COVID-19 day 258: 📈 What we know about Trump's positive COVID-19 diagnosis : 04 October 2020

We are having another resurgence: Friday the US reported the most new cases in seven weeks, and Sunday the US reported more deaths than any Sunday in six weeks.

Sunday was day 258 since the first case of coronavirus disease was announced in the United States. We experienced a week’s worth of news in three days (Trump’s diagnosis) but there are other important points lost in that noise.

The US is having another resurgence: Johns Hopkins reported 54,441 new cases on Friday, the most in seven weeks (14 August). On 04 September, there were 50,502.

The United Kingdom is in the midst of a major spike. Each of the comparison nations had a peak and then a gradual decline in cases approaching zero (less than 10 cases per 1 million people). The red line is Australia; they’ve had two tiny peaks. Too soon to tell about India.

The US has not been able to bring the virus under control. We’ve had two large peaks, with the second having a rate double that of the first. The best we’ve done is to have about 60 cases new cases per million (seven-day average) after the first peak (97); we’re now down from the second peak (204) to 132 new cases /million each day.

  • Global cases have passed 35,000,000

  • Global deaths have passed 250,000

  • Today, the US reported more deaths than any Sunday in six weeks. Johns Hopkins reported 412 new deaths on 04 October compared to 266 (27 Sept), 250 (20 Sept), 378 (13 Sept) and 403 (06 Sep); 305 (30 August); and 449 (23 August). The seven-day average of 720 deaths is down from 04 September (851). Sunday reports are Saturday data, and many states do not report on the weekend.

  • Utah set its second highest daily report on Sunday with 1,387 new cases. Indiana, Montana, Wisconsin and Wyoming have each added more cases in the past week than in any other seven-day period.

Sections (no jump links, sorry!)
1, One big thing; 2, Recommendations; 3, Politics, economics & COVID; 4, Key metrics;
5, Resources

⓵ One big thing - the President tests positive

Just after midnight Thursday night (east coast time, Friday morning), President Trump tweeted that he and Melania had tested positive for COVID-19. This was about eight hours after we had learned that a key Trump advisor, Hope Hicks, had tested positive.

Hicks had helped prepare Trump for Tuesday’s debate with Joe Biden in Cleveland and had traveled on Air Force One to-and-from. She also traveled with him to Minnesota for a rally on Wednesday; that’s when she started showing symptoms.

What we know about Thursday

An hour and a half before a fundraiser, Trump learned that Hicks had tested positive. He went ahead with the fundraiser at his Bedminster, NJ, golf club. That was in direct opposition to CDC guidance; when you know you’ve been exposed, you are to cease interactions with others and quarantine.

People in quarantine should stay home, separate themselves from others, monitor their health, and follow directions from their state or local health department.

“He socially distanced, it was an outdoor event and it was deemed safe by White House operations,” asserted White House Press Secretary Kayleigh McEnany. In contrast to McEnany’s assertion, this photo shows a very-much indoors event for at least part of the evening. That’s because prior to the main event, Trump met with a smaller group inside for a roundtable discussion. There was also an indoor VIP reception, and photos were taken with donors, also indoors.

Trump then returned to the White House, talked to Sean Hannity on Fox, and later tweeted his diagnosis. According to the Wall Street Journal, Trump tested positive with a quick test before getting a confirmation from a more sensitive PCR test.

We do not know when on Thursday that Trump took the quick test or which quick test was used. However, “the White House has relied on Abbott’s ID Now Covid-19 tests, which return results within five to 15 minutes of sample collection.”

Those tests have been criticized for their high detection limit — in other words, they only return positive results if individuals tested submit samples with large amounts of viral material. As a result, it’s possible that early in the course of an infection, or as an infection is waning, the test could return a “false negative” result even if its subject is still contagious.

It’s a controversial piece of equipment.

  • We do not know when Trump had last been tested.

  • We do not know if he was tested on Tuesday, the day of his debate with former Vice President Joe Biden. He provided a negative test taken within 72 hours of the debate.

Then there’s Walter Reed

Late Friday morning, Trump’s oxygen levels dipped and he had a “high fever.” Dr. Sean Conley prescribed supplemental oxygen. About 4 pm Conley prescribed an experimental monoclonal antibody drug which has not been approved for any use. The Regeneron CEO, who “has known the president for years”, gave his permission and the FDA cleared it under a “compassionate use” case. We do not know when permission was requested.

After the markets had closed, about 6 pm, Trump flew by helicopter to Walter Reed National Military Medical Center. The last time a sitting president was admitted to Walter Reed was in 1981, when Reagan was shot.

About midnight Friday, Conley released a letter stating that Trump had received his first dose of remdesivir, which appears to have a “modest clinical benefit … although, as the authors acknowledge, the clinical importance of this finding is uncertain.”

