faithwashtub

COVID-19 Update, 03-06-20

QUICK FOREWORD: I've been making these daily updates since February 25 now but couldn't figure out the best way to get it to the Reddit community since r/coronavirus doesn't allow text posts. I hope this will be ok with the mods; please let me know if you'd rather me not do this.  In these updates, I start with global news and a smattering of recent research, and then delve into state-by-state responses to the current outbreak in the US. This is by no means comprehensive, but I try my best to fit as much information in as I can. Cheers!

COVID-19 as of today, 03-06-20 (summary is my own):

[Some Quick Definitions for Commonly Used Terms, skip ‘em if ya know ‘em:

Community Spread – Illness with an unknown source. This typically means that there are more cases in the community that have not been detected. May also be called community acquired or local transmission.

Cumulative Confirmed Case Fatality Rate – The total number of patients who were confirmed to have COVID-19 and died, divided by the total number of confirmed COVID-19 cases, from the beginning of the outbreak to today.

Patient Under Investigation (PUI) – A person who is showing one or more COVID-19 symptoms (fever, cough, difficulty breathing) who has not yet received test results.

Presumptive Positive – The first test back for a PUI is positive, but another test is still needed to confirm this. Confirmed means that two tests have shown that the case is positive.]

The Vatican City and countries Cameroon, Colombia, Costa Rica, Peru, Serbia, Slovakia and Togo announce their first COVID-19 cases. This morning, the reported confirmed case count exceeded 100,000. At least 56% of those cases have since recovered. The Czech Republic, Ireland, New Zealand, the Philippines and Slovenia are the newest countries to report community spread. The current cumulative confirmed case fatality rate is at 3.77% in China and at 1.9% in the rest of the world. [1, 2]

[TWO PARAGRAPHS] The WHO points out similarities and differences between COVID-19 and seasonal flu, or influenza. Influenza has a shorter incubation period than COVID-19 – an incubation period is the number of days it takes from the time you are exposed to a case to the time you start developing symptoms. Influenza’s incubation period is 1 to 4 days, while COVID-19’s incubation period is 2 to 14 days. In general, illnesses with longer incubation periods may be easier to spread, since an illness that takes longer to detect is an illness that may be harder to detect.

They also point out that with the flu, you can transmit the illness up to 3 to 5 days before you begin developing symptoms. So far, the evidence for COVID-19 suggests that some people can transmit the illness 1 to 2 days before developing symptoms, but that most confirmed cases with known exposures have not been infected from exposure to asymptomatic cases (asymptomatic means without symptoms). [1, 3]  

The World Cup Finals for skiing, several major Italian cycling races, the Women’s Six Nations Match between Scotland and France, the next French soccer league home game, and the Asian weightlifting championships in Uzbekistan have all been cancelled or postponed. The Danish soccer club Copenhagen said all of its games in March would be played without fans. [4]

The US Trade Representative’s office removes tariffs from dozens of medical products imported from China; this includes face masks, examination gloves and hand sanitizing wipes. [5]

India has shut down schools, stopped exporting many pharmaceutical ingredients, and urged state governments to cancel upcoming festivities for the Hindu springtime holiday Holi. It is screening international travelers at 30 airports and has tested 3,500 samples so far as officials trace, test and quarantine contacts of 31 confirmed COVID-19 cases. [6]

Last week, COVID-19 began spreading through prisons in China, with more than 500 cases in 5 facilities. The US, who has more people in jail or prison per capita than any other country in the world, attempts to prevent COVID-19 outbreaks in its prisons and jails by urging lawyers to scale back in-person visits, while stepping up inmate health screenings and sanitizing jail. [7]

[TWO PARAGRAPHS] The Director of the Center for Tobacco Research Control and Education at the University of California San Francisco summarizes the current evidence on how smoking or vaping could increase people’s risk for developing severe illness if they contract COVID-19. First, he explains that smoking is associated with a higher risk for acute respiratory distress syndrome (ARDS) in people with severe infections. ARDS allows fluid to leak into the lungs, making breathing difficult or impossible. 

