Lets just pour it on for 2020 – https://www.scmp.com/news/china/diplomacy/article/3092563/chinese-embassy-warns-deadly-unknown-pneumonia-kazakhstan?

“‘Unknown pneumonia’ deadlier than coronavirus sweeping Kazakhstan, Chinese embassy warns”

Kazakhstan denies this – https://www.hindustantimes.com/world-news/kazakhstan-denies-china-s-advisory-of-pneumonia-deadlier-than-coronavirus/story-QFdydbXmyt8XElpIng8MMO.html

“The Kazakhstan health ministry acknowledged the presence of “viral pneumonias of unspecified etiology,” but denied that the outbreak was new or unknown.”

A not very comforting rebuttal….yes we have something that we don’t know but this is not new or unknown….

Didn’t hear much about this side effect – https://www.sciencedirect.com/science/article/pii/S1201971220305282

“The treatment had to be interrupted for potential side effects for 4 out 5 patients including two alamine aminotransferase (ALT) elevation and two renal failure cases.”

Kidney and liver failure is the potential outcome for remdesivir. I cant get over the fact how far apart the analysis and review of HCQ vs. Remdesivir….risk/reward – the amount cost (risk) and the amount tested and how many people have taken remdesivir unknown side effects (risk) – and the reward of improving a few days earlier (reward) not improving fatality rate seems to be a trade I wouldn’t take now compared to HCQ with zinc.

Back to Harris County – unfortunately got to use the saying “Houston we have a problem” Not sure why this graph was not displayed vs those other complicated graphs. We are now pulling the data available by TX DHS. They have the ICU data by Trauma Service Area (TSA) which does not coincide with county data. The ICU bed availability is also competing with other ICU bed requirements non-covid – hence a range.

We did see an uptick in deaths for Harris county 12 deaths. The Max daily death for county for Covid was 14 on July 6th

Confirmations stopped their declines rate and went up 205 yesterday relative to the previous day making total daily confirmation at 906.

I have tried to be consistent with the message. Confirmations will rise from spread and confirming what is already out there. The virus is out and it is likely to spread. The constraint is the ICU beds from being overwhelmed resulting in doctors/nurses making a decision to who lives and who dies. Deaths are inevitable but once ICU fills deaths will rise more than necessary. Those likely to go to ICU will have to do more measures than those that would not likely have to go to ICU – smart quarantine was needed not a free for all into the economy and not everyone isolated either. Nonetheless NO ONE should WANT to get the virus. Long term implications are unknown and being a carrier even if asymptomatic is not an envious position as you will likely impact those nearest to you not strangers since you are not likely to be in room for a long time with a stranger communicating. Based on the data/studied reviewed the virus spreads through air/droplets from an infected person. Overtime the more the infected person speaks/breathes in an enclosed area the greater the viral load. It requires a certain amount of viral load to infect you. The healthier you are the higher the viral load you can take. Any action that reduces viral load will shift the odds in your favor. Viral load can be considered as a pollutant in the air. As with all pollutants the goal does not have to be zero it just has to be small enough to not impact you. Dilution is the key to pollution mitigation – this is why being outside in a breeze works and is effective and why we have not seen any study or documentation showing an outbreak from an outside event. Fresh air HVAC units are available along with UV filtration and advance filters to capture particles as small as viruses.

Brazil up another 1220. Not to be lose is their confirmations have also been up. Current fatality rate sits under 4% – slightly better than the US. US death up 990 with 63K confirmed increase.

CA lead the way in deaths at 141 and TX second at 131. Texas lead in confirmation at 11.6K

LA and Maricopa and Miami led the way in deaths the CA, AZ, and FL as expected. Hidalgo county surprisingly lead the way in deaths in TX – https://www.themonitor.com/2020/07/09/covid-19-death-toll-sees-sharp-rise-20-people-die-hidalgo-county/

“The individuals who died, according to a county news release, resided in Alamo, Edinburg, Hidalgo, McAllen, Mission, Pharr, San Juan and Weslaco. Ages ranged from their 20s to over 70.”

Interesting that Maricopa and LA are converging in confirmation per capita around 6%. They do have a large difference in fatality rate 1.4% (Maricopa) vs 3% for LA. Maricopa and LA has tested around 12% per capita. Miami-Dade has tested 15% per capita. Harris county has only tested 8% per capita.

