Dear Friends, This is a case update. I’ll also have an important message about antibody dependent enhancement.
Cases continued to rise unchecked in the US, California and San Diego County in the last week, although the long holiday weekend did have impacts on reporting. Some good news is that the number of deaths reported in the US has been slowly declining despite the case increase. Keep in mind however, that deaths will lag behind cases by as much as 2 weeks, so we may yet see an impact from the higher caseload. The number of deaths have been trending flat in California.
Rt Live is reporting that all but 8 US states or territories have Rt values above 1.0, meaning that the virus is expanding in those states.
I’m going to bring up an issue that I’ve been avoiding talking about for some time. I’ve been avoiding talking about it because it’s not a certainty, and also because the possibility will be scary for some. The reason I feel compelled to talk about it now is that many are having a hard time understanding why I am still so concerned about the virus when the fatality rate is low and dropping, and folks want to get back to normal life. I’m even hearing about young people having COVID parties in which people gather with a sick individual so they can all get infected and be immune from the virus thereafter.
Before I share this, I’ll also say that the medical community is doing a better job treating patients with COVID, and the disease is becoming more survivable. In addition, we now know a lot about how the virus is spread, and if a person wants to remain uninfected, they can do that, while still getting together with friends and family, and still working and getting on with life. You can be reasonably certain you will not get infected if you do the following:
1) Wear a mask or face covering in public. Avoid places with unmasked people. 2) Keep 6 ft away from others. 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.
Antibody Dependent Enhancement: Several years ago, scientists were developing a vaccine against Dengue Fever, a mosquito borne disease which causes debilitating joint pain in patients. Some time after trial vaccination, several vaccinated patients died suddenly of Dengue Fever. This became the most studied example of Antibody Dependent Enhancement (ADE). Normally, for the annual flu let’s say, a person gets infected by the flu, is sick for a few days, and the immune system develops a response by creating antibodies against that specific strain of the flu. If they are exposed again in a month, nothing will happen. If the patient is exposed to a different strain the following year, they may still get sick, but the antibodies they developed the year before may help them have less severe disease and recover more quickly. Part of the immune response is that some immune cells display antibodies on their surface to capture new invaders.
With Dengue and some other viruses, the first stages are normal. A person gets infected and develops a response. If they get re-infected a month later, nothing happens. But if they get infected with a slightly different strain months or years later, instead of being protected, the virus attaches to antibodies displayed on immune cells and uses the antibodies as a site of entry into the immune system. The immune system is quickly infected, and the patient has a more severe disease with the second infection. Some estimates are that disease may be 3-4 x more severe in these patients.
As it turns out, SARS-1, which arose in 2002, and MERS, which has small outbreaks every year, are both Coronaviruses and both appear to be able to use the ADE pathway. This raises the possibility that SARS-2, the current virus, can also use the ADE pathway. This means that a person infected for a second time with a different strain of SARS-2, or any other Coronavirus for that matter, may be at much higher risk for severe disease.
This is why I’m not in favor of pursuing herd immunity as a pathway out of this crisis, because it will prime people for ADE related problems if a similar strain should strike next year.
This is not a new idea. If you search for “ADE” or “Antibody Dependent Enhancement”, you will see many articles, some peer reviewed from respected journals, on the phenomena. Dr. Fauci has even referenced it using the term “enhancement” when talking about vaccine development.
Why haven’t the government public health departments been more open about this? They tend to make statements only based on what they can be reasonably certain of, which is why they have been so slow to react to many aspects of the current crisis.
Again, it’s not certain that ADE will play a role next year. It’s too early to know. I’m informing you of the possibility so you can make wise decisions for you and your family.
This is a case update. Unfortunately, we are experiencing an explosion of new cases in the US, California, and San Diego County this week, continuing the trend that started a few weeks ago. For all of these regions, this week brought record highs for all three regions. California reached approximately 66k active cases, and San Diego County has doubled it’s active caseload to 4,222 in just the past week.
Why is this happening? Probably for multiple reasons. First, as things re-open, some businesses and individuals are not following guidelines for safe reopening. San Diego County had 7 super-spreader events in the last week, 4 at restaurants, and 1 at a private residence. You may have seen a story in the news this week about a bar in Michigan in which 85 college aged people were infected in a single evening. As you might imagine, they were not wearing masks, and were not practicing social distancing. The recent protests and riots almost certainly have had an impact as well.
