{"id":10507,"date":"2020-04-19T13:16:32","date_gmt":"2020-04-19T13:16:32","guid":{"rendered":"https:\/\/adhc.lib.ua.edu\/pandemicbook\/?page_id=10507"},"modified":"2022-02-23T20:35:53","modified_gmt":"2022-02-23T20:35:53","slug":"04-19","status":"publish","type":"page","link":"https:\/\/adhc.lib.ua.edu\/pandemicbook\/04-19\/","title":{"rendered":"04-19"},"content":{"rendered":"\t\t
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Sunday, April 19<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tUS Cases 515,146
US Deaths 42,978<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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-Apr 16: The White House unveils<\/a> <\/span>its proposed guidelines for resuming economic activity. 4,591 deaths are reported in the United States from COVID-19, nearly doubling the previous one-day record<\/a> <\/span>of 2,569. Jobless claims rise <\/span>to 22 million in the last month.<\/p>

-Apr 17: Trump tweets repeatedly, calling to “liberate” states where\u00a0 \u00a0protesters are demanding their governors reopen businesses. “Liberate Michigan!”, “Liberate Minnesota!,” and “Liberate Virginia, and save your great 2nd Amendment. It is under siege!” Trump says in three separate tweets. Meanwhile, health experts say<\/a> <\/span>the U.S. needs to at least double or triple its testing capacity before reopening can happen.\u00a0 The United States Department of Agriculture says<\/a> <\/span>it will offer $16 billion in direct grants to farmers and ranchers who are struggling.<\/p>

-Apr 18: People gather<\/a> <\/span>in front of several statehouses across the U.S. on Saturday to protest stay-at-home orders, chanting, “Let us Work!” and “Fire Fauci.” In Maryland, they make noise but don’t get out of their cars. Trump son-in-law Jared Kushner\u00a0tells<\/a>\u00a0<\/span>Bob Woodward privately that the United States is now in a \u201ccomeback phase.\u201d He explains, \u201cTrump\u2019s now back in charge. It\u2019s not the doctors.\u201d\u00a0<\/p>

-Apr 19: Governors from states that have been hit hard by the coronavirus pandemic dispute<\/a> <\/span>President Trump’s assertion that they have enough coronavirus tests to safely reopen their economies soon. Reopening protests continue, including “Operation Gridlock” in Arizona. President Trump, who was asked Sunday whether he was inciting violence by encouraging people to “liberate” their states, said that people who are calling on state governments to lift coronavirus stay-at-home orders were “good people” who\u00a0have “cabin fever”<\/a><\/span>\u00a0and “want their life back.” *<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\tFrom the Cutting Room Floor...\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Dr. Erin Bromage specializes in infectious diseases and host immune responses of animals in the bio department at the UMass-Dartmouth. He\u2019s been answering common questions about this second SARS virus, and the pandemic more generally.[1]<\/a> He confirms much that I had suspected.  His posted questions also tap into the issues that people are struggling to grasp. Here\u2019s a paraphrase of his \u201cWhere are we now?\u201d post with some thoughts.<\/span><\/p>\n

[read_more id=”1″ more=”Read more” less=”Read less”]<\/p>\n

(1) Where did it come from?<\/em> Or, rather, where didn\u2019t<\/em> it come from? This virus was not intentionally engineered; it\u2019s not a Chinese weapon. That\u2019s propaganda. But scientists cannot rule out at this time that the virus escaped accidentally from a lab, he says. It\u2019s very unlikely, but there is now very circumstantial evidence for it.[2]<\/a> University of North Carolina scientists and Chinese scientists collaborated on a NIH-funded project studying coronaviruses from 2014-2019. However, their published work shows too few similarities between this second SARS and the many bat coronaviruses they examined. Most likely, this was a bat-to-human zoonotic event, perhaps with a scaly pangolin host in between.[3]<\/a><\/span><\/p>\n

(2) Did I already have COVID-19 last winter?<\/em> No. Bromage rehearses the detective-story rundown of the outbreak as we know it. The first major crossover event occurred in November in or near Wuhan, but not necessarily at the seafood market.<\/span>[4]<\/a> The United States had a few cases but contained them and shut down travel from China by the end of January.<\/span>[5]<\/a> Most cases, according to him, likely derived from Europe and ran through the East Coast, not from China and the West Coast. Recent news suggests, however, that the so-called \u201cChina travel ban\u201d let in a staggering 430,000 passengers anyway, many of whom were not screened.<\/span>[6]<\/a><\/p>\n

