COVID-19 day 80 : 📈 466,033 cases; 16,690 deaths : 09 April
Some doctors are rethinking ventilator use for COVID-19 patients; 16.8 million unemployment claims in three weeks, dwarfing statistics back to 1948; FEMA backs down on testing termination
It’s day 80 since the first case of coronavirus disease was announced in the United States.
In this first-person essay, David Lat discusses his New York University Langone medical center admission, where he spent six days on a ventilator.
[A]fter my admission to the hospital, my physician father had warned me: “You better not get put on a ventilator. People don’t come back from that.”
News stories have beat the drum for ventilators, which has become a symbol of the crisis surrounding this disease. But I’m pretty sure most of us don’t truly know what it means when someone has to be intubated.
Generally speaking, 40% to 50% of patients with severe respiratory distress die while on ventilators, experts say. But 80% or more of coronavirus patients placed on the machines in New York City have died, state and city officials say.
Doctors don’t know how or why coronavirus patients are different from bacterial pneumonia patients, for example. Only that they are.
[I]t’s been common for coronavirus patients to have been on a ventilator “seven days, 10 days, 15 days, and they’re passing away,” said New York Gov. Andrew Cuomo, when asked about ventilator death rates during a news briefing on Wednesday.
Governor Cuomo’s anecdote is supported by preliminary research from Wuhan and Seattle. Consequently, some doctors are questioning the rush to ventilation for COVID-19 patients.
What’s driving this reassessment is a baffling observation about Covid-19: Many patients have blood oxygen levels so low they should be dead. But they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of blinking off from lack of oxygen…
“We need to ask, are we using ventilators in a way that makes sense for other diseases but not for this one?” [Muriel Gillick of Harvard Medical School] said. “Instead of asking how do we ration a scarce resource, we should be asking how do we best treat this disease?”
A new CDC study suggests that approximately 90% of patients hospitalized with coronavirus symptoms had one or more pre-existing medical conditions. The top five: hypertension (49.7%), obesity (48.3%), chronic lung disease (34.6%), diabetes (28.3%), and cardiovascular disease (27.8%).
Another troubling underlying medical condition, as Lat’s story shows, may be asthma.
Thursday, Johns Hopkins reported 466,033 (432,132) cases and 16,690 (14,808) deaths in the US, an increase of 7.8% and 12.7%, respectively, since Wednesday.
That case rate is 130.55 per 100,000; the death rate is 44.74 per million.
One week ago, the case rate was 74 per 100,000, and the death rate, 18.3 per million.
🤓Recommended reading
The Pandemic Will Accelerate History Rather Than Reshape It. Foreign Affairs, 07 April 2020.
One characteristic of the current crisis has been a marked lack of U.S. leadership. The United States has not rallied the world in a collective effort to confront either the virus or its economic effects. Nor has the United States rallied the world to follow its lead in addressing the problem at home.
🎦Recommended viewing
I promise you’ll get a chuckle, if only for the accent. 🤓
💃🏼Life hack
If you’re interested in COVID-19 clinical trials: ClinicalTrials.gov, Dashboard to trials, WHO database
🌐Global news:
Financial Times /New Straits Times / New York Times / South China Morning Post / The Age / The Globe and Mail / The Guardian / Wall Street Journal / Washington Post // CIDRAP / STAT News // ProPublica / The Atlantic / The Conversation / The Economist // ABC News (Australia) / ABC News (US) / BBC News / CBC / CBS News / CNBC / CNN / C-SPAN / NBC News
⓵ Around the country
All 50 states, the District of Columbia, Guam, the Northern Mariana Islands, Puerto Rico and the US Virgin Islands have identified COVID-19 cases. The only state with no reported deaths remains Wyoming.
From 30 March 30 to 04 April, FEMA and HHS delivered ventilators to Connecticut, Illinois, Louisiana, Michigan and New Jersey. Which state is missing?
Florida citizens are globetrotters. USA Today reported that Floridians who tested positive for COVID-19 had visited 46 states and every continent except Antarctica in the weeks before that fateful nose swab.
On Wednesday, I reported that FEMA would be withdrawing its support for a community-based testing program it was conducting with state and local government partners. On Friday, 10 April.
On Thursday afternoon (according to Google), FEMA walked back that termination notice. States had until 5 pm EST to let FEMA know if they want to take over the site. There’s nothing in the news release about what happens to a community-based testing site if a state doesn’t have the resources. Energy and Commerce Chairman Frank Pallone, Jr. (D-NJ) was not happy.
I can find no public list of the 40 sites anywhere. The program appears to have been announced on 15 March and slated to begin “the end of the week” (20 March?).
“We believe we’ve created a model, based on the public health and the FEMA system, that is optimized, that can be used for drive-through or potentially walk-through [testing],” [Brett] Giroir said. “Each of these pod-based units, we believe, can screen 2,000 to 4,000 individuals a day.”