In my May 12 post, I explained how you can tell if testing is having an impact on confirmed cases by graphing daily tests against daily new confirmed cases. In the last few weeks, the R2 number has risen into the 0.5 range for the US and California. An R2 number of 0.95 “proves” correlation, but a number in the 0.5 range suggests some contribution by increased testing. These graphs suggest that increased testing has contributed some of the new cases numbers, but some of the new cases are simply new infections as well.
An R2 number of above 0.95 suggests good correlation, a number of 0.59 suggests that while there may be some contribution from increased testing, much of the increase is real new cases.An R2 number of above 0.95 suggests good correlation, a number of 0.51 suggests that while there may be some contribution from increased testing, much of the increase is real new cases.
There is some good news. That is that if you are careful and follow the below guidelines, you can be reasonably certain you won’t catch COVID:
1) Wear a mask or face covering in public. Avoid places with unmasked people. 2) Keep 6 ft away from others. 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, however.there may be some contribution from increased testing, much of the increase is real new cases.
An epidemic is like a brush fire. When it dies down, we can start to be complacent, but diligence is still required. We are experiencing this new burst of cases because we have let our guard down. Hopefully, we can get things back under control soon.
Maybe take a break. After all the troubling news of the past month, a friend of mine complained that he is feeling depressed and not doing well. While I encourage everyone to follow the news and to be engaged with public life, studies show that over consumption of social media can lead to depression and anxiety. If you feel depressed, or your blood pressure is high, or you’ve been ranted to your wife more than she would like (I know someone like that), you may benefit from a news and/or social media fast. Consider taking a day or more off a week to let yourself calm down and get back to normal. In our information age, we can receive all the bad news of the world at all times, and we aren’t designed to carry that burden.
This is a Coronavirus case update. New confirmed cases continue to climb for all three regions that I monitor closely, the US, California, and San Diego County. Calculated active cases in California are now at approximately 50,000 active cases, up from 20,000 at the height of the first peak in early April. Los Angeles County continues to dominate the caseload, with 51% of total confirmed cases in LA County.
Internationally, Brazil just crossed the 1 million confirmed case mark, and is #2 in total confirmed cases behind the US. Brazil’s new daily cases may have hit it’s peak, however, so new cases may finally be slowing down. Russia and India are next in total cases.
Over the past week, San Diego County Public Health has reported several small outbreaks in restaurants and businesses. As we re-open, it will continue to be important to wear masks and social distance while in public.
This long post will be a summary of what we have learned so far about the Coronavirus, and I’ll make some predictions about what to expect next. Since I’ll be sharing so much information, I won’t give references for everything here. I also have to make the disclaimer that new studies are constantly being done, and some of the below information may need to be revised later. To make my standard disclaimer, I am not an epidemiologist or a physician. I have a Ph.D. in molecular biology, and my specialty is infectious disease testing. On much of the below, I have an informed but not expert opinion.
Coronaviruses: Coronaviruses are a large group of viruses unrelated to the flu. What we think of as the common cold, are actually member of several classes of viruses like Adenovirus, RSV viruses, Rhinovirus, and several Coronaviruses. Many Coronaviruses cause diseases no more virulent than the common cold. However, just like novel flus can cause extra trouble, so can novel Coronaviruses. The first SARS virus was much more lethal that the SARS-2 virus, but because SARS had a short incubation period and made almost every infected person sick, it was much easier to contain. The Middle East Respiratory Syndrome (MERS) Coronavirus infects a few people every year, and is very lethal, with a fatality rate of 34%, but it also has not made a global impact. The reason SARS-2 is so dangerous is that it’s VERY infectious (Ro of between 2.5 and 5.7) and has a VERY long incubation time (2-14 days), making it very hard to track. Plus, it’s at least 2x as deadly at the annual flu.
Name: The official name of the virus is SARS-2-CoV (for Severe Acute Respiratory Syndrome-2 CoronaVirus). The official name for the disease it causes is COVID-19 (for COronaVIrus Disease-2019). You may notice that the term SARS actually sounds a lot like a disease. You would be right. So why did they need a different disease name than SARS-2, or SARS-19? I don’t know.
Spread: Early reports were that SARS-2 mostly spread like a flu, with droplets spreading from coughing or sneezing. It became apparent later that the virus was also spread through aerosols by laughing, singing, shouting, or even just talking in close proximity for long periods. As further study was done, it appears that most infected people don’t infect anyone else. Rather, most infections come from “super-spreader” events, in which a single person infects a large group of people. This usually happens indoors (at least 19 times more likely) during activities like fitness classes, funerals, concerts, and choir practices. While outdoor activities aren’t completely immune to these events, they are much more rare.
