In 2019 the U.S. was ranked as the country best prepared for a pandemic. This year it is again at the top. As the Wall Street Journal headlines:
U.S. Leads the Globe as Coronavirus Deaths Pass 150,000, Hospitalizations Rise
The Washington Post adds another highlight:
U.S. reports 1,400 coronavirus deaths in a day - about one per minute
The number of new cases in U.S. have somewhat peaked for now as the sunbelt states have taken some measures to decrease new infections. But I am afraid that the trend down will (again) be very slow and that we will see another rise as some other states - Ohio, Tennessee, Indiana and Kentucky - show upticks in new infections. They may be the next ones who will get into trouble. The curve of new deaths from Covid-19 follows the new cases curve by three to four weeks. Deaths will probably peak at the end of August.
The economic damage the pandemic has caused in the U.S. is extreme:
The U.S. economy shrank at an annualized 32.9% rate in the second quarter - the worst-ever contraction on records that date back to 1947, the government said on Thursday.
The staggering contraction beats the last record set in 1958, when GDP shrank at an annualized 10% rate.
Interestingly the contraction in 1958 was a direct result of the 1957/58 H2N2 influenza pandemic.
Globally the situations is mixed. South-east Asia seems to have the problem under control. India is a mess. South America has huge problems. Western European countries seem mostly okay for now but I expect another big rise there as people are beginning to lose discipline. East Europe looks bleak. There is little reliable dataavailable for the Middle East and Africa.
Over the last six month scientists and doctors have learned a lot about the virus and the diseases it causes. I use the plural here as the virus is causing so many different troubles that it is hard to see them as one malady.
A number of professors at the UCSF have written a very good piece which describes all the different effects they see in their patients:
We Thought It Was Just a Respiratory Virus - We were wrong.
When the pandemic reached Europe there were discussions about the published numbers of Covid-19 death. Had people who had heart attacks and were positive for Covid-19 died from Covid-19 or with Covid-19? Those who argued against lockdowns and masks believed that most of the heart attack deaths did not come from Covid-19 and that it was wrong to include them in the total Covid-19 deaths number. But the extensive damage the virus directly causes in a multitude of organs makes it clear that Covid-19 was most likely the direct cause of all those deaths.
There was recently a similar conflict in Idaho about the death of a pediatric nurse practitioner who had died of a heart attack caused by Covid-19:
The post, which Rep. Tammy Nichols, a Middleton Republican, shared Wednesday without comment, pointed out that Samantha Hickey, who died two weeks ago at 45, suffered a heart attack. The post by Cate Tedeski implied that Hickey's death was somehow being misrepresented by the news media to scare the public.
It linked to an Idaho Statesman story that reported how Hickey, who worked for St. Luke's Health System, died of a heart attack after contracting the coronavirus.
The cardiology doctor who had cared for the nurse practitioner went public and described the case:
SARS-CoV-2, or the virus that causes the disease COVID-19, is a new virus that we still know very little about. Not only can the virus cause severe pneumonia and lung failure, but it can also cause unique cardiovascular injury. In some patients with COVID-19, the stress from the infection and inflammation causes small heart attacks that can be identified through blood tests. In other patients and for reasons that we don't understand yet, COVID-19 causes clotting within the blood vessels that can result in heart attacks and strokes.
In addition, the virus can directly attack the heart muscle itself and cause a disease called viral myocarditis. Myocarditis can happen to anyone of any age and it is unpredictable who will become severely ill. Sometimes, the virus causes so much damage to the heart muscle that patients die from rhythm abnormalities or shock because their heart can no longer function.
Sadly, Samantha Hickey died from cardiac shock due to COVID-19 myocarditis. She was an otherwise healthy 45-year-old before becoming infected.
Heart problems caused by Covid-19 are widespread. Consider this study which looked at cardiac changes in the MRI of people who have had Covid:
Findings: In this cohort study including 100 patients recently recovered from COVID-19 identified from a COVID-19 test center, cardiac magnetic resonance imaging revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), which was independent of preexisting conditions, severity and overall course of the acute illness, and the time from the original diagnosis.