He goes on to state that in animal and cell studies, exposure to e-cigarette aerosols (the clouds that people breathe out when they vape) negatively affect ciliary function. Cilia in the lungs and respiratory tract work to keep your airways clear of mucus and dirt and help you breathe more easily. Another study of 30 people found that using e-cigarettes decreased their cough sensitivity, or their likeliness of coughing, which they measured by exposing them to capsaicin (red pepper). If e-cigarette use truly does make people less likely to cough and damage how their cilia function, these people could be more likely to develop pneumonia as a complication of COVID-19. [8, 9, 10, 11] 

An article published ahead of schedule in the journal Emerging Infectious Diseases describes symptoms of two COVID-19 cases from a cruise ship in Japan. One case had a sore throat, throat dryness, a runny nose and a slight cough, but no fever, shortness of breath or sputum (a mix of saliva and mucus that can be coughed up) throughout her illness. Her symptoms resolved by Day 19, and her last positive test was on Day 20. She had two negative tests on Day 22 and 23. The other case had fever and throat redness, but did not report a sore throat, and never had shortness of breath or sputum throughout his illness. His symptoms resolved by Day 4, but he was still positive for COVID-19 on Day 21. The article does not state whether the second case ever had negative tests. The current guidance is that a person is considered to be free of COVID-19 once they have two negative tests in a row. [12]

In the US, here are states and large counties that have updates for today, in alphabetic order:

Alabama announces that its state public health lab is now able to test for COVID-19 cases. [AL] 

Arizona announces a third presumptive positive COVID-19 case. The case is hospitalized; her source of exposure is under investigation. [AZ]

[THREE PARAGRAPHS] California announces nine new cases; 4 are travel-related, 2 are person-to-person, and 3 are from community spread. 2 that formerly had unknown sources have been determined to be from community spread. The state now has 69 cases. In addition, 21 new cases from the Grand Princess cruise ship off the coast of San Francisco have been confirmed to have COVID-19; 19 of these were crew members. 3,500+ people are currently on the ship. 

Yesterday, the governor announced that all commercial and Medi-Cal plans managed by the Department of Managed Health Care would not pay for any ER, urgent care or other healthcare provider visit where the visit’s purpose is to test for COVID-19. Also yesterday, the CA Employee Development Department announced that residents who are unable to work due to having COVID-19 (self-isolation) or having been exposed to COVID-19 (self-quarantine) would be able to apply for a disability insurance claim, which would cover 60-70% of lost wages during the time that person has to stay at home. 

Multiple reports from healthcare providers and members of the public in California claim that they have been unable to be tested, despite some having symptoms and/or exposures consistent with COVID-19. Some appear to have been due to shortages of testing supplies, while others may be due to a lack of knowledge on who does testing. In a press briefing this afternoon, the Director of the Los Angeles County Department of Public Health announced that a commercial lab began assisting with testing yesterday, which should greatly improve testing capacity for the county of 10.5 million people. She explained that each test kit allows for 800 tests to be run, but that multiple tests need to be run for each individual, so the number of tests would not equal the number of people tested. She further explained that LA County will now be able to test based on the CDC’s new criteria: that anyone whose healthcare provider requests testing, regardless of known exposure, will be able to be tested. [CA1, CA2, CA3, CA4, CA5]

Colorado announces 6 additional presumptive positive cases today; it announced 2 yesterday. Of these 8 cases, 5 were exposed through international travel, 1 was through international travel or exposure to an out-of-state case, and 2 are actively being investigated to figure out their sources of exposure. [CO]

In the District of Columbia, after two individuals who attended the American Israel Public Affairs Committee conference tested positive for COVID-19, the White House is preparing to allow staff to telework. [DC]

Florida announces two new presumptive positive cases awaiting confirmatory testing; both cases are in Broward County and mark the first cases in south Florida. The state also had two deaths today in already confirmed COVID-19 cases, one in Santa Rosa County and the other in Lee County; both deaths were in people who had recently made international trips and both were in their 70s. [FL]

Georgia announces 1 new presumptive positive case who is awaiting confirmatory test results. [GA]

Indiana announces its first presumptive positive case in an individual with recent travel to Boston, MA. They await confirmatory test results. [IN]

Louisiana reminds its residents that free flu shots are available at any parish health unit. They also remind people that if they don’t get the flu shot and get the flu, their weakened immune system can leave them more susceptible to developing other illnesses such as COVID-19 if exposed to it. [LA]