Nonetheless, in aggregate, important questions remain regarding the efficacy of remdesivir. First, the optimal patient population is unclear. Second, the optimal duration of therapy is unclear. Third, the effect on discrete clinical outcomes is unclear. Fourth, the relative effect of the drug if given in the presence of dexamethasone or other corticosteroids is unclear.

As of Saturday, Trump began taking dexamethasone, a corticosteroid; it was prescribed after he had another drop in his oxygen levels.

Dexamethasone has been shown to help patients who are severely ill with Covid-19, but it is typically not used in mild or moderate cases of the disease.

This steroid is used to prevent an overreactive immune system response known as a “cytokine storm.” It is normally used only with patients who require oxygen or are on ventilators. “It feels like a whole lot of Kremlinology and I’d just be happier if they’d tell us the truth,” said Robert Wachter, the chair of the University of California, San Francisco’s department of medicine.

Is Trump directing his care (“VIP syndrome”)? Conley conceded that he had held an upbeat news conference for the patient and team.

Between 2-14 days after exposure, COVID-19 patients may exhibit a variety of symptoms, which can include coughs, chills, diarrhea, difficulty breathing, fatigue, fever, nausea and the loss of the sense of smell or taste. In severe cases, patients may have high fever and chest pain.

One of the common early symptoms among elderly Covid patients is a drop in mental acuity or periods of mild confusion…

On Sunday, Trump exited the hospital and rode around in a “hermetically sealed” SUV to wave at supporters lined up outside the hospital. Without an alert to the press pool. This endangered the lives of the Secret Service staff with him, and some are outraged, especially since Secret Service agents have already caught the coronavirus while protecting the president.

Trump also recorded a video where he said he had visited soldiers in the hospital.

It is unlikely that Walter Reed allowed a COVID-19 positive patient to visit other patients; if they did, whomever approved it should lose their license to practice medicine. Delusion or deliberate lie? With Trump it’s hard to tell, but both of these incidents reflect poor judgment and could easily be coronavirus-related.

“Suddenly, they’re throwing the kitchen sink at him,” Dr. Thomas McGinn said. “It raises the question: Is he sicker than we’re hearing, or are they being overly aggressive because he is the president, in a way that could be potentially harmful?”

The official statement of Trump’s symptoms and treatment does not jibe with another Sunday statement that Trump could be released on Monday. The optics don’t look good now if he is not released; they would look worse if he were re-admitted.

With the president determined not to concede weakness and facing an election in just 30 days, officials acknowledged providing rosy assessments to satisfy their prickly patient…

Even as the White House released new details about the president’s condition on Sunday, it continued to withhold others, including when Mr. Trump had his last negative test for the coronavirus and his first positive one.

Reporters are frustrated with “a days-long torrent of falsehoods, obfuscation, evasion, misdirection and imprecision from those surrounding Trump as he faces the greatest threat to a president’s health in decades.”

Americans should be, too.

Share ⚡️COVID-19 Memo from a News Hound

What does “testing negative” mean?

No test detects the virus immediately.

There are two kinds of diagnostic tests, a quick test which produces results while you wait and a laboratory test that may take days. Both can yield false negatives.

In May, Johns Hopkins researchers reported that people who have been infected with SARS-CoV-2 were 67% more likely to test negative than positive if tested within four days after infection.

When the average patient began displaying symptoms of the virus, the false-negative rate was 38%. The test performed best eight days after infection … but even then had a false-negative rate of 20%.

There are two primary reasons for false negatives. First, there isn’t enough viral material for the swab to capture. Second, poor testing technique. It’s also possible a sample can be contaminated or that there is a problem with the testing medium (rare).

So when you’re tested because you have symptoms, the odds are better that the test will snag sufficient viral material to produce an accurate test.

But if you have no symptoms - you’re taking a quick test (which isn’t as sensitive as the lab test) as a form of screening - the odds of a false negative shoot up. And that’s one problem with the White House protocol:

“What seems to have been fundamentally misunderstood in all this was that they were using [a quick test] almost like you would implement a metal detector,” said Ashish Jha, dean of Brown University’s School of Public Health.

Moreover, rapid tests like the White House uses “aren’t cleared by regulators for screening people who don’t have symptoms.”

What about the Rose Garden event the prior Saturday?

On Saturday 26 September, Trump held an event to fete his Supreme Court nominee, Amy Coney Barrett. News reports estimate 150 people attended; gatherings of more than 50 people are prohibited in DC, which has no jurisdiction over the White House.

It was an outdoor-indoor event but people sat close to one another for about an hour. Few wore masks; after passing the quick test, guests were told that they could take them off. They then proceeded to party like it was 2019.