Miami-Dade is so much better than LA and Maricopa – why is that? They are older have lower income has more population than Maricopa – uses more public transport than both LA and Miami. My hypothesis is the general public is more outside than those in LA and Maricopa. Miami folks go hang out at the beach. I need to find a stat to prove that.

Kazakhstan is in red below and you can see their deaths are rising along with confirmations.

Not worth the gamble in getting covid if you can avoid it. On social media we see many stories of recovered but higher heart rates – but could be anxiety given all the news. This study highlights neurological issues – https://academic.oup.com/brain/article/doi/10.1093/brain/awaa240/5868408

“The high incidence of acute disseminated encephalomyelitis, particularly with haemorrhagic

change, is striking. This complication was not related to the severity of the respiratory

COVID-19 disease. Early recognition, investigation and management of COVID-19-related

neurological disease is challenging.”

The only positive in the report if you read the details these impacts are usually found in the elder patients 50+.

For some good news Harris County/Houston area saw its first day in 9 days where the ICU beds availability increased…and no it did not come with a spike in deaths.

Still its only 1 data point

Confirmations did dip for two days straight now.

Brazil continues to lead in deaths at 1223. US under 1K at 820

California lead the way in deaths at 145

California deaths mainly from LA. Same counties are the leaders in confirmations – LA, Harris, Maricopa, and Miami

Still no big jump in deaths

To put them into perspective – our chart ordered by confirmation per capita for all counties with greater than 500 confirmed. As we noted before in our other report the bookends Trousdale due to a prison and Clark due to very little testing.

Good news many not growing in deaths (Columbia slowly climbing)– but bad news many countries have been not declining but just holding steady with so many days e.g. Russia, India

Ignorance is bliss.

Bad news day….

I reached out to the team maintaining the Texas data site to understand the confirmation.

So we would only report one positive per person, and do not have any documented cases of reinfection in the state. However, one person could be responsible for multiple negative tests.

Matt

Matt Turner, PhD, MPH

Agency Analytics Unit

Center for Health Statistics

DSHS

This makes the data even worse as the infection rate is likely higher since multiple negative test.

This study is confirming what the data has been saying and seems to show covid-19 is a force to be reckon with – https://wwwnc.cdc.gov/eid/article/26/9/20-1806_article

“our findings suggest retained infectivity and virion integrity for up to 16 hours in respirable-sized aerosols.”

The only positive light perhaps is –

“No ultraviolet light source was used within the cavity of the drum during suspensions.”

Now they need to run it with UV to prove UV install is a mechanical solution to reduce viral load – I am quite positive it will show that.

Well the Brazilian President Jair Bolsonaro now has tested positive – https://www.npr.org/sections/coronavirus-live-updates/2020/07/07/888137097/brazilian-president-jair-bolsonaro-tests-positive-for-coronavirus

Well he better hope HCQ treatment will work for him. It is a shame the anti-mask stance.

Study after study – along with just plain LOGIC is not working….VIRAL LOAD is key – reduce viral load reduce chance to getting it….put something in front of your inhalation it will reduce viral load perhaps not much but it WILL….it WILL also reduce viral load you introduce into the environment. AT least 1 in 3 are asymptomatic so you CAN be perfectly healthy and be a carrier AND it can sustain for MONTHS (not highly probable – but documented). As they said in the Hunger Games – “Happy Hunger Games, and may the odds be ever in your favor.” If you put the mask on it will push the odds to your favor for you and your love ones. This thing is not mainly spreading through strangers as you don’t socialize with strangers that long. Ventilate your home with fresh air. Clear the air in your home. Dilution is the solution to pollution! Exercise – eat healthy – push the odd in your favor.

I had to search for some good news – https://www.news-medical.net/news/20200707/Asthma-inhalers-being-trialed-for-treatment-of-COVID-19.aspx

“Studies have shown that some corticosteroids, such as dexamethasone, could reduce the inflammation of the respiratory tract in these patients and benefit them by alleviating the symptoms of severe disease.

Researchers in this new trial are studying if the steroid inhalers used for reducing the exacerbations of asthma could be useful for patients with early COVID-19 and reduce their risk of severe disease.”

