Day Sixteen of a partial lockdown in the Boston area. 52,000 tests have been administered by the state of Massachusetts. We are up to 7,738 confirmed cases. There are approximately 15% new cases reported every day which means Massachusetts has a “doubling rate” of about five days. What “flattening the curve” means is decreasing the daily percentage increase in cases which extends the time of the doubling rate. Currently Massachusetts has an infection rate of about 1.1 people out of a thousand.

We rank fourth in the United States behind New York State at 4.1 people out of a thousand, New Jersey (2.6) and Louisiana (1.5). New York City has a rate of 5.7.

With a doubling rate of 5 days, Massachusetts will have 4 people out of a thousand infected in 10 days.

The state tested an average of 4500 people each of the last two days and approximately 15% of those tested positive. In the coming days I will also post the number out of a thousand Massachusetts residents who have actually been tested.

Of the 7.738 people who have tested positive in Massachusetts, only 682 have required hospitalization. There have been 122 deaths, or 1.5% of those infected in Massachusetts so far. I need to caution here that this percentage may be low, since data from other countries suggests it takes on average 17 days for hospitalized patients to die from the virus. Therefore there is a lag between confirmed cases and deaths. Data from China suggests the rate is higher, however, there are continuing questions about the veracity of Chinese data.

The numbers and shape of the “curve” of new cases after approximately 2000 cases have been discovered look very much like those of most Western European countries with similarly sized populations. In the coming days I will show comparisons to some other countries like Belgium, The Netherlands, and Austria which have experiences very similar to Massachusetts.

 

Here are some selections from an article written by a Belgian doctor on his opinion of what works and what doesn’t. These are what I consider the salient points. I provide the link at the end.

 

Marc Wathelet, a Virologist and Specialist in Coronaviruses and Respiratory Diseases

“I am the virologist, specialist in coronaviruses and respiratory diseases, whose views differ significantly from the experts who advise the government on the management of the COVID-19 pandemic.

The situation is dire and I would like to offer you a clear plan for getting out of the health, economic and social crisis that Belgium and the rest of the world are facing.

Everything I am proposing is based on the basic principles of public health that have been known since ancient times; and the history of the five pandemics of the previous five centuries has only one refrain, the cities and the countries that emerge from pandemics relatively unscathed are those that respect these rules, the others pay their tribute. It was true yesterday, it is true today, it is enough to see how Taiwan, Hong Kong, and Singapore handled the crisis from the start, and how China and South Korea recovered. Contrary to what the Prime Minister says, there are countries that are doing very well in their handling of this crisis.

[…]

SARS and MERS were not very contagious for respiratory viruses, and from an epidemiological point of view we knew for example that the contagion only happened when the patient was already sick for 4-5 days, which explains that for these two epidemics the virus was spread mostly to relatives and attending medical staff.

By contrast, COVID-19 is transmitted before the onset of symptoms, which implies that public health measures which could control a virus like SARS and MERS (but only if they were rigorously applied, with quarantine of people returning from risk area, and mass screening), could never be sufficient to contain such a contagious virus.

This contagiousness, comparable to that of rubella or mumps before vaccination, implies that this virus can only spread like wildfire in an immunologically naive population. And a virus capable of being transmitted by aerosol can only explain this contagiousness; it is a property of practically all respiratory viruses, SARS and MERS being notable exceptions to the rule.

The WHO has in fact admitted in a press release that aerosol transmission is possible and requires more study, when we don’t have time for more study. I worked in an institute dedicated to respiratory diseases and there the work on aerosols, chemical or infectious, is done every day, it is perhaps 10% of their activities; I have absolutely no doubt that this virus is transmitted by aerosol, if I can leave my reserve as a scientist who must doubt everything. In an emergency situation, we follow the preponderance of evidence.

The WHO’s first fault was that it did not recognize that aerosol transmission was substantial and therefore that the recommendations had to be changed to contain the spread of the virus, which they still have not done. The WHO’s second fault is to underestimate the contagiousness of the virus, with a basic reproduction number of ~ 2.5 when in reality it is ~ 7, with a doubling time of 2.4 days in the absence of any public health measure.

[…]

In Belgium, we have had a doubling time of ~ 3.3 days for the past 15 days, the same figure as Italy before its lockdown. On March 24, Italy is at 5.5 days of doubling time, but it is still not enough. So we are not doing enough in Belgium, we will not stop the exponential progression with the current measures.

The recipe for successful countries is: sanitary cordon, screening of travelers, massive use of adequate masks by the population, quarantine when necessary, surveillance of respiratory diseases, massive screening, tracing of possible contacts, and early hospitalization when necessary. But you have to be organized before the pandemic to be able to apply this recipe.

[…]

In any viral epidemic, there are three fractions: a) the uninfected population, b) an infected but asymptomatic fraction (and here potentially contagious and the number of which is unknown), and c) an infected fraction with various symptoms and varying degrees of severity. When we put the population in lockdown (we start with 4 weeks then we reevaluate), we limit our contacts to only the household and the people met in food stores.