(3) What kind of tests are there and how do they work?<\/em> There are three main kinds of tests: RT-rPCR (reverse transcriptase (RT), real-time (r), polymerase chain reaction (PCR)), a newly developed antigen test, and the serological\/antibody test. The RT-rPCR test is the most commonly used one\u2014the one that people complain about because you get a swab on the end of a long stick jammed up your nose until your brain hurts, and then they delicately smoosh that mess into a vial. They mash up your cells, sieve out the RNA and DNA, spinning out all the other cytoplasmic stuff that you learn about in AP Biology, use some reagents to boost it, and viol\u00e1<\/em>, you can read whether there\u2019s some coronavirus RNA floating around in your mucus membranes. A positive result for this test is very accurate and means there\u2019s actual SARS-CoV-2 ribonucleic acid in your body, but not necessarily that you\u2019re sick from it yet. A negative result means \u2026 well, it could mean they messed up the sample or just did the test wrong or that the virus isn\u2019t floating around in your nose in high enough quantities. There are rising numbers of false negatives with this RT-rPCR.[7]<\/a> This scenario almost certainly led to China\u2019s decision to switch diagnostic measures to clinical ones like chest X-rays, which, in turn, lead to China\u2019s upward revision of cases and deaths (headlined as a \u201csurge\u201d instead of a change in diagnostic practice) in February.[8]<\/a><\/span><\/p>\n

The second test, an antigen test, is much faster, less invasive, and safer for staff. But as Bromage reports, false and inconclusive results happen more often.<\/span><\/p>\n

Finally, the serological tests see if you\u2019ve got some coronavirus protein antibodies floating around inside of you, indicating you had a coronavirus at some point. It has an error rate of about 50%, however. Avoid making decisions based on this test, cautions Bromage.<\/span><\/p>\n

Interestingly, a pre-print appeared on medRxiv this week (with all the caveats about pre-prints) using antibody seroprevalence sampled early this month in Santa Clara, California.[9]<\/a> The Stanford and USC researchers conclude that there is a far higher infection rate than previously acknowledged. What\u2019s more interesting is that John Ioannidis is an author in the study. Ioannidis is a modern-day legend for instigating the \u201creplication crisis\u201d in the social sciences. Basically, he believes most social scientific statistical work is shoddy and has spent his career trying to debunk both the methods and the conclusions. Nonetheless, a number of other scientists have taken to Twitter peer-reviewing the antibodies study\u2014and casting serious doubt on Ioannidis\u2019 work.[10]<\/a> They are questioning his numbers and his methodology. This online version of back-street-arm-wrestling-match peer-review is both interesting and a little terrifying, given that the pre-print studies seem to be fed into the broader media at a rate correlating not with their ability to withstand review but merely with the relative celebrity of the authors and their institutions.<\/span><\/p>\n

Back to Dr. Bromage:<\/span><\/p>\n

(4) If I am infected, will I later be immune?<\/em> We don\u2019t know. Versions of the common cold are also caused by a coronavirus, and we don\u2019t remain immune to that for long.<\/span><\/p>\n

(5) Is it as bad as the flu?<\/em> It\u2019s probably much worse. Even if the much higher-than-flu mortality rate isn\u2019t as high as it seems, it is spreading like a California forest fire through dry underbrush. His analogy is good:<\/span><\/p>\n

[A] restaurant can serve 50,000 meals over a year, but the same restaurant can\u2019t fulfill 50,000 orders in a week. Most orders couldn\u2019t be fulfilled….with health care, an unfulfilled order means a death. Remember, from a flu index case, a ten-point transmission chain results in ~15 infections. While with SARS-CoV, a single index case transmission chain results in 59,000 infections [and rising].<\/span><\/blockquote>\n

My interpretation of Dr. Bromage\u2019s answer to \u201cwhere are we now?\u201d is: we\u2019re maybe starting to get into a better place<\/em>. Most of us have sheltered at home, which has begun to flatten the curve. We are far from sorting out the PPE situation, the test situation, and the economic situation even in health care facilities. And just as we\u2019re beginning to get this under control in the metropolises, it seems to be spreading to the smaller cities where people seem less willing to comply with stay at home orders.<\/span><\/p>\n


<\/span><\/p>\n

Notes<\/p>\n

[1]<\/a> Erin Bromage, \u201cWhere We Are Now?,\u201d Erin Bromage, Ph.D.: COVID-19 Musings, April 19, 2020, https:\/\/www.erinbromage.com\/post\/where-we-are-now<\/a>.<\/span><\/p>\n

[2]<\/a> Josh Rogin, \u201cOpinion | State Department Cables Warned of Safety Issues at Wuhan Lab Studying Bat Coronaviruses,\u201d The Washington Post<\/em>, April 14, 2020, https:\/\/www.washingtonpost.com\/opinions\/2020\/04\/14\/state-department-cables-warned-safety-issues-wuhan-lab-studying-bat-coronaviruses\/<\/a>.<\/span><\/p>\n