“Lead researcher on this team Dan Nicolau, an associate professor at QUT, explained that the asthmatics and those with chronic lung disease and chronic obstructive pulmonary disease (COPD) were on regular inhaler therapy with corticosteroids, were found to have a lesser risk of severe illness in the early phase of the pandemic. He said that this was paradoxical because those with long term lung disease were initially considered to be at a higher risk of a respiratory viral infection such as SARS-CoV-2”

“If successful, Budesonide inhaler therapy could be a low cost and readily available therapy for early COVID-19 patients. It would reduce their risk of getting severe respiratory complications, Nicolau said.”

Well back to large death numbers Brazil 1254 US 1195

New leaderboard in death for US – Illinois 247. Same top 3 confirmations state CA, TX, and FL

Same counties LA, Maricopa, Harris, and Miami-Dade leading confirmation. 210 IL death reported yesterday were unassigned to a county – perhaps revision or data issue.

Death are still slow relative to the confirmation rates in these counties.

Another 1535 in Harris county – ICU beds availability decline 36 to 118 Hospitalized went up 43 2656….43/1535=3% going to hospital per confirmed. Beds will be filled testing another 2121/.03/.135(positivity rate)=524K. ICU beds are the bigger constraint.

Bad News chart – scary ramp in ICU beds for Covid

Zoom up and linear regression – beds will fill in a week – 874 max bed per available 118

IF this is the case then in a week we should see an increase in deaths as ICU beds fill and then decision to put in ICU will be more judicious which would likely lead to deaths unless over prescribing ICU right now.

Its just the data here – I hate to be the bearer of this news. Lets hope something is wrong with the data.

Very interesting study – holding many key takeaways – https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31483-5/fulltext

“In April, 2020, the Spanish Ministry of Health and the Institute of Health Carlos III, in collaboration with the health services of the Spanish regions (Autonomous Communities), launched ENE-COVID, a nationwide, population-based, longitudinal seroepidemiological study, to quantify the extent of SARS-CoV-2 circulation throughout the country. The study included more than 61 000 individuals from randomly selected households; was designed to be representative by province, age group, and sex; and used two tests for the determination of SARS-CoV-2 antibodies. Here, we describe the study design and the results of the first wave of the study, conducted between April 27 and May 11, 2020”

“Despite the high impact of COVID-19 in Spain, prevalence estimates remain low and are clearly insufficient to provide herd immunity. This cannot be achieved without accepting the collateral damage of many deaths in the susceptible population and overburdening of health systems. In this situation, social distance measures and efforts to identify and isolate new cases and their contacts are imperative for future epidemic control.”

The big headline conclusion will be herd immunity will not likely be achievable without more collateral deaths– however I think the other takeaways are just as profound if not more.

“One in three infections seems to be asymptomatic”

“Our results confirm that close contact with people with COVID-19, and particularly those in the same household, increases viral transmission. Appropriate quarantine and separation from other household members can be particularly challenging and not realistic in urban areas and less affluent scenarios. While mass quarantine during the lockdown would reduce the number of potentially infective contacts, it would also increase the transmission of the virus in a confined space, as a recent simulation study has suggested.26”

The above cannot be stressed enough – IF you open economy then infection rise – then you quarantine – household will likely get infected as being indoor as viral load rises is the worse situation to be in. Family/Friends is a main driver for infections not the random stranger you passed by walking in park or grocery store. A long conversation chatting in a room with no fresh air builds viral load.

“We found no differences in seroprevalence between females and males”

“For the few patients who do not develop antibodies against SARS-CoV-2, it is unknown whether they are susceptible to reinfection.29, 31, 32 Prevalence in those participants reporting negative PCR was higher than in those without a PCR test, which might be explained by delayed PCR testing that yields a negative result or by imperfect sensitivity of PCR tests.33”

“One of the most practical conclusions from our survey is that, although the immunoassay had better performance features, our rapid point-of-care test yielded comparable epidemiological information while having a greater uptake, lower cost, and easier implementation. Thus, a high-performance point-of-care test could be a suitable option for large seroepidemiological studies.”

“a substantial number of symptomatic patients with COVID-19 did not undergo PCR testing. However, the fact that only 15·3–19·3% of symptomatic participants had antibodies against SARS-CoV-2 suggests that a sizable proportion of suspected cases might have symptoms not caused by this coronavirus.”