Maine announced yesterday that it’s going to begin testing for COVID-19 at its state public health lab some time in the next few days. [ME]

Maryland announces that a recently confirmed COVID-19 case had visited an event at The Village at Rockville, a retirement community, from noon to 6 pm on February 28. The Maryland Department of Public Health urges those who attended the event to monitor themselves for symptoms through March 13, and lists the number for a hotline for anyone who has questions about this information. [MD]

Massachusetts, in the past two days, has announced 6 new presumptive positive cases, bringing their total number of cases (confirmed or presumptive) to 8. 5 of the presumptive cases were all linked to a late February meeting of an international company headquartered in Massachusetts, 2 had recent travel to northern Italy, and one who had recent travel to Wuhan, China. All 8 cases are self-isolated and recovering in their homes. [MA]

Michigan announced yesterday that it has more than doubled its previous testing capacity; it can now test for more than 300 individuals. [MI]

Minnesota announces its first presumptive positive case; it is awaiting confirmatory testing. The case recently took a cruise and was exposed to another case on it, developed symptoms on February 25, and sought care yesterday. The patient is self-isolated and recovering at home. [MN]

New Jersey announced a second presumptive positive case yesterday, who is self-isolating and recovering at home. The state decreed immediate restrictions on travel for state employees, and suspended all international travel until further notice. [NJ]

New York holds two separate press briefings today, each to announce 11 new confirmed cases; this brings the state’s total to 44. The governor announces that travel insurance companies and travel agents will now allow New York residents and businesses to purchase travel insurance that would allow them to cancel a trip for any reason, including reasons related to COVID-19. In the governor’s words, “While the overall risk level of the novel coronavirus in New York remains low, I want New Yorkers to know that I'm not urging calm. I'm urging reality. I'm urging a factual response as opposed to an emotional response. In New York we have the most sophisticated healthcare system on the globe, and we are continuing to prioritize testing, quarantine protocols and containment tracking to keep New Yorkers safe.” [NY1, NY2]

North Carolina announces its second presumptive positive case, this one in an individual who had recently traveled to Italy in late February. This individual was a contact of a case in Georgia and may have been infectious while on his flight back from Italy. The CDC is conducting a contact investigation for the individuals who may have been exposed on the flight. [NC]

Ohio’s Department of Public Health opens a call center to answer the public’s questions about COVID-19. [OH]

Pennsylvania announces a six-fold increase in its testing capacity, from 25 to 150 per day. [PA]

Rhode Island announces its third presumptive positive case. This individual is self-isolated and recovering at home; she was a close contact of a New York case from late February. [RI]

South Carolina announces its first two presumptive positive cases, which are awaiting confirmatory test results. One case recently traveled to France and Italy, and is self-isolated and recovering at home. The other is not linked to the first; she is an elderly adult who has been hospitalized and is in isolation. It’s not immediately clear whether she was isolated upon arrival to the hospital or what her exposure was. [SC]

Tennessee, after announcing its first presumptive positive case yesterday, states that it has received negative test results for the case’s household contacts and two unrelated people. The case recently traveled out of state and is self-isolated and recovering at home. [TN]

In Texas, the city of Austin cancels the South by Southwest event. This is the first time in 34 years that it will not take place. The event organizers point out that on Wednesday, Austin Public Health stated that “there’s no evidence that closing SXSW or any other gatherings will make the community safer.” [TX]

Utah announces its first presumptive positive case in a person who was on the Grand Princess, the cruise ship currently moored off the coast in San Francisco. The case is older than 60 and is self-isolated and recovering at home; the county she resides in issued an isolation order. Most states have not issued isolation orders, instead asking patients to self-isolate. [UT] 

Washington is now reporting 79 confirmed cases and 1 new death, bringing their death count to 11. 10 of the 11 deaths have been associated with the long-term care nursing facility in Kirkland. University of Washington Medicine has begun testing for COVID-19, increasing the state’s testing capacity; officials tell the public to expect new cases as more tests are performed. [WA1, WA2, WA3]