[3]<\/a> Roujian Lu et al., \u201cGenomic Characterisation and Epidemiology of 2019 Novel Coronavirus: Implications for Virus Origins and Receptor Binding,\u201d The Lancet<\/em> 395, no. 10224 (February 22, 2020): 565\u201374, https:\/\/doi.org\/10.1016\/S0140-6736(20)30251-8<\/a>.<\/span><\/p>\n

[4]<\/a> Josephine Ma, \u201cChina\u2019s First Confirmed Covid-19 Case Traced Back to November 17,\u201d South China Morning Post<\/em>, March 14, 2020, https:\/\/www.scmp.com\/news\/china\/society\/article\/3074991\/coronavirus-chinas-first-confirmed-covid-19-case-traced-back<\/a>.<\/span><\/p>\n

[5]<\/a> Lily Kuo, \u201cBirth of a Pandemic: Inside the First Weeks of the Coronavirus Outbreak in Wuhan,\u201d The Guardian<\/em>, April 10, 2020, https:\/\/www.theguardian.com\/world\/2020\/apr\/10\/birth-of-a-pandemic-inside-the-first-weeks-of-the-coronavirus-outbreak-in-wuhan<\/a>.<\/span><\/p>\n

[6]<\/a> Zolan Kanno-Youngs, \u201cTravelers From Coronavirus Hot Spots Say They Faced No Screening,\u201d The New York Times<\/em>, March 13, 2020, sec. U.S., https:\/\/www.nytimes.com\/2020\/03\/13\/us\/politics\/coronavirus-travelers-screening.html; Steve Eder et al., \u201c430,000 People Have Traveled From China to U.S. Since Coronavirus Surfaced,\u201d The New York Times<\/em>, April 4, 2020, https:\/\/www.nytimes.com\/2020\/04\/04\/us\/coronavirus-china-travel-restrictions.html<\/a>.<\/span><\/p>\n

[7]<\/a> Kristin V. Brown, \u201cFalse Negatives Raise Doctors\u2019 Doubts About Coronavirus Tests,\u201d Bloomberg.Com<\/em>, April 11, 2020, https:\/\/www.bloomberg.com\/news\/articles\/2020-04-11\/false-negative-coronavirus-test-results-raise-doctors-doubts<\/a>.<\/span><\/p>\n

[8]<\/a> Dominique Patton and David Stanway, \u201cChina\u2019s Hubei Province Sees Surge in Coronavirus Deaths on Switch to New Methodology,\u201d Reuters<\/em>, February 13, 2020, https:\/\/www.reuters.com\/article\/us-china-health-hubei-toll-idUSKBN207010<\/a>.<\/span><\/p>\n

[9]<\/a> Eran Bendavid et al., \u201cCOVID-19 Antibody Seroprevalence in Santa Clara County, California,\u201d MedRxiv<\/em>, April 30, 2020, 2020.04.14.20062463, https:\/\/doi.org\/10.1101\/2020.04.14.20062463<\/a>.<\/span><\/p>\n

[10]<\/a> Natalie E. Dean, \u201cA Thread Written by @nataliexdean,\u201d Threader.app, April 18, 2020, https:\/\/threader.app\/thread\/1251309217215942656<\/a>.<\/span> [\/read_more]<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tTrump supports the people protesting stay-at-home orders\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t@realdonaldtrump, Twitter.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\n\t\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tTrump supports the people protesting stay-at-home orders\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t@realdonaldtrump, Twitter\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\n\t\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tTrump supports the people protesting stay-at-home orders, throwing in the Second Amendment for good measure.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t@realdonaltrump, Twitter\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\n\t\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tPeople evacuating from China\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tEder, Steve, Henry Fountain, Michael H. Keller, Muyi Xiao, and Alexandra Stevenson. \u201c430,000 People Have Traveled From China to U.S. Since Coronavirus Surfaced.\u201d The New York Times, April 4, 2020, sec. U.S. https:\/\/www.nytimes.com\/2020\/04\/04\/us\/coronavirus-china-travel-restrictions.html.\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\n\t\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tDeaths by age\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tEUROMOMO. \u201cGraphs and Maps from EUROMOMO.\u201d EUROMOMO, April 17, 2020. https:\/\/euromomo.eu\/dev-404-page\/.\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\n\t\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tMass burials on Hart Island, New York\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tRobbins, Christopher. \u201cNYPD Seizes Drone Of Photojournalist Documenting Mass Burials On Hart Island.\u201d Gothamist, April 17, 2020. https:\/\/gothamist.com\/news\/nypd-seizes-drone-photojournalist-documenting-mass-burials-hart-island.\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\n\t\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tCOVID deaths in relation to pneumonia and influenza\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\thttps:\/\/www.erinbromage.com\/post\/where-we-are-now\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\n\t\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tReportedly, this is not as comfortable as it looks. \t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\thttp:\/\/www.dlolab.com\/sites\/dlolab.com\/files\/files\/images\/virtual-test-guide\/nasal_swab_demo.jpg\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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