Viral load upon exposure appears to be an important determinant of how severe a case will be. Basically, this means that if you’re infected by a “low dose” of virus, your disease is likely to be less severe. I have several physician friends who have stated that it seems to them that cases in the hospital are less severe than they used to be. One likely reason for this is that since more people are wearing masks in public than early on, those who are infected are being infected by a lower viral load.
Early studies demonstrated that viable virus can exist on objects for hours or days. However, it does not appear that a substantial number of people are being infected because they have touched a contaminated object.
The WHO made a confusing claim recently that asymptomatic people cannot spread the virus. While this is technically correct, they were not clear that “asymptomatic” is a technical medical term meaning someone who does not have, and will never have, symptoms. Another group is “pre-symptomatic”. These are people who currently don’t have symptoms, but will develop symptoms in a few days. As it turns out, pre-symptomatic people do spread virus, and are likely responsible for up to 80% of new cases. So yes, people without symptoms can and do pass the virus to others.
Risk Factors: Many believe that only old people are at risk. While it’s true that age is a dominant factor, other risk factors are important, and younger people have also experienced severe symptoms. Other risk factors include respiratory conditions like asthma or COPD, heart conditions, kidney conditions, liver disease, diabetes, obesity, auto-immune disease, use of NSAID anti-inflammatory medications, being immunocompromised (HIV infected, undergoing cancer treatment, under medication for a transplant), vitamin-D deficiency, type A blood (Type O appears to be protective), inadequate sleep.
Always check with your doctor before changing your medications. I have an auto-immune disease and take daily anti-inflammatories, but my doctor has advised me to continue taking these unless I experience COVID symptoms.
Make sure your doctor is aware if you have any of the above conditions.
Symptoms: Many people who have SARS-2 experience no symptoms, or experience mild flu symptoms. If you have ANY cold or flu symptoms, contact your doctor and see if you can be tested. If you live in San Diego County, and your doctor cannot offer you a test, call 2-1-1 to get a free test from SD County Public Health. If you have additional symptoms like shortness of breath (you just can’t seem to get enough air), loss of smell or taste, nausea or diarrhea, contact your health care provider or an urgent care immediately.
In severe cases, the virus can do wide spread and permanent damage to multiple organ systems. Early treatment is necessary to prevent the most severe symptoms.
Precautions: While lockdowns may have been effective in the US during the early stages of the pandemic, especially at a time when masks were hard to come by, recent evidence suggests that lockdowns provide only a moderate benefit over other means of control. Here’s what appears to be beneficial:
Masks: Masks are not all the same and some are better than others. Their main benefit is that they stop, reduce, or slow the travel of virus from infected people. This prevents surrounding people from infection, or lowers the viral load of exposure. Some, but not all, also prevent the wearer from inhaling airborne virus. N95 style masks without a valve are best if you can obtain one.
Best option: An N95 mask with no valve.
Social Distancing: Aerosolized virus can travel through the air. Staying 6 ft away from others helps prevent infection.
Handwashing:
Adequate sleep: Sleep is very important for a wide variety of body functions, including the immune system. Get 7 – 8 hours of sleep per night. A 26 minute power nap during the day is also beneficial if needed.
Vitamin D: Several studies have suggested that patients with the most severe cases of COVID also have the lowest levels of Vitamin D. Because of our often indoor lifestyle, most Americans are Vitamin D deficient to some degree. The best way of getting some Vitamin D is to make it yourself by going outside in shorts and a T-shirt for 30 minutes a day. This is because Vitamin D is manufactured in our skin in response to sunlight. If it’s not practical for you to do this, consider a Vitamin D supplement. Darker skinned people are more likely to be Vitamin D deficient in the US.
Home isolation: If you have cold or flu symptoms, contact your doctor immediately and see if you can get a test. Tests are much more available that early in the pandemic, and you should be able to get a test by request. Also, if at all possible, isolate yourself from the rest of your family until you can be tested as negative. Many new infections are taking place among family members.
Testing: There are several kinds of tests, and they tell you different things.
PCR: These tests use material collected from the nose and need to go to a specialized laboratory for processing. They are very sensitive and specific, and indicate whether the patient is currently infected. This is the most common kind of test.
