Category Archives: Case Update

Case Update: December 21st, 2020; Allergic Reactions to Vaccines in a Small Number of Patients

December 21, 2020All Articles, Case Update, Risk Factors, Treatments, VaccinesErik P. Johnson

This is a case update and I’ll also discuss recent news about vaccines and allergic reactions.Cases continue to rise dramatically in parts of the United States, particularly, the Southwest, the East Coast, and South. The Northern states, where the third wave began, are continuing to improve, some counties are getting new cases under control.

Graph is by me, from data collected from Johns Hopkins University COVID site.

Endcoronavirus County Level Map, December 21st, 2020

California is doing particularly badly, with the highest new case loads occurring in 5 California counties in the top 10 counties for the country. LA County alone has 170,000 active cases (new cases in the last 2 weeks), more than 3 times that of the next county, San Bernardino County.

Graph is by me, from data collected from Johns Hopkins University COVID site. “Active Confirmed Cases” numbers are calculated based on the assumption that patients confirmed to have SARS-2 virus at least 17 days ago have recovered.

San Diego County is in 7th place for new cases in the country with 33,000 new cases. Cases continue to increase despite new restrictions on outdoor dining.

Graph is by me, from data collected from San Diego County Public Health. See also regularly updated slides from SD County.

Graph is by me, from data collected from San Diego County Public Health. See also regularly updated slides from SD County. “Active Confirmed Cases” numbers are calculated based on the assumption that patients confirmed to have SARS-2 virus at least 17 days ago have recovered.

I never go indoors without a mask on, but still frequently eat at restaurants outdoors and do a lot of hiking. I almost never wear a mask outdoors. I get tested nearly every week, and am always negative. Here in SD County, I’m noticing a lot of people wearing masks outside, and often get the stink eye from them when I’m not wearing a mask outside. Especially if there’s a breeze, I believe it is unnecessary to wear a mask on a hike! Data shows very few outbreaks occurring outside, at least in non-crowded environments. One Japanese article claimed a 19 fold smaller likelihood of becoming infected outside, and other articles saw no transmissions outdoors, according to an article in Science Magazine.

Allergic Reactions to Vaccines: As of this writing, 6 people have been reported to have suffered from severe allergic reactions after receiving a vaccine against the SARS-2 virus. This is out of 272,000 vaccinations given so far, or about 0.002% of vaccinations. The CDC has issued a guidance that those with known allergies to vaccines or injectable medications should not get vaccinated. Those with allergies to food, pets, venom, or latex are still safe to receive the SARS-2 vaccine. For those with latex allergies, know that most medical facilities have changed to non-latex gloves because of allergies to latex.

Mild allergic reactions such as site redness or pain are more common, but will resolve on there own within a day or 2.

I am currently encouraging the elderly or those with significant risk factors to get vaccinated when you can, and to inform your health care provider of your risk status so you can “get in line” for your vaccine.

Don’t fear, but be smart!
Erik

Case Update: December 12, 2020; Important news on Vaccines and ADE!

December 12, 2020All Articles, Case Update, Most Popular, Treatments, VaccinesErik P. Johnson

Here’s an overdue case update. Cases continue to rise for the US, California, and San Diego County. The timing of the current US peak makes it clear that the bump is directly related to the Thanksgiving holiday, starting less than a week after Thanksgiving, and after cases had started to come down. LA County currently has more that 100,000 active cases, more than twice the number than the next highest county, Cook County, the home of Chicago.

New case peaks have left the Northern states and are now centered in the Southwest and Northeast.

Endcoronavirus County Level Map, December 12th, 2020

San Diego County now has 24,000 active cases, far higher that the 4,000 we had at the low point between peaks 2 and 3.

More on ADE and Vaccines: Some potential very good news for me on the vaccine front. For months I’ve been warning about ADE, the phenomena that some viruses can be even more dangerous in a second infection than the first. Karen Parrott, a former colleague at Quest Diagnostics, often provides me with interesting COVID related stuff. This week she sent me a podcast featuring Paul Offit, the developer of the first Rotavirus vaccine and an author of many books on immunology and vaccine production. I am not an immunologist but he is. More importantly, he’s the first authoritative person that I’ve heard in the media speak at length on the ADE issue and how it relates to COVID. He claims in the attached clip (time stamped at 14:40) that the current vaccines do not appear to trigger the ADE pathway in animal models, and human trial subject never displayed the signs that ADE was involved in secondary exposures. This difference from SARS-1 and MERS may be related to the fact the SARS-2 is much less virulent than these other 2 viruses.