[1] WHO COVID-19 Situation Report, 03-06-20

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_2

[2] Johns Hopkins Coronavirus (COVID-19) Map

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

[3] How Flu Spreads

https://www.cdc.gov/flu/about/disease/spread.htm

[4] Skiing finals, Italian cycling races canceled due to virus

https://apnews.com/15623e056d060216da18543b1f2da2ed

[5] U.S. excludes Chinese face masks, medical gear from tariffs as coronavirus spreads

https://www.reuters.com/article/us-health-coronavirus-usa-tariffs/u-s-excludes-chinese-face-masks-medical-gear-from-tariffs-as-coronavirus-spreads-idUSKBN20T2ON

[6] India’s beleaguered health system braces for virus surge

https://apnews.com/668fb152281c390145e650e3e53ed547

[7] US prisons, jails on alert for spread of coronavirus

https://apnews.com/af98b0a38aaabedbcb059092db356697

[8] Reduce your risk of serious lung disease caused by corona virus by quitting smoking and vaping

https://tobacco.ucsf.edu/reduce-your-risk-serious-lung-disease-caused-corona-virus-quitting-smoking-and-vaping

[9] Acute Respiratory Distress Syndrome (ARDS)

https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/ards/

[10] What are cilia?

https://ciliopathyalliance.org/cilia

[11] Effect of e-Cigarette Use on Cough Reflex Sensitivity

https://www.sciencedirect.com/science/article/pii/S0012369215001336?via%3Dihub

[12] COVID-19 in 2 Persons with Mild Upper Respiratory Tract Symptoms on a Cruise Ship, Japan

https://wwwnc.cdc.go.v/eid/article/26/6/20-0452_article

[AL] ADPH state laboratory now tests for novel coronavirus COVID-19

http://www.alabamapublichealth.gov/news/2020/03/06.html

[AZ] Public Health Confirms an Additional Presumptive Positive Case of COVID-19 in Arizona

https://www.azdhs.gov/director/public-information-office/index.php#news-release-030620

[CA1] State Health & Emergency Officials Announce Latest COVID-19 Facts

https://www.cdph.ca.gov/Programs/OPA/Pages/NR20-013.aspx

[CA2] Governor Newsom, State Health Officials Announce More than 22 Million Californians Now Eligible for Free Medically Necessary COVID-19 Testing

https://www.cdph.ca.gov/Programs/OPA/Pages/NR20-012.aspx

[CA3] 21 positive for coronavirus on cruise ship off California

https://apnews.com/61a4efa966c02cbda9584f7266b99802

[CA4] Chaos at hospitals due to shortage of coronavirus testing

https://www.latimes.com/science/story/2020-03-06/chaos-at-hospitals-due-to-shortage-of-coronavirus-tests

[CA5] Los Angeles County Department of Public Health COVID-19 Press Briefing, 03-06-20

https://www.facebook.com/lapublichealth/videos/481977365832135/ 

[CO] Six additional presumptive positive cases of COVID-19 identified in Colorado, at least five have recently traveled internationally

https://www.colorado.gov/pacific/cdphe/news/six-additional-presumptive-positive-cases-covid-19-identified-colorado-least-five-have-recently\

[DC] House makes telework plans amid coronavirus outbreak

https://thehill.com/homenews/house/486418-house-prepares-for-telework-scenarios-amid-coronavirus-threat

[FL] Two patients in Broward County test positive for novel coronavirus, state officials say

https://www.miamiherald.com/news/health-care/article240980976.html

[GA] DPH Awaits CDC Confirmation of Positive COVID-19 Test

https://dph.georgia.gov/press-releases/2020-03-06/dph-awaits-cdc-confirmation-positive-covid-19-test

[IN] State Health Department Confirms 1st Case of COVID-19 in Hoosier with Recent Travel

https://calendar.in.gov/site/isdh/event/state-health-department-confirms-1st-case-of-covid-19--in-hoosier-with-recent-travel/

[LA] Louisiana Department of Health gets creative to provide flu vaccinations

http://ladepthealth.blogspot.com/2020/03/louisiana-department-of-health-gets.html

[MA] Five New Presumptive Positive Cases of COVID-19 Identified by Massachusetts State Public Health Laboratory

https://www.mass.gov/news/five-new-presumptive-positive-cases-of-covid-19-identified-by-massachusetts-state-public

