Good news day again!

Common blood thinning medication might help mitigate Covid-19 – https://www.biorxiv.org/content/10.1101/2020.07.14.201616v1.full.pdf

“SARS-CoV-2 spike protein interacts with cell surface heparan sulfate and

angiotensin converting enzyme 2 (ACE2) through its Receptor Binding Domain”

“These findings support a model for

SARS-CoV-2 infection in which viral attachment and infection involves formation of a complex

between heparan sulfate and ACE2. Manipulation of heparan sulfate or inhibition of viral

adhesion by exogenous heparin may represent new therapeutic opportunities.”

Immunity via Tcell could last 17 years! AND not only that but similar infections with related viruses may be able to protect you – perhaps explain how some people do so well they were infected previously by a similar virus – https://www.nature.com/articles/s41586-020-2550-z_reference.pdf

“Memory T cells induced by previous pathogens can shape the susceptibility to, and clinical severity of, subsequent infections1. Little is known about the presence of pre-existing memory T cells in humans with the potential to recognize SARS-CoV-2. Here, we frst studied T cell responses to structural (nucleocapsid protein, NP) and non-structural (NSP-7 and NSP13 of ORF1) regions of SARS-CoV-2 in COVID-19convalescents (n=36)”

“We then showed that SARS-recovered patients (n=23) still possess long-lasting memory T cells reactive to SARS-NP 17 years after the 2003 outbreak, which displayed robust cross-reactivity to SARS-CoV-2 NP”

“antibody levels appear to wane faster than T cells. SARS-CoV-specific antibodies dropped below the detection limit within 2 to 3 years10, whereas SARS-CoV-specific memory T cells have been detected even 11 years after SARS infection”

“Our findings also raise the intriguing possibility that long-lasting T cells generated following infection with related viruses may be able to protect against, or modify the pathology caused by, SARS-CoV-2 infection.”

“Theoretically, individuals exposed to coronaviruses might just prime ORF-1-specific T cells, since the ORF-1-coded proteins are produced first in coronavirus-infected cells and are necessary for the formation of the viral replicase-transcriptase complex essential for

the subsequent transcription of the viral genome leading to various RNA species Therefore, ORF-1-specific T cells could hypothetically

abort viral production by lysing SARS-CoV-2-infected cells before the formation of mature virions.”

A new test – the all in one test – that can produce results in 20 minutes and tell if you are currently infected and if you had it! https://www.scmp.com/news/asia/australasia/article/3093608/australian-researchers-invent-20-minute-coronavirus-blood

“Their test, using 25 microlitres of plasma from blood samples, looks for agglutination, or a clustering of red blood cells, that the coronavirus causes.

While the current swab test is used to identify people who are infected with the coronavirus, the agglutination assay – or analysis to detect the presence and amount of a substance in blood – can also determine if someone had been recently infected, after the infection is resolved, they said. Hundreds of samples can be tested every hour, the researchers said, and they hope it can also be used to detect antibodies raised in response to vaccination to aid clinical trials. ”

In order of merit in understanding the extent of a pandemic confirmations – hospitalization – deaths. As discussed before and also noted in the media – confirmations don’t really assess the issue of the pandemic at least in real-time. After things are settled somewhat and testing is expanded to a random statistical sampling of the population confirmations then and only then can give you an extent of the pandemic but usually at this point priorities are shifted to not understand what has happened but to recover where you are at. Hospitalization would seem to be able to give a good assessment on where things are and hopefully be a leading indicator in order to avoid deaths. However hospitalization likely have some human aspects that are not necessarily accounted for. Below analysis I will try to rationalize this issue. Eventually death is likely the most reliable method – which is used the most in calculating/understanding historical pandemics most will use crude mortality rates – death/population. As noted before deaths are not a metric you want to wait on for obvious reasons.

Texas Health and Human Services for Trauma Service Area Q (Houston) https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/0d8bdf9be927459d9cb11b9eaef6101f Seemed to hype the urgency and concern relative to Texas Medical Center data https://www.tmc.edu/coronavirus-updates/tmc-2-week-projection-using-bed-occupancy-growth/

Which one is more right?