As of this writing, eight people have tested positive: Trump and Melania; former White House adviser Kellyanne Conway; Sen. Mike Lee (R-UT) and Thom Tillis (R-NC), who wore a mask outside but not inside, per photos; former New Jersey Gov. Chris Christie; and University of Notre Dame President John Jenkins. The eighth person is a journalist who has not been named.

Infectious-disease experts say it is too early to call this a superspreader event; it included the Rose Garden ceremony as well as an indoors receiving line and a smaller gathering with Judge Barrett and her family indoors. However, it has the necessary ingredients: “prolonged, close contact without masks among a large group of people.”

What about the debate on Tuesday?

Although masks were required at the Cleveland Clinic-hosted event, members Trump’s contingent, including his family, did not wear masks in the auditorium. They declined masks offered by a Cleveland Clinic physician. They also flouted mask rules at their Cleveland hotel.

Christie, who was one of the people helping prep Trump for the debate, said no one wore masks during prep. Hicks and Sen. Lee were also part of the prep team.

Collateral damage

  • Others who have tested positive:
    ◾️In the White House, Nicholas Luna, the director of Oval Office operations, and Bill Stepien, Trump’s campaign manager
    ◾️In the GOP, Sen. Ron Johnson (WI) and Ronna McDaniel, chair of the Republican National Committee
    ◾️Two additional unnamed journalists

  • Local officials in five states have heard nothing about contact tracing

  • Chief of staff Mark Meadows has not given direction to West Wing staff. The first lady’s chief of staff, Stephanie Grisham, told her staff to work from home as did the vice president’s chief, Marc Short.

⓶ Recommendations

🤓 Recommended reading

Nine months into an outbreak that has killed a million people worldwide, Ischgl [Austria] is where the era of global tourism, made possible by cheap airfares and open borders, collided with a pandemic. For decades, as trade and travel drew the world closer, public health policy, enshrined by treaty, encouraged global mass tourism by calling for open borders, even during outbreaks. But what is now clear is that the policy was about politics and economics more than public health.

Ski, Party, Seed a Pandemic: The Travel Rules That Let Covid-19 Take Flight. NY Times, 30 September 2020.

⓷ Politics, economics and COVID-19

❌ In the past two weeks, thousands of minks at have died on Utah fur farms because of COVID-19. It’s likely that workers spread the disease to the minks. We discovered that minks were susceptible in April after outbreaks at several farms in the Netherlands, Denmark and Spain; more than 1 million minks are dead in Europe.

⓸ Key metrics

🦠 Friday, Johns Hopkins reported 7,332,200 (54,441 new) cases and 208,695 (906 new) deaths, an increase of 0.75% and 0.44%, respectively, since Thursday. A week ago, the daily numbers increased by 0.79% and 0.47%, respectively.

  • Friday
    - cases 🔺27% compared to seven-day average; deaths 🔺28%
    - seven-day average: 42,784 cases and 706 deaths 
    -2.85.% cases leading to death
    - case rate, 221.5 per 10,000; death rate, 6.3 per 10,000

  • One week ago
    - cases 🔺25% compared to seven-day average; deaths 🔺29%
    - seven-day average: 44,111 cases and 740 deaths 
    - 2.90% cases leading to death
    - case rate, 212.5 per 10,000; death rate, 6.2 per 10,000

Note: the seven-day average is important because dailies vary due to factors other than actual case numbers, particularly over a weekend.

🇺🇸 02 October 

  • CDC: 7,213,419 (206,402 new) cases & 47,046 (900 new) deaths
    One week ago: 6,916,292 (42,340 new) cases & 201,411 (918 new) deaths

  • State data*:  7,295,626 (49,190 new) cases & 200,638 (862 new) deaths
    One week ago: 7,000,073 (56,120 new) cases & 195,796 (928 new) deaths
    KS reports only M-W-F; CT and RI report only M-F

  • WHO: 7,077,015 (203,875 new) cases & 32,688 (255 new) deaths
    One week ago: 6,868,828 (40,043 new) cases & 200,725 (1,125 new) deaths

🌎 02 October 

Johns Hopkins interactive dashboard (11.00 pm Pacific)

  • Global: 34,503,125 (297,370 new) cases & 1,026,756 (4,993 new) deaths
    One week ago: 32,476,713 (335,488 new) cases & 987,775(5,967 new) deaths

* Johns Hopkins data, ~11.00 pm Pacific.
State data include DC, Guam, the Northern Mariana Islands, Puerto Rico and the US Virgin Islands

⓹ Resources

👓 See COVID-19 resource collection at WiredPen.
📝 Subscribe to Kathy’s COVID-19 Memo :: COVID-19 Memo archives
🦠 COVID-19 @ WiredPen.com
📊 Visualizations: USWorld
🌐 Global news (at WiredPen)

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