Antibody: These tests detected antibody from a patient’s blood to see if the patient has been infected for at least a few days. IgG tests may also tell if a patient was infected weeks or months previous, but are no longer infected. Some patients do not mount an immune response that will provide long term antibody.
Isothermal amplification: The Abbott ID Now COVID tests uses this relatively new technology. These tests are similar to PCR and are both sensitive and very fast.
If you have cold or flu symptoms, contact your doctor immediately and see if you can get a test. Testing is much more available than it was early in the pandemic. San Diego County is encouraging anyone who wants a test to be tested.
Treatments: Treatment for COVID is complicated and not all patients can be treated in the same way. Additionally, treatments are evolving rapidly, and your doctor many not treat you in the ways listed below.
Ventilators: Some doctors now state that ventilators carry risks that may be unacceptable for COVID patients. Many doctors now favor a nasal cannula, using ventilators only as a last resort if breathing is labored.
Hydroxychloroquine, Azithromycin, Zinc: Several doctors from several countries have reported success with this combination. Studies on the effects of these drugs have as yet still been non-conclusive. Some positive studies suggest that Zinc is the main virus fighter of the treatment, with Hydroxychloroquine allowing better penetration of Zinc into cells. Unfortunately, the debate on the efficacy of this regimen has taken on a strongly political tone, which almost always interferes with the scientific process. Now pundits, as well as scientists, weigh in on this regimen. I’m still holding a “wait and see” posture with this treatment.
MATH+: This regimen uses Methylprednisolone (an anti-inflammatory), Vitamin C, Thymine, and Heparin, as well as optional other treatments including Vitamin D and Zinc. Early reports suggest success with this treatment.
Vaccines: Each spring, scientists learn which flu is likely to be prominent by the following Fall. They make some guesses and create a vaccine for the flu season. The manufacture process takes a few months. But it’s only this short because they already know how to make a flu vaccine. Development of a brand new type of vaccine takes between 4 and 30 years! There are many methods to make a vaccine, and scientists must try many of them before finding one that works. Then they must try the vaccine on patients and make sure they are relatively safe. Every vaccine carries some risk of side effects.
Early estimates for a Coronavirus vaccine were around 18 months. My guess is that this is too optimistic. Personally, I wouldn’t count on a vaccine for at least a few years. In addition, some studies have suggested that Coronavirus vaccines in particular may cause side effects that may make vaccine development challenging. My standard practice for my family is to wait on new drugs for a few years before using them myself. While I pro-vaccine in general, I would personally recommend waiting for a few years before getting a Coronavirus vaccine.
Herd Immunity: Some are promoting herd immunity as a way to move through the crisis faster. The idea of herd immunity was popularized in pre-pandemic discussions on vaccines, promoting the idea that the more people are vaccinated, the more protection for those who can’t be. This is a good idea when a vaccine is available, but not when there is no vaccine. Putting many people in harm’s way to protect fewer others is not wise and is not standard medical practice.
The Future: Of course, it’s impossible to know what will happen next. My initial prediction was that the first wave would be over by July, and at this point, this doesn’t look likely. New confirmed cases have started to rise or rise faster in the 3 areas I monitor most closely, the US, California, and San Diego County, and cases are rising fast in some countries previously unaffected, especially Brazil, Russia, and India. So I’m starting to think we may not be out of the first wave before the Fall season.
In addition, RNA viruses, such as Coronavirus, can mutate very quickly because the proteins used to copy their genomes are very error prone. This means that a virus may change to a new form that can re-infect a person who has already had a previous version. Some reports suggest that this may already be happening with SARS-2. Some good news is that on the very long term (years), novel viruses tend to evolve to be less virulent, because it’s not in the “interest” of the virus to make the host very sick. The message is, we may need to adapt to a new reality for the next few months or years. We can’t really afford to be “locked down” anymore, but mask wearing and elbow bumps may be a part of the landscape for some time.
This is a case update. New confirmed cases are starting to trend upward for the US again for the first time since about April 9. In 19 US states, the Rt number is higher than 1.0, suggesting that the virus is spreading in these states. On endcoronavirus.org, you can clearly see recent spikes of new cases in some states, and in many countries.
In California, the number daily new cases continues to accelerate. San Diego has started to go up too. San Diego County has started to publish the number of recovered patients. My graph of cases in SD County now includes active cases, taking recovered people into account. Some of these points of data on my graph are given by SD County, the others are calculated by me based on the data points. Looking carefully at the SD County data, the number of recovered people is approximately the number of total cases from 17 days previous. The suggestion is that it takes approximately 17 days to recover after being confirmed as a COVID case, so I’ve made a similar calculation for California. Just to be clear, in my graph of active cases in California, the data points are based on assumptions about recovery time, not actual data.