Harris county is reporting more confirmation (3668). There are few things we need to clarify/understand in the confirmation data. The data does not normalize for a person. I have seen multiple reports that employees are required to test 2 negative before coming back to work. Many people are testing positive and testing weekly to wait for the negative. IF someone takes a test each week for 2 weeks in a row somehow the data IF we are trying to track spread should not indicate that person is infected twice. IF more and more employees are requiring weekly testing you could be getting more on more positives as they wait to get 2 negatives in a row to go back to work. True it does grow in positive on a per person BUT if the person takes 14 days to switch to negative one could see 2X more than you think the second week as the volume of test grows. Hospitalization growth cannot be denied – nor can death but the confirmation seems to be conflated. Other rumors that have been discussed is people going to test and leave because took too long and then get news they got tested positive even though they did not get tested. Perhaps rumors to confuse the situation but if true that would be messed up.

From yesterday 212 more in hospitals in Harris county so 212/3668=6% requiring hospitalization…15/212= out of 5% in hospital 7% goes to ICU (0.4% confirms go to ICU) We could potentially take on another 34750 confirmation. This math doesn’t balance with discharge if any also assumes ALL ICU per Covid. IF this occurred we would be close to 2% of the country confirmed –NYC (2.5%).

As I have shown the county level holds the real data as statewide and country wide data is too diluted from the root of the problem. We see NYC is a complete outlier.

We can observe the recent rise and one could say it is from opening up economy to protest. However it could also be from temperatures driving people indoors and closing the windows. Below are HOURLY temps max for the day – so showing at some point AC is starting to kick in during the day. The higher the max the more hours the ac is likely on and you have closed up from the outside. NYC was closed in with heaters running in March – the rest of these areas had their windows open and they were going outside. And now we have a role reversal. My southern friends seem to not to be handle the heat and close up their house and stay inside – if an infected person is over (1 in 3 asymptomatic) and you end up chatting for a few hours eventually viral load will be high enough for infection. Each region I am sure have different thresholds and that going to the beach in the 80’s in Miami is probably okay – but once over 90’s perhaps its time to stay in.

Not a bad death day reporting no country over 1K

CA leads death at 68. TX leads confirmation at 10.7K

Harris county TX leads in confirmation for the country

Mexico fatality rate is dropping now – hopefully will be with the rest of the pack. US almost at 1% of population confirmed.

The business of hospitals – as they say in many cases just follow the money if you want to understand what is going on – not sure on his premise and conclusions but it does bring into question how all this money is being managed – https://www.usatoday.com/story/opinion/2020/07/05/coronavirus-hospitals-businesses-public-option-health-care-column/3266503001/

With that in mind I am trying to understand what is going on in Harris County TX. Lots of things are not adding up. AT THE VERY LEAST I can conclude we are not NY in terms of extent and issue.

Below is NY hospital metric and you can see NY surge in confirmation was at very small test levels and that immediately corresponded with hospital increases and deaths. Deaths were not delayed less than a week in terms of hospital peak. In fact fatality rates were rising in NY in the beginning. Positivity rate reached 50% in beginning (April 3rd).

Compare this with TX data so far https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/0d8bdf9be927459d9cb11b9eaef6101f

Increase hospital visits from under 2K in beginning of June to now 8K

TX is not behaving at all like NY. Confirmations rising but deaths are range bound. Fatality rate is dropping. Positivity rate is increasing to now under 15%. Surge in positivity started mid June. I am not sure if we changed testing method or availability or even financial incentives – it is coincided with more testing. How are everyone being paid? – how is the contract tracer being paid? – how is the testing labs being paid? – what is the process with a positive vs. negative? What one cant deny is the admission to hospital – this growing number is a concern. What are these patients doing? How long? What treatment? Demographics?

The other thing we cant deny is the limited deaths – is this just a delay? Do we have better treatment? Are they being admitted when they really should just be sent home?

Currently Harris County – Area Q seems to be in ample situation in terms of hospital beds and ICU. IF we assume some historical data we have seen around 5% of hospital admission gets to ICU stage – this puts total for Harris at 122 vs. 139 available (and this assumes 139 is static).

Harris county is starting to see a drop in rate of confirmations. Harris county is sitting at 0.8% confirmed per capita. I still think something is not adding up.