[MD] Maryland Department of Health reports potential COVID-19 exposure risk at The Village at Rockville

https://health.maryland.gov/newsroom/Pages/Maryland-Department-of-Health-reports-potential-COVID-19-exposure-risk-at-The-Village-at-Rockville.aspx

[ME] Maine to Begin Testing for COVID-19 at State Lab

https://www.maine.gov/dhhs/mecdc/press-release.shtml?id=2204263

[MI] MDHHS Bureau of Laboratories obtains additional coronavirus testing kits, more than doubles the number of people possible for testing

https://www.michigan.gov/mdhhs/0,5885,7-339-73970_71692_71696-521063--,00.html

[MN] Health officials confirm first case of novel coronavirus in Minnesota

https://www.health.state.mn.us/news/pressrel/2020/covid19030620.html

[NC] North Carolina Identifies Second Case of COVID-19

https://www.ncdhhs.gov/news/press-releases/north-carolina-identifies-second-case-covid-19

[NJ] Governor Murphy, Acting Governor Oliver, and Commissioner Persichilli Identify Second Presumptive Positive Case of Novel Coronavirus in New Jersey

https://www.nj.gov/health/news/2020/approved/20200305a.shtml

[NY1] At Novel Coronavirus Briefing, Governor Cuomo Confirms 11 Additional Cases - Bringing Statewide Total to 33

https://www.governor.ny.gov/news/novel-coronavirus-briefing-governor-cuomo-confirms-11-additional-cases-bringing-statewide-total

[NY2] At Novel Coronavirus Briefing, Governor Cuomo Confirms 11 Additional Cases - Bringing Statewide Total to 44

https://www.governor.ny.gov/news/novel-coronavirus-briefing-governor-cuomo-confirms-11-additional-cases-bringing-statewide-tot-0

[OH] Ohio Department of Health Opens Call Center to Help With COVID- 19 Response

https://odh.ohio.gov/wps/portal/gov/odh/media-center/odh-news-releases/odh-opens-call-center-to-help-with-covid-+19-response

[PA] Department of Health Provides Update on COVID-19, Testing Capability at State Lab

https://www.media.pa.gov/Pages/Health-Details.aspx?newsid=727

[RI] RIDOH's State Health Laboratories Identifies Third Case of COVID-19

https://www.ri.gov/press/view/37858

[SC] DHEC Investigating Two Possible Cases of 2019 Novel Coronavirus in South Carolina

https://www.scdhec.gov/news-releases/dhec-investigating-two-possible-cases-2019-novel-coronavirus-south-carolina

[TN] COVID-19 Test Results Negative for Contacts of First Tennessee Case

https://www.tn.gov/health/news/2020/3/6/covid-19-test-results-negative-for-contacts-of-first-tennessee-case0.html

[TX] SXSW Event Update

https://www.sxsw.com/2020-event-update/

[UT] Utah Health Officials Announce First Case of COVID-19

https://health.utah.gov/featured-news/utah-health-officials-announce-first-case-of-covid-19

[WA1] 2019 Novel Coronavirus Outbreak (COVID-19)

https://www.doh.wa.gov/Emergencies/Coronavirus?fbclid=IwAR1gRRR3DEWyfsD3ZNt353IR2V0fSb5jpS-HEq46UmykfGtVT8WP99n7wdo

[WA2] Update: King County COVID-19 case numbers for March 6, 2020

https://kingcounty.gov/depts/health/news/2020/March/6-covid-19-case-updates.aspx

[WA3] Snohomish County health officials expect new coronavirus cases to increase as testing expands

https://www.seattletimes.com/seattle-news/health/snohomish-county-health-officials-expect-new-coronavirus-cases-to-increase-as-testing-expands/

DISCLAIMER: As per usual, I’m posting for myself, not my employer. Knowledge is power, and I’m trying my best to present different aspects of the outbreak in a holistic manner. I’ve often found that misinformation is easier to latch onto if you don’t fully understand the truth of a situation – because when you don’t know something, you tend to seek out an explanation to fill in the gaps, and clearly written misinformation is much easier to understand than true scientific evidence that’s presented in a way that only other scientists can understand. I don’t think you could ever over-explain something so critical.

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