This makes me more optimistic that the vaccine will be safe from an ADE perspective. I won’t be able to get the vaccine for some time, but I am more willing to get it now than ever before. Several physicians I know are eager to get it as soon as it is available. This is great news!

In the interest of full disclosure, I will point out the some patients receiving the vaccine the UK have experienced some injection site irritation, especially in those with allergies. This is actually somewhat normal for vaccines, and appears to pass within a few days.

In addition, now that mRNA vaccines have been produced for the first time, future development of this new kind of vaccine should be even faster than this time!

Don’t fear, but be smart,
Erik

Case Update: December 4, 2020

December 5, 2020All Articles, Case UpdateErik P. Johnson

Well folks, I’m disappointed to report that after a dip in cases, the confirmed case numbers are rising fast again. The timing clearly suggests that the rise in cases is related to the Thanksgiving holiday. The numbers really seem to have peaked a few weeks ago, but are back on the rise again in the US, California, and San Diego. The situation is still developing of course, so we don’t yet know how much of a rise we will see. I’m reporting this early to give you a heads up that this is happening.

Don’t fear, but be smart,
Erik

Case Update, December 1st, 2020

December 2, 2020All Articles, Case UpdateErik P. Johnson

Friends,
This is a case update. As I suggested last week, it appears we may be past the peak of wave 3 for now. New confirmed case numbers for the US continue to trend downward, and California and San Diego County numbers appear to perhaps have peaked as well. Tammy Stevenson was right last week to point out that holiday gatherings may produce some new outbreaks. New cases don’t appear for between 5 and 20 days, so we may still see some Thanksgiving related increases, but for now, the numbers look very encouraging.

The Northern states, where the 3rd wave started, are recovering, except perhaps for Michigan and Minnesota, and the peak of the wave is moving southward. Los Angeles County now has the most new cases in the country, surpassing Cook County (Chicago). Gallatin, Madison, and Carbon counties in Montana are all past their 3rd wave peak.

Endcoronavirus County Level Map, December 1st, 2020

New confirmed cases in Gallatin County, Endcoronavirus County Level Map, December 1st, 2020

Note: Since writing the above, several of my friends in the medical community have told me that they are not as optimistic as I am! While their info doesn’t contradict mine per se, they are expecting a spike in cases due to holiday gatherings. Just posting this in the interest of completeness.

Don’t fear, but be smart,
Erik

Case Update: November 24, 2020

November 24, 2020All Articles, Case UpdateErik P. Johnson

This is a case update. We are continuing to see a rise in cases for the US, California, and San Diego County. However, there is a glimmer of hope. If you look carefully at the graph for the US (or just look at the red arrows), you’ll see that this Sunday’s new confirmed case number is very close to last week’s.

With numbers varying so much every day, it can be hard to see trends. But I noticed some time ago the Sunday consistently had the lowest new case numbers of the week. If a Sunday’s number was higher than the previous Sunday’s number, we would have a bad week, but if it was lower, things were getting a little better. After several weeks of steadily increasing case numbers, Sunday number suggests that we may have reached the peak of the 3rd wave. Of course, this may not pan out, and I may be apologizing later for misleading you, but it looks good right now. Also, lots of extra people are getting tested right now before Thanksgiving, which will also add to the numbers for this week.

Also notice a few more orange counties in the northern states on the map of US counties. These are likely counties where things are improving. Peaks of new cases are moving south however.

Endcoronavirus County Level Map, November 24th, 2020

So we can be optimistic while still working toward the end of the 3rd wave!

Don’t fear, but be smart!
Erik

Case Update: November 19th, 2020

November 19, 2020All Articles, Case UpdateErik P. Johnson

This is a case update. The US continues to see a large spike in new cases during a 3rd wave. New cases appear to be centered in the northern states and around the Great Lakes, but more southern states are now experiencing new cases as well. The county with the highest new cases right now is Cook County, the home of Chicago. New confirmed cases in the US are now double what they were during the second wave. This is all likely being driven by colder weather causing people to gather indoors.

Endcoronavirus County Level Map, November 19th, 2020

California and is also experiencing a 3rd wave, just slightly higher in numbers than the 2nd wave.

San Diego County’s 3rd appears substantially higher than the 2nd wave. County Health reports that most known outbreaks are occurring in restaurants, especially those with bars, with the second most being businesses. The County is not reporting to the public what kind of businesses are experiencing outbreaks.