US deaths only 271 – but confirmations continue to soar

CA and FL lead the pack in confirmation – NY leads in death at 49

Same counties

Nothing note worthy (different – still bad for the same cohorts) on the global pic.

We are living in a world where we have lost the rationale as individuals and need a study/experts to tell us what is in our face. Who would have thought drunk people couldn’t socially distance and make rational decisions – https://www.theguardian.com/world/2020/jul/05/crystal-clear-drunk-people-cant-socially-distance-say-police-in-england

As I have been noting the data for quite some time has been saying aerosols are a concern – not sure the nuance on wording from WHO but don’t stay in a non ventilated room with people for an extended amount of time (minutes). Once again you don’t need an expert or some advance study to know this to save yourself – https://www.smh.com.au/world/north-america/serious-threat-scientists-say-who-ignores-aerosol-risk-of-coronavirus-20200705-p5595g.html

Even though the data shows a healthy individual will not likely die – I wouldn’t want to get sick just as much I avoid the flu each season. I don’t think I want to get covid IF I can avoid it within reasonable actions. The unknown and the reporting of longterm impact is scary. However I need to temper my fear knowing the media feeds fear. How many are really in this undesirable club of long-term impact? I also know people before Covid that had unexplainable sickness now Covid is a great place to drop all those unexplainable health issues – https://www.theatlantic.com/health/archive/2020/06/covid-19-coronavirus-longterm-symptoms-months/612679/

Another awful unintended consequence of lockdown/covid – https://science.sciencemag.org/content/368/6497/1290.full?utm_medium=twitter&utm_source=dlvr.it

“Cancer is a complex set of diseases whose prognoses are influenced by the timing of diagnosis and intervention. In general, the earlier one receives cancer treatment, the better the results. There already has been a steep drop in cancer diagnoses in the United States since the start of the pandemic, but there is no reason to believe the actual incidence of cancer has dropped. Cancers being missed now will still come to light eventually, but at a later stage (“upstaging”) and with worse prognoses. At many hospitals, so-called “elective” cancer treatments and surgeries have been deprioritized to preserve clinical capacity for COVID-19 patients. For example, some patients are receiving less intense chemotherapy and/or radiotherapy, and in other cases, patients’ operations to remove a newly detected tumor are being delayed. There can be no doubt that the COVID-19 pandemic is causing delayed diagnosis and suboptimal care for people with cancer.”

“ignoring life-threatening non–COVID-19 conditions such as cancer for too long may turn one public health crisis into many others.”

Brazil fixed their death reporting with a 2381 daily death reporting. US confirmation contine to rise 42k+

NJ lead the death at 25 – but the big headline will be FL confirm at 11.5K

County view it’s the usual suspect.

Brazil back up with the latest reporting for the 7 day moving average death chart

Happy Independence Day! “We’re going to live on! We’re going to survive!” Bill Pullman, a.k.a President Thomas J. Whitmore Independence Day (1996) — I think this is a better time to reference the movie.

Another retrospective study – but at least this time they looked at the combination proposed for a very long time by many of the proponents HCQ AND ZINC. – sorry no double blinded randomized trial of HCQ and zinc – Maybe someone will go ahead and pay for this study in the name of humanity! – https://www.preprints.org/manuscript/202007.0025/v1

“Conclusions: Risk stratification-based treatment of COVID-19 outpatients as early as

possible after symptom onset with the used triple therapy, including the combination of

zinc with low dose hydroxychloroquine, was associated with significantly less

hospitalizations and 5 times less all-cause deaths”

“There were no cardiac side effects.”

“This retrospective case series study analysed data from COVID-19 outpatients with

confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection

in a community in New York State, USA.”

“The author Roland Derwand is/was at the time of writing an employee of Alexion

Pharma Germany GmbH. His engagement and contribution to this study and

publication was private and independent from his employer. The author Martin Scholz

is/was at the time of writing External Senior Advisor for the company LEUKOCARE in

Munich, Germany, and is/was Manging Director at Starts- and -Ups Consulting,

Frankfurt, Germany. Vladmir Zelenko is/was general practitioner in New York State. All

three authors confirm that this article content has no conflict of interest”

Clearly a reporting issue as Brazil showed up with 0 deaths but 42k+ confirmation. US leads death “reporting” at 694 – but big news is the confirmation at 54K.