For San Diego, active cases have been hovering around 2,000 for several weeks, without much change, but for an increase in the last few days. For California, we’ve seen a steady trend upward in active cases from 20,000 in early April, to 40,000 cases today. There are of course lots of potential reasons for these increases, from gradual re-opening to the protests and riots stemming from the George Floyd incident. I was once optimistic that the first wave of cases would be over this Summer, but new trends have called this into question. I’m now feeling totally unable to predict how things will go.
I heard a radio commentator talking about a recent study that I haven’t been able to find. The study said that while Social Distancing account for maybe a 50% drop in new cases, the lockdown accounted for only a 5% additional drop. Given the economic and social cost of the lockdown, the study suggested they were not on the whole worth the cost. If you’ve seen the actual study, please post it in the comments!
So please continue to social distance and wear your masks in public! But it’s time to figure out how we can get the economy running again! We have big problems to solve, time to get to work!
Here’s the weekly update on the virus. As I predicted in my June 2nd post, we’ve started to see an increase in cases, at least for areas that I closely monitor. For the United States as a whole, the increase has been subtle, really just a flattening of a steady downward trend. For California and especially San Diego County, there has been a pronounced uptick in cases during the last week. The City of San Diego had some protests last weekend, but not nearly as much as in other cities like Minneapolis, NYC and LA. If the pattern for San Diego holds for other cities, they will experience more severe increases in cases. Oddly, many in the media strongly discouraged protests in favor of re-opening, but are seemingly promoting protests about police brutality without regard to precautions like mask wearing. Even the WHO is encouraging mass protests. Of course there are good reasons to attend a peaceful protest. If you go to a protest, please wear a mask. Of course, I have to discourage you from attending a riot.
I do have to point out that there are many factors that contribute to these increases, such as the ongoing re-opening, and no single factor can be blamed.
Endcoronavirus.org has introduced a new feature in the last week, a county level map showing the recent change in new cases. Clicking on a county will give you a plot of new cases for that county. High caseloads for urban areas is a well known pattern, but I’ve also noticed hot-spots of cases in certain rural areas. A new article in the Wall Street Journal may suggest a reason. Large families living in the same house may present an opportunity for rapid spread should someone be infected who lives there. As we discussed on May 27th, the virus spreads much more quickly in indoor venues than it does outside. This suggests that if you have a large family, members will need to be extra cautious to not bring virus in from the outside.
My friend who works for San Diego County Health, Brit Colanter, just posted that all San Diego County residents are encouraged to get tested for COVID-19. Check with your health care provider first to see if they will give you a free test. If not, check the below website, or call 2-1-1 for an appointment at a County Site. State run testing sites are located in Escondido, El Cajon, Chula Vista, San Ysidro and Southeastern San Diego. Check the website for a phone number or link to get an appointment at a state site.
These are likely the Abbott, ID Now rapid COVID test.
Getting a test gives you peace of mind, but also helps scientists understand the real rate of infection in the County!
Well, this has been a very discouraging weekend for me and I’m sure for many of you. The unjust killing of George Floyd as well as the riots that were fomented by far left elements have taken the spot light from the Coronavirus of course.
It has been a very rough week, and I’m afraid I don’t have an encouraging update for you. Nationally, the daily new cases continues to go down. However, according to Rt Live, 13 states currently have Rt values above 1.0, including California, meaning that the virus is now spreading again in those states. Daily new cases in California are continuing to increase in California, and in fact the increase has been accelerated since restaurants and other businesses were reopened on the 21st.
Rt values for various US States and territories. 13 states currently have Rt values above 1.0, meaning that virus is now increasing in those states.
San Diego is nearly flat in new case numbers, but zooming in on recent new confirmed case numbers shows that the County is actually improving, even after re-opening, so we can be glad for that at least, if you live in SD County.
San Diego County new confirmed cases since April 23, 2020. Dotted trendline highlights a trend of decreasing numbers.
For those of you in Montana, there was a small cluster of new cases this week which made the Rt value go up above 1.0 for a brief time. This is because the Rt value reflects a change in numbers, and since the numbers were so low in Montana, any cluster will make this number rise. After a few days, the Rt value for Montana is back below 1, and Montana continues to do well. But this illustrates how important it is to be diligent, even in a state that is generally doing well.