Two third of those people had not even been hospitalized. They were 'mild' cases. The heart damage in the 60% of the people who have had Covid-19 may be permanent. Even otherwise healthy people can have this outcome. Red Sox pitcher Eduardo Rodriguez is one of those casualties
Moreover the CDC has now acknowledged that some 35% of those who had a symptomatic Covid-19 cases have not fully recovered even after 2-3 week. This includes the 'long haulers' like Hannah Davis who recently gave this update:
I just crossed the 4 month mark of being sick w' #COVID19. I am young, & I was healthy. Dying is not the only thing to worry about. I still have a near-daily fever, loss of cognitive function, essential tremors, GI issues, severe headaches, heartrate of 150+, viral arthritis, 1/
heart palpitations, muscle aches, a feeling like my body has forgotten to breathe. Over the past 124 days I've lost all feeling in my arms & hands, had extreme back/kidney/rib pain, phantom smells (like someone BBQing bad meat), tinnitus, difficulty understanding text/reading, 2/
difficulty following conversations, sensitivity to noise & light, nonstop bruising. *Thinking* can cause headaches now. I'm not alone in the cognitive issues; it's as common a symptom as cough.
No one knows when #longcovid patients aren't contagious; many are alone for months.
Long term effects of Covid-19 are not rare. In Spain over half of coronovirus patients have developed neurological problems.
While we have learned a lot about the virus and the diseases it causes there are even more things we do not know. Many young people, most of whom do not have to fear death from Covid-19, seem to assume that the virus will spread to nearly everyone and therefore do not care about getting infected right away. That is a stupid idea:
With each passing month, researchers are learning more about how to best treat the sickest patients. While there still is no cure, there is now some evidence for how to use treatments such as remdesivir and dexamethasone, said Dr. Abraar Karan, an internal medicine doctor at Brigham and Women's Hospital in Boston, so arguably, your chances of survival are better now than in February. "The longer you wait to be infected, the less chance you have of being part of an experiment, and the better chance you have to be receiving the outcome of a well-done experiment," he said.
I had long assumed that The SARS-CoV-2 virus spreads mostly by aerosols in rooms with air conditioners. It was the only explanation for several superspreading events described in the early literature. The dozen people who were infected in a restaurant in Guangzhou had all been sitting in the cycling airstream of an air conditioner. Some 50 cases in a one floor call center in Singapore also pointed to air conditioning as the distribution element. The many cases in a large outbreak in a German meat processing plant were also caused by aerosols in a air conditioned atmosphere. A detailed analysis of that event is here. The authors summarize:
In conclusion, this study indicates that transmission of SARS-CoV-2 can occur over distances of at least 8 [meter] in confined spaces under conditions of relatively low air exchange rates and high rates of recirculated unfiltered air.
People infected with SARS-CoV-2 spread droplets and aerosols when they speak, sneeze or cough. Air conditioning systems also dry the air while cooling it. In dry air droplets from an infected person lose their water content very fast and turn into virus carrying aerosols. Aerosols do not sink to the ground. Air conditioning systems can spread them very effectively.
Air conditioning system in modern airplanes use HEPA filters that catch aerosol size particles. N95 (FFP2 in Europe) masks do the same. For all of those who work with other people in a closed environment in which unfiltered air conditioning is used I recommend to wear a mask.
There is research about other viruses that support this recommendation:
In contrast to the neglected importance of aerosols fomites have received way too much attention. Their risk was exaggerated. The chance that some virus in a droplet on some surface makes it into ones nose is very small. That is why I have not wiped one surface for fear of Covid-19 and have never changed my hand hygiene. The deep cleaning is nonsense. Such Hygiene Theater Is a Huge Waste of Time.
For air conditioned public rooms and offices upgrading to HEPA-filters in air conditioners should have the highest priority. Unless that has happened masks should be made mandatory in such places.
Posted by b on July 30, 2020