NY leads death at 73. Confirmation leaders FL, TX, AZ, CA

Most of the latest increases has been focused in the following counties: LA California, Maricopa AZ, Harris County TX, Miami-Dade Fl

There has been continued discussion that death is coming and that these counties represent another NYC. These statements seem to only be made to get clicks and not stated in any facts. I can say at the very least it is different this time compared to NYC. The chart below shows the peak in change of NYC confirmation was very close to the peak of change of death and that as confirmation grew death grew – there wasn’t a big delay. Also NYC numbers as I have noted many times are a complete outlier worldwide. LA is already at confirmation levels seen April 13th for NY – at that time NY deaths total 7349 vs. LA current total deaths at 3457. The testing pool is likely completely different than NYC and LA now. This has been an issue all along with testing/confirmation – it is a function of mechanics and people behavior and not very consistent across jurisdiction.

Colombia and Egypt are probably the new countries to watch as their deaths are steadily rising.

Perhaps good news and bad news depending on how you want to look at it as many things are now – https://www.spectator.co.uk/article/herd-immunity-may-only-need-a-10-per-cent-infection-rate

Article now notes herd immunity may not need to be so high as initially alluded at 60%. Still most countries are far away even at 10% unless you want to apply some number adjustments via extrapolation or educated guess in terms of pervasiveness of the virus. We certainly have pockets which one could deduce is at herd immunity e.g. NYC – but what about the outskirts and surrounding cities/states/etc…. Where do you draw the circle? In terms of countries that have the most knowledge on where they are the largest test per capita is right now Bahrain and Luxembourg both near 30% per capita. They are kind of like a tale of two countries. You have Luxembourg fatality rate being much higher than the common flu (2.5%) and then you have Bahrain who is at 0.3%. Bahrain is growing in confirmation whereas Luxembourg has been relatively flat for the last month. Still both are well below 10% confirmed. Researching Bahrain – they have some very common sense guidelines for business from barbers to transportation. They focus on ventilation and opening up windows. https://www.moh.gov.bh/COVID19/Infographic

But even with all that their confirmations are growing but they are managing to keep the death rate low.

How exactly did they keep the death rate so low – https://www.thestar.com.my/news/world/2020/03/25/covid-19-bahrain-one-of-the-first-in-the-world-to-use-hydroxychloroquine-for-treatment

“The Kingdom of Bahrain is one of the first in the world to administer hydroxychloroquine to treat active Covid-19 cases, says the country’s Supreme Council of Health chairman Lieutenant-General Dr Shaikh Mohamed Abdullah Al Khalifa.

The Bahrain News Agency (BNA) quoted Dr Shaikh Mohamed, who is also the National Taskforce for Combating Covid-19 head, as revealing the information on Tuesday (March 24).

According to the news report, the drug is reported to have had a profound impact when used to treat the symptoms exhibited by active Covid-19 cases.

Bahrain first used the drug on Feb 26, following the registration of its first Covid-19 case on Feb 24.”

As with research you start looking into things and it takes you in a different path than you intended. I was really trying to get a handle on herd immunity and seeing which countries could be there and how far away we are from that. Only to end up examining Bahrain amazing job in death rate in face of increasing confirmations whereas Luxembourg was the opposite.

Luxembourg is following the WHO directives – https://msan.gouvernement.lu/en/dossiers/2020/corona-virus.html

“There is no specific treatment at this time, although research is ongoing. The treatment is therefore mainly symptomatic, i.e. it is similar to the treatment for a cough, respiratory problems or high temperature.”

“The World Health Organization (WHO) recommends that no medications, including antibiotics, should be self-medicated to prevent or cure COVID-19.”

Ok well good luck with that advice…just the numbers here…..If you are around someone with Covid or initially getting symptoms of covid AND you don’t have any heart conditions I really don’t see why one wouldn’t take HCQ with Zinc. Waiting for the “experts” to tell you something while we see in our faces there is potentially life-saving value and limited downside (cost and severity of side effects) it is a no brainer in mind. Someone/some entity should be accountable for the lives not saved due to poor advice – worse yet and hopefully not – due to improper incentives vs. being ignorant.