Lets look at what has happened over the last few weeks – The below charts are confirmed cases for Harris County and the corresponding THHS Trauma Service Area Q data – for those not knowledgeable Houston is primarily in Harris County. Also to note 7 day moving average is needed to smooth out weekend reporting and July 4th holiday reporting which had near zero confirmations then an extreme jump on the 6th. You will note in the middle of June confirmations started to rise and then hospitalizations started rising. After July 4th we see a drop in hospitalization but yet the confirmations are still rising. In fact the percentage of those being hospitalized dropped from 17% to less than 1% less than anytime before the big rise. It took from the middle of June to rise from 5% to 17% by July 4th, but now we drop from 17% to less than 1% in less than 2 weeks.

A common excuse is the testing expanded and now covers more people not needing to be hospitalized. This would have to be a very selective testing as the amount of people going to ICU/Hospitalized did not go down but actually is up (4th chart below).

If we look into the ICU piece of the puzzle which everyone used to closed down the economy as this does represent the critical constraint to life or death. Interesting the news of imminent overflow eventually caused a pause right below that number for the past week. Once again confirmations did not stop rising just the ratio from confirmations to ICU drop from 4% to less than 0.04%. Clearly people would be turned away IF limit is reached and then corresponding death would rise. There is NO point in turning a patient away from ICU when there is availability IF they need it until you hit the point of overflow.

My proposed hypothesis to explain this phenomenon is two fold. The less nefarious side is the human nature of not taking into account scarcity until scarcity shows up. The criteria to hospitalization and ICU was relaxed in the beginning. An over hospitalized rate would also explain/support the big drop in deaths/confirmation noted in the delayed confirmation 2-4 week range. Over hospitalization should make over abundance of care so that patient would very much survive from any other health issues beyond covid that could occur (including accident broken leg, car accidents, falls, other infections, etc…). Then as the news and pressure from administration and politicians AND the fact there were less beds available the criteria to admission has resulted in a tighter criteria – this resulted in slight rise in mortality rate but still record low for the country.

The more nefarious view is when calculating a revenue per hospital. Empty bed = no revenue. Full bed = revenue. I have read that some would argue Full Bed could actually result in losses as cost are outweighed to treat a covid patient. Nonetheless empty bed one couldn’t request any money or even complain of losses. Obviously the mix of the two could likely be happening. Empty beds allows not only the doctors and nursed to be more cautious (over treatment) about their treatment plan but as things get tight they do make the right call and allocate resources more effectively. The administration side of things obviously don’t want to overbuild capacity and want to show they are great planners and have planned appropriately so empty beds is not necessarily a good thing.

This is not isolated to hospitals but is in all human aspects of materials. As a resource planner in the power generation space you are blamed for an oversupply of resources but those complaints are far much better than the complaints of blackout or brown out. In order to mitigate the oversupply utilities may dispatch plants uneconomically and/or export power to show that the resources are still working and that the perception its not all for waste. Perhaps some purposely overbuild in order to get returns to be able to give out dividends but in general one needs to show proof that there was some rational for this case.

Bottom line – Houston health system is working to its design. Top world class health facility in the world is fully capable of making the correct call and using resources as needed. Death rates are still the best in the country and the envy of the world. Can they tighten their criteria and or free up more resources? very likely. Hospitalization data is not a complete forward indicator without considering some business/human decisions factors. It is a reality that there is still an underlying business underneath it all. Businesses are required to allocate capital and make use of what is deployed. Does this mean we are not going to have a problem? No – IF we continue to grow in confirmation the new slope would eventually hit a point where decisions leads to increase deaths that would not be ethical. However that growth is MUCH larger than what the initial hospitalization data suggest.

Brazil continues to lead in deaths 1322 and now looks very similar to the US in fatality rate ~4% and confirmed per capita ~1%

Texas leading both confirmation and deaths.

Bexar County (San Antonio) actually leading confirmation for all counties in US – 5980 – looks like they are playing catch up with their data – https://www.ksat.com/news/local/2020/07/16/bexar-county-reports-thousands-of-backlogged-covid-19-cases-601-new-cases/

Another weakness in the confirmation data as the current data stream assumes it all occurred yesterday – but they are saying it was backlog for the past 2 weeks!

“On Thursday, officials reported an eye-popping 5,501 more COVID-19 cases in Bexar County, 691 of which surfaced today, while the rest were backlogged.

San Antonio Mayor Ron Nirenberg explained that the backlog was a result of kinks in the communication process with the state, and that cases have been underreported in the past two weeks. Despite that, all patients who tested positive were notified within four days.”

France and China spike in deaths