Rioting has of course broken out in many cities in the US. Starting as peaceful protests, many were hijacked by far left elements that wanted to cause wide-spread chaos. Among other damage, rioters and looters were often in close contact without masks on. And yes, I know is sounds a little comical to be worried about that when watching scenes of small businesses being destroyed. Look for Coronavirus case numbers to rise sharply later this week. I’ll keep you posted.
Today I have a weekly update on cases, followed by some speculation on what it means. As we’ve seen before, the United States has a slowly diminishing daily new case load for confirmed cases. Death rates for the US, perhaps a better measure than confirmed cases, are also slowly diminishing. Several sites seem to be accepting the data from Sutton et al (Universal Screening for SARS-CoV-2in Women Admitted for Delivery, NEJM, April 22, 2020) to estimate that actual cases is 8 times that of confirmed cases. California continues to have a slowly increasing caseload.
According to the John Hopkins University COVID site, LA County accounts for a full 48% of cases in California, with Sierra and Trinity Counties, in the East and North having just 1 case each. Cases are definitely centered in urban areas, mostly in Southern California. Daily death number in California appear to be perhaps flat. Interestingly, with all of these graphs, California daily deaths in particular, there is a clear weekend effect, with a weekly low in numbers on Sunday or Monday of each week. So when you look at the daily caseload for the US, with it’s jagged Sierra-like peaks, you’ll know it’s because health-care workers take the weekend off too, and reporting is being done during the week! San Diego’s numbers continue to be relatively flat.
Data is collected from San Diego County Public Health at approximately 9:30 pm nightly.
What we would like to see now is a lowering in the number of active cases. Unfortunately, this highlights a problem in all of this, how health departments define a “recovered” case. San Diego has just begun to report recovered cases. The reported numbers suggest that cases resolve in about 16 days after confirmation on average. For the US, reported recoveries suggest that patients recover in 50 days. California doesn’t report recoveries at all. Each entity defines a recovered case differently, so it will be difficult for us in the public to tell how many have recovered.
Data is collected from Johns Hopkins University at approximately 9:30 pm nightly. https://coronavirus.jhu.edu/map.html Reported recovered patients suggest recovery after 50 days after confirmation.Data is collected from San Diego Public Health at approximately 9:30 pm nightly. Active cases after 5/15 are based on data released by San Diego County. Points previous to 5/15 are calculated based on the assumption that recovery time after detection is 16 days. Reported recovered patients suggest recovery after 16 days after confirmation.
Reports from last week regarding the possible failure of lockdowns to bring numbers down are causing a lot of speculation on line as to the best way to improve. Many Western countries are struggling to reduce the number of new cases, and many countries are only now having their initial surge in cases (see my May 24th post).
In the US, several states are creeping back toward an R0 of 1.0 after re-opening. We definitely want to stay below 1.0, as this indicates a slowly vanishing caseload. Texas was doing very well for a long time, but the R0 there is above 1.0 for the first time in quite a while. Cases are predominantly in urban areas, Houston, Dallas, and Austin.
A lot of studies are being done on the best approach. Japan is of particular interest because after an initial very small peak, they had a much larger peak starting in late March. They didn’t have the massive testing of So. Korea, nor did they have a strict lockdown. But they got things back under control quickly, and they have a very low daily caseload now, despite the VERY high population density of cities like Tokyo. So far, people are speculating that they are doing well because it’s culturally acceptable there to wear masks on a regular basis, and others are just calling it a mystery. I’m sure researchers will be taking a close look at Japan.
All the best to you and your family!
Don’t fear, but be smart,
Erik
Sutton et al (Universal Screening for SARS-CoV-2in Women Admitted for Delivery, NEJM, April 22, 2020):
On Wednesday, San Diego County announced that the county will be moving further into California’s Step 2 re-opening plan. This means restaurants will be opening for modified seating with some other restrictions, and many more businesses will able to open as well. To sum, customers will still need to maintain 6 ft separation, and everyone will need to wears masks while shopping. Restaurant guests will need to wear masks while not at their table. Tables in restaurants will need to be moved so that seated customers are at least 6 ft apart. Tables that cannot be moved will need to have barriers between them. Restaurants can also expand outdoor seating!
I’m excited for this change, but it will be important for the public to follow these new guidelines. We want to keep making forward progress!
doubloondiagnostic.com 