Don’t fear, but be smart,
Erik

Case Update: November 11th, 2020

November 11, 2020All Articles, Case UpdateErik P. Johnson

This is a case update. The US is experiencing a third peak in cases. This is likely being driven by cold weather, driving people indoors where the virus spreads more easily. The 3rd peak is already almost 2x as high as the 2nd peak in July and August, and it’s still going up fast. Some states are experiencing record hospitalizations.

Endcoronavirus State Map, November 11th, 2020

Endcoronavirus County Level Map, November 11th, 2020

California has been trending up for the last several weeks, and San Diego is trending up this week for the second week since the 3rd wave began.

I been seeing new ads in California, talking about benefits of mask wearing. The ads have several shots of people wearing masks in small groups outdoors. As you know, I am a big fan of masks in indoors environments, and wear a mask a lot when at work in a lab or when traveling. However, wearing a mask outdoors is almost always unnecessary unless you are in a large group of people. I’m am not saying that you should ignore local guidance if they require mask wearing outdoors! I am saying, however, that as far as getting infected is concerned, you don’t need to wear a mask while you’re jogging, hiking, or riding a bike.

Don’t fear, but be smart,
Erik

Case Update: November 1st, Quadruple Therapy, Air Travel, Symptoms in households with small children.

November 1, 2020All Articles, Case Update, TreatmentsErik P. Johnson

I have the weekly update, and I’ll also talk about a promising new treatment regimen and a surprising paper about children and COVID.

Update: Unfortunately, the US is experiencing a 3^rd wave. This is driven by new confirmed cases in the Northern states, likely because colder weather is driving people indoors. I traveled to Anchorage and Minneapolis in the last few weeks, and I will tell you first hand that eating outside at a restaurant is not an option in those places, but the restaurants have lots of people in them. They’re not full, mind you, they are following the current rules, but lots of people are indoors without masks on. I’ve also been in plenty of airports, in “red” and “blue” states, in which people are filling the restaurants in between flights, with seemingly no regard to the virus. No, I can’t tell you for certain that people are being infected in restaurants, but this is consistent with the idea that indoor activity is driving the increase in new cases. Several European countries are also experiencing 2^nd or 3^rd waves at this time.

Endcoronavirus County Level Map, November 1st, 2020

California has had a flat but persistent new case load for the past several weeks, but new cases are starting to increase here too. This is likely most driven by new cases in LA County (18k), which has by far the most confirmed cases in California (308,000), and indeed has almost twice as many confirmed cases as the next highest county, Cook County, the home of Chicago (185,000). Yes, counties in Northern California are experiencing the big upticks in cases right now, but the population and actual case numbers of these counties is so low that they cannot drive the increase in California. Incidentally, Cook County currently has the most confirmed new cases of any US county at 24,000.

San Diego County continues to have a stable but persistent new case load of about 300 new confirmed cases per day. There may be just a hint of 3rd wave starting in San Diego County right now.

Air Travel: When I travel by air, I pretty much never take off my mask on the plane. On layovers, I grab lunch to go at restaurant or convenience store, then go find an isolated spot to eat it.

Delta and Alaska are currently keeping middle seats open. United and American are not. The airlines claim that the air on the plane is filtered by industrial grade HEPA filters every 4 minutes. A pilot friend tells me that this is true. The intake vents are on the floor, and output vents are in the ceiling, like your personal vent, so air is constantly moving to the floor during the flight. If all this is true, then a commercial airplane is a relatively safe place to be!

New Treatment: Doctors in India have developed a treatment combination that has shown great success. Ivermectin is a drug that is commonly used for parasite infections, but is now being used for COVID. It is being used in combination with Doxycycline, Zinc, and Vitamin D. In a study, 93% of confirmed patients do not move on to severe disease while using this regimen, as compared to 58% who developed severe symptoms in the control group.

I’ve said before that Vitamin D has protective effect against the virus, so consider supplementing daily with Vitamin D, or getting out in the sun 30 minutes a day. This is especially important if you have darker skin. Also, supplement with Zinc and Vitamin C.

Less severe symptoms in households with small children: A pre-published study from Scotland claims that adults in households with small children get less severe symptoms if infected than those without small children! This is a counter intuitive result of course. We have known for some time that a low viral load on exposure can lead to less severe symptoms. Also, it appears that most infected children carry a low SARS-2 viral load. This paper puts these pieces together. It suggests that adults with infected children are getting exposed to a lower viral load and having less severe symptoms that adults getting exposed to a higher viral load. In fact, the paper suggests that the more children a household has, the less likely adults are to have severe symptoms!