Actual numbers: screened 84,800+ individuals and tested 77,000+ individuals. That’s ONE DAY’s work, according to Giroir, a deputy to HHS secretary Alex Azar.
⓶ Around the world
The number of affected countries/territories/areas jumped from 29 at the end of February to 207 today (no additions). 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.
British Prime Minister Boris Johnson has been moved out of intensive care
In Spain, after more than three weeks of shelter-at-home measures, the increase in the daily rate of new infections is down to 4% from a high of 22%. “The velocity of the increase of the virus is decreasing throughout Spain,” said Maria Jose Sierra, deputy head of the health emergency centre.
Let’s look south, to Ecuador. On 03 April, NPR wrote a feature on Ecuador, reporting 120 deaths. It’s a small country: 17.6 million people, slightly smaller than New York. Today the official death toll is 272.
The epicenter is the Pacific port city of Guayaquil. As with far too many news reports, there is an obligatory reference to “limited testing.” There are anecdotes, horrific anecdotes, of people dying at home.
Then, without a smidgeon of irony or reference to official numbers the New York Times duo writing this analysis type this:
Since the start of the crisis in late March, the government has recovered 1,350 bodies from Guayaquil’s homes, according to the office of Jorge Wated, who heads the task force responsible for picking up the dead in the city. About 60 bodies are collected daily, his office said [emphasis added].
This disease is killing people in their homes. Around the world. Including NYC.
I have no words.
⓷ Politics, economics and COVID-19
That trip to Guam the disgraced Acting Secretary of the Navy took? It cost a quarter of a million dollars.
On 29 March, NPR told us that a plane had landed from China carrying medical supplies. Project Airbridge. A public-private partnership. FEMA would pay for the commercial flight; distributors, the supplies.
[Jared Kurshner’s] statement said a "majority of these supplies will be provided by FEMA to the states of New York, New Jersey, and Connecticut with the rest going to nursing homes in the area and to other high risk areas across the country."
From 30 March to 05 April, FEMA organized 10 flights. And guess what? Yup, that original claim … vaporware.
Administration staff confirmed that the federal government is not taking control of the supplies flown into the United States in “Project Airbridge” or directing private sector suppliers to send supplies to particular hospitals with urgent needs. Instead, suppliers are required only to agree to sell half of their shipments to customers in “hotspots” such as New York, New Jersey, New Orleans, Detroit, and Chicago. Suppliers are not required to reimburse the federal government for the cost of air shipment [emphasis added].
And we’ll be paying the suppliers back … because, Medicare and other coronavirus hospitalization costs.
The number of unemployment claims in the past three weeks is now 16.8 million, the “largest and fastest string of job losses in records dating to 1948.” (What? You didn’t know that there was a recession in 1948?) Now 10% of the workforce is idle.
In reporting the unemployment story, an AP writer framed the additional $600 a week federal unemployment benefit as a way to "increase … purchasing power and support the economy." The frame "support the economy" is so widespread as to be as invisible as air.
What about ... $600 a week in unemployment benefits means a family might be able to pay the rent and buy groceries. "The economy" is a nebulous concept. Families and rent and food. Concrete. And people aren't looking for unemployment benefits to "support the economy." They are looking for help because they are out of work, through no fault of their own. They (we) need the help to keep a roof over our heads. That’s the social contract.
AP estimates that as many as 50 million people could be laid off.
⓸ Case count
There is a lag between being contagious and showing symptoms, between having a test and getting its results. The virus was not created in a lab.
🌎 09 April
Globally: 1 436 198 confirmed (82 837 - new) with 85 522 deaths (6287 - new)
The Americas: 454 710 confirmed (37 294 - new) with 14 775 deaths (2178 - new)
Johns Hopkins interactive dashboard (11.00 pm Pacific)
Global confirmed: 1,602,216 (1,484,811)
Total deaths: 95,735 (88,538)
Total recovered: 355,079 (329,876)
🇺🇸 09 April
CDC: 427,460 (395,011) cases and 14,696 (12,754) deaths
Johns Hopkins*: 466,033 (432,132) cases and 16,690 (14,808) deaths
State data*: 460,048 (425,992) identified cases and 16,535 (14,652) deaths
View infographic and data online: total cases, cases/100,000 and deaths/million.
* Johns Hopkins data, 11 pm Pacific.
State data include DC, Guam, the Northern Mariana Islands, Puerto Rico and the US Virgin Islands
See US (state/territory) total cases, cases/100,000 and deaths/million as infographics.
⓹ What you can do
Stay home as much as possible, period.
Digestive problems may be a symptom.
Resources
👓 See COVID-19 resource collection at WiredPen.
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🦠 COVID-19 @ WiredPen.com