom.


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