Don’t fear, but be smart!
Erik

Case Update: October 21st, 2020

October 22, 2020All Articles, Case UpdateErik P. Johnson

Friends,
Just a short update today. For the US, new case numbers continue to rise. Most new cases are centered in the Northern states, and new cases are spreading South. My guess is that the cold weather is driving these new cases, as people are spending more time indoors. Despite this, new cases are so far not producing an increase in fatalities.

Endcoronavirus County Level Map, October 21th, 2020

California and San Diego continue to have a persistent number of new daily confirmed cases.

Don’t fear, but be smart,
Erik

Case Update: October 13, 2020; Voting, Re-Infection, 3D Structures

October 13, 2020All Articles, Case Update, Masks, Most Popular, Re-openingErik P. Johnson

I’ve been traveling a LOT recently and just skipped last week’s update. Sorry for the long delay.

The US continues a slow trend upward in new confirmed cases. According to endcoronavirus, most of these new cases are arising in the Northern states, although the upward trend seems to be creeping south. This seems to confirm my suspicion that the new uptick in cases is caused by colder weather, and people being indoors together more often. If this suspicion is correct, we may be in for a long broad 3rd wave of cases this winter. You may remember that the Southern states (California all the way to Florida) drove new cases this summer. During the summer of course, people in Southern states tend be indoors with their air conditioners more often. This is my theory for the time being.

Endcoronavirus County Level Map, October 13th, 2020

After the end of the 2nd wave, California is experiencing a persistent 3000 new confirmed cases a day, and San Diego County has a persistent 300 new confirmed cases a day. Unfortunately, I’m firmly convinced at this point that COVID may be with us at least until next Spring. As you know if you’ve been reading my posts, I think we will need to adapt to this situation, and open up our economy and normal life as much as possible, while still taking precautions.

As I’ve mentioned before, I am doing a lot of traveling these days, and get tested almost every week, and I’m always negative so far. I use air travel and go into all kinds of gas stations and stores. I do the following:

1) Wear a mask or face covering in public. Avoid places with unmasked people.
2) Keep 6 ft away from others. (I basically ignore this one if other precautions are in place, especially on an airplane!)
3) Avoid indoor gatherings, especially ones in which singing or shouting is likely.
4) Small outdoor gatherings are fine, even without masks, if everyone maintains a distance. Have guests bring their own food.
5) While many restaurants are open for limited indoor seating, I personally am still not comfortable eating indoors at a restaurant. I enjoy eating outdoors at restaurants, however.
6) Wear an N95 or KN95 mask when going to more high risk areas like airports or public areas where people may gather. These masks are rated to filter out 95% of viral particles. In my opinion, surgical masks and especially neck gators are nearly worthless in these settings.
7) I never take my mask off on the plane, and find an isolate spot in the airport to eat or drink on layovers.

Voting: If you haven’t heard, there is an election coming up. As with many issues, mail-in voting has become a politicized issue. The New York Times recently had a story expressing reservations about mail in voting, claiming that mail in ballots are more likely to be disqualified than in person voting. This is because filling out and mailing in these ballots can be complicated and prone to errors that disqualify these ballots. Some stories even claim that people have been sanitizing their ballots, ruining the ink and disqualifying be ballot. It is therefore my recommendation that everyone vote in person if possible. Follow the above precautions, and I’m confident you can do so safely. Dr. Fauci claims that in-person voting is safe if proper precautions are taken.

Reinfection: There is a recently published study of a confirmed case of re-infection in an American man. Apparently, this is the first confirmed and well characterized case in the US, although there have been other suspected cases. His symptoms were more severe with the second case, suggesting that my fears of ADE may be warranted. However, there have been only 22 confirmed cases of reinfection world wide, so it’s still apparently a very rare phenomena. The paper also states the 2nd infecting strain is distinct from the first, consistent with the ADE model.

The paper suggests that there may have been dozens of circulating strains since the beginning of the pandemic. While this case of re-infection appears consistent with ADE, the rarity of the re-infection phenomena along with the many circulating strains suggests that ADE, while theoretically possible, may not have large real-world significance.

New 3D structure: Last, for those of you who want a deep dive, the New York Times has a nice story with a collection of 3D structures of the virus from different sources.

Don’t fear, but be smart!
Erik