With that I will move on to this paper – https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext

“In this multi-hospital assessment, when controlling for COVID-19 risk factors, treatment with hydroxychloroquine alone and in combination with azithromycin was associated with reduction in COVID-19 associated mortality. Prospective trials are needed to examine this impact.”

“This is a comparative retrospective cohort study evaluating clinical outcomes of all consecutive patients hospitalized at the Henry Ford Health System (HFHS) in Southeast Michigan being treated for COVID-19.”

“Overall crude mortality rates were 18.1% in the entire cohort, 13.5% in the hydroxychloroquine alone group, 20.1% among those receiving hydroxychloroquine + azithromycin, 22.4% among the azithromycin alone group, and 26.4% for neither drug (p < 0.001)”

“A review of our COVID-19 mortality data demonstrated no major cardiac arrhythmias; specifically, no torsades de pointes that has been observed with hydroxychloroquine treatment.”

Mutation for Covid is confirmed – good news it is just as equal in severity – bad news its more contagious – https://www.cell.com/action/showPdf?pii=S0092-8674%2820%2930820-5

This could push us to herd immunity.

“G614 is associated with potentially higher viral loads in COVID-19 patients but not with

disease severity.”

“G614 is associated with higher infectious titers of spike-pseudotyped virus”

“Our data show that over the course of one month, the variant carrying the D614G Spike mutation

became the globally dominant form of SARS-CoV-2.”

“Our global tracking data show that the G614 variant in Spike has spread faster than D614. We

interpret this to mean that the virus is likely to be more infectious, a hypothesis consistent with the

higher infectivity observed with G614 Spike-pseudotyped viruses we observed in vitro (Fig. 6), and

the G614 variant association with higher patient Ct values, indicative of potentially higher in vivo viral

loads (Fig. 5). Interestingly, we did not find evidence of G614 impact on disease severity; i.e., it was

not significantly associated with hospitalization status”

Brazil continue to lead in deaths – but also very high confirmations keeping the fatality rate still rather decent. Also note they are treating with HCQ whereas Mexico is following WHO directive. Big headlines is US confirmations at 53.6K. US deaths are not too bad at 678 compared to confirmation. Looks like a data issue with UK – I will need to look into in terms of confirmation.

The big states confirming FL, CA, TX, GA

Those states they have been ramping up testing. AZ is now confirming over 1% – other states still very far behind the reality of how many do have covid. Therefore there will be confirming a certain segment that does already have it. The rates for confirmation per test have been rising for all states more so in AZ.

County view it’s the same cohorts discussed before Miami Dade leads FL, Harris County leads TX, Maricopa leads AZ, and LA leads CA. So far no alarming death increases.

US is back down on its 7 day moving avg death. Italy has a had bit of resurgence in death. India and Russia has been on a plateau for awhile.

Even Sweden in their approach still confirming per capita less than 1%. There is a case that so much testing may be a poor capital allocation – depenind on cost of testing and the use of the data.

A global summary US does lead in deaths and confirmation. But our fatality rate is not the highest. We have tested on a per capita basis more than most countries. We therefore do have one of the highest confirmation per capita in the world – but yet that still sits at less than 1%.

This just might flip the whole covid thoughts upside down – https://wwwnc.cdc.gov/eid/article/26/9/20-1798_article?deliveryName=USCDC_333-DM32083

They show potentially how a single asymptomatic carrier spread covid throughout the community impacting 71 positive cases while still being asymptomatic 1+ month later!

The figure is very interesting and certainly a lot of work would have to be done in order to fill the figure out. There are some big questions left answered from the 2 negative test of patient A0 on March 31 and April 3 – only later on April 11th tested positive. Also to note the Chinese investigators conclude A0 as source and so happened to have traveled to US and arrived March 19 – where in the US?

They have come to conclusion it is by touch – but that is not necessarily clear.

“Patient B1.1 was the downstairs neighbor of case-patient A0. They used the same elevator in the building but not at the same time and did not have close contact otherwise.”

“we believe A0 was an asymptomatic carrier (7,8) and that B1.1 was infected by contact with surfaces in the elevator in the building where they both lived (9).”

IF it was from touch then why not more – could it be A0 was singing or sneezing or coughing and then B1.1 went in. IF from touch could it be that the virus has mutated to be different than the Restaurant, Gym, and Office building studies where no/minimal ancillary person to the events got sick.