So infected people will only contaminate at most those who live under the same roof, plus a very small fraction outside their house. The number of people infected in this population can therefore only be multiplied at most by, say, four; the average number of people living under the same roof should be taken as a multiplier. During the lockdown, those who were infected and asymptomatic can either get rid of the virus naturally or become symptomatic, be identified and then treated appropriately for the severity of their symptoms.

Contrast this to a scenario of no containment during these 4 weeks, where the number of people infected would be multiplied by 256, at the current rate of 3.3 days as doubling time. The measures in place today in Belgium will lengthen this doubling time, but not enough, the curve will remain exponential.

[…]

Let’s remember the difference between isolation (or surgical) masks and the famous N95/FFP2 masks. The first wave in Wuhan the medical staff was short of FFP2, all the photos show them with surgical masks; result: 3,000 infected medical staff. The Chinese government sends reinforcements, 42,000 medical personnel equipped with FFP2; result: zero infection out of 42,000!

Furthermore, I tried to communicate the importance of recycling FFP2 masks, without any success. It is a matter of life and death. These masks are considered for single use and staffs throw them away too quickly. This is not the place to be technical, but I have proposed four methods to recycle them and they must be implemented according to the sterilization equipment available in hospitals, information that I have still not been able to obtain. We must educate medical staff on how to extend the life of these masks and recycle them, today, the urgency is immense.

The army, firefighters and probably the police have gas masks, which should not be left in the barracks, they are even more effective than the FFP2. We do not care if it looks crazy to see doctors with gas masks, I prefer to see them stay alive and able to care for patients, and also it would prevent them from becoming vectors of spread themselves. How many gas masks, which are cleanable and reusable, are available?…”

Marc Wathelet, a Virologist and Specialist in Coronaviruses and Respiratory Diseases

 

Wednesday,  April 1st, 2020 

Whiting Petroleum Corporation declares bankruptcy. Whiting was once the largest oil producer in the Bakken shale region. (Reuters)

Rep. Max Rose is expected to deploy the National Guard to New York as an effort to contain the coronavirus. (Politico)

Report: China under-reported coronavirus numbers, U.S. intel concludes The U.S. intelligence community reportedly concluded in a classified document that China, where the coronavirus pandemic originated, has under-reported its number of COVID-19 cases and deaths. China reportedly intentionally left death and cases reports incomplete, and two anonymous intelligence officials said the numbers out of China are fake. Officially, China has tallied more than 82,000 cases and 3,300 deaths, whereas the U.S. already has more than 189,000 cases and 4,000 deaths. Beijing somewhat acknowledged their stats were skewed after they changed their methodology to include some asymptomatic cases, but it’s unclear how many more asymptomatic infections were discounted overall. Thousands of urns outside funeral homes have reportedly led people to doubt the Chinese government’s death total, as well.  Source: Bloomberg

China reports 130 asymptomatic cases of COVID-19. This was their first time reporting asymptomatic cases. (Bloomberg)

The total number of cases in New York rises to over 75,000. The state’s death toll reaches 1,550. (New York Post)

Italy extends their lockdown to April 13. (Reuters)

Russia is expected to send a plane with masks and medical supplies to the United States to help fight the COVID-19 pandemic. (Politico)

Florida, Georgia issue statewide stay-at-home orders  Gov. Ron DeSantis (R) announced Wednesday he’s issuing a stay-at-home order for all of Florida that will go into effect at midnight on Thursday and last for at least 30 days amid the COVID-19 coronavirus pandemic. Georgia Gov. Brian Kemp (R) similarly announced a statewide stay-at-home order that will go into effect on Friday. Florida had previously been among the last large U.S. states without a statewide stay-at-home order, and DeSantis was under mounting pressure to issue one; he previously ordered residents of Broward, Miami-Dade, Palm Beach and Monroe counties to stay at home. Florida has confirmed almost 7,000 coronavirus cases, while Georgia has confirmed nearly 5,000.  Source: NBC News

Report: National stockpile of medical gear has almost run out  Respirator masks, gloves, and other protective equipment kept in the U.S. government’s emergency stockpile are almost all used up, Department of Homeland Security officials tell The Washington Post. “The stockpile was designed to respond to a handful of cities. It was never built or designed to fight a 50-state pandemic,” one DHS official said. Hospital workers already lack supplies they need to protect themselves as they treat COVID-19 patients, and an empty stockpile will only exacerbate the problem. The national stockpile is one of the few escapes from a marketplace where price gouging is an issue, and as New York Gov. Andrew Cuomo (D) described in a recent press conference, shortages have forced states to outbid each other to get necessary supplies. Source:  Forbes

U.N. calls for coronavirus response totaling 10 percent of global GDP  António Guterres, the secretary general of the United Nations, on Wednesday called the coronavirus pandemic “an unprecedented test” for the world. “COVID-19 is the greatest test that we have faced together since the formation of the United Nations” in 1945, Guterres said as the U.N. released a report on the social and economic impacts of the pandemic. The report says world leaders must mount a coordinated international response totaling at least 10 percent of global GDP to boost health-care spending and support people suffering financially under lockdowns imposed to slow the spread of the virus. Guterres said developed countries must assist those less developed. “Otherwise we face the nightmare of the disease spreading like wildfire in the global South,” he said. Source: The New York Times