The proof or substance that this had to be A0 who came from the US/abroad is the genome –

“The viral genome sequences from the cluster were distinct from the viral genomes previously circulating in China, indicating the virus originated abroad (10) and suggesting case A0 was the origin of infection for this cluster.”

What are at least the facts – Covid can spread and spread efficiently. Perhaps from surfaces perhaps from respiratory (I am still leaning towards that but a mutation certainly is possible). Covid can kill you as a result of your body response to covid. IF you are healthy you can beat covid – healthy is a person who has one or less comorbidity (heart issue, obesity, immune deficient, diabetes). You can get sick even if healthy but it wont likely kill you. SOME do experience longterm issues. Use your quarantine time to get healthy.

Viral load is the key. You will come across covid there is no doubt. It is about keeping the covid levels low so you don’t get infected. Your body can fight off covid at certain levels. Mask even not perfect will reduce viral load for both parties at least in terms of circulation in the air. Not being around people reduces viral load. Being outdoors with breeze reduces viral load. Indoors/car with air just being recirculated with an infected individual will increase viral load – the longer the time the increase viral load.

Study to support opening up of gyms – https://www.medrxiv.org/content/10.1101/2020.06.24.20138768v2.full.pdf

“Conclusions: Provided good hygiene and social distancing measures, there was no increased

COVID-19 spread at training facilities.”

Perhaps people who exercise do a better job of fighting of infection? And/or they did self-select so no one who had comorbidities were allowed to be a part of the study. So only healthy people can go to the gym?

The unintended consequences of quarantine – https://www.washingtonpost.com/health/2020/07/01/coronavirus-drug-overdose/#click=https://t.co/OghOpWfme9

“Suspected overdoses nationally — not all of them fatal — jumped 18 percent in March compared with last year, 29 percent in April and 42 percent in May, according to the Overdose Detection Mapping Application Program, a federal initiative that collects data from ambulance teams, hospitals and police. In some jurisdictions, such as Milwaukee County, dispatch calls for overdoses have increased more than 50 percent.”

“As the pandemic has pushed massive doses of fear, uncertainty, anxiety and depression into people’s lives, it has cut off the human connections that help ease those burdens.”

“Research has established strong links between stagnating economies and increases in suicides, drug use and overdoses. In recent years, economists Anne Case and Nobel Prize-winner Angus Deaton have dubbed such increasing fatalities in declining blue-collar communities “deaths of despair.”

“Many factors — not just job loss — trigger opioid use, said Alex Hollingsworth, a health economist at Indiana University. “Don’t use opioid deaths as a reason to reopen.””

Even though Brazil death continues to climb their fatality rate is much better than Mexico. Noted before Brazil went with HCQ treatment vs. Mexico following advice of WHO.

Texas shoots up in confirmation by over 9.3K. Metric to watch the next weeks are death and fatality rates for TX

Big jump in TX came in Bexar County – San Antonio region – https://www.expressnews.com/news/local/article/Bexar-County-reports-1-268-new-coronavirus-cases-15378030.php

“Statistics provided by the Metropolitan Health District painted a dire picture of the virus’ spread across San Antonio. On Tuesday, the number of COVID-19 patients in area hospitals rose to 966. That’s almost five times as many as two weeks ago and more than 10 times the number reported June 1.

The number of patients needing intensive care and ventilators soared again Tuesday, reaching 288 and 158, respectively. On June 1, just 39 patients were in intensive care and only 20 were on ventilators.”

“Nirenberg and Wolff tightened their emergency orders regarding masks. Those orders already mandate that businesses require employees and customers to wear face coverings in situations where maintaining a 6-foot distance from others is difficult.

Under changes announced Tuesday, businesses also must require employees and customers to answer questions about COVID-19 symptoms before entering. Businesses with “indoor facilities” — a category that includes gyms, restaurants, shops, supermarkets and many other establishments — also must check people’s temperatures.”

“One in every four admissions to San Antonio-area hospitals now stems from the novel coronavirus.”

Below is Harris and Bexar view we don’t necessarily have a forward view metric. We can see death relative to 2-4 weeks back seemed to be under check so far. Whether this latest blitz of confirmations lead to abnormal percentage of death cannot be ferreted out with data at hand. There are several people noting they need to get tested to come back to work and so this will drive more testing.

Where we do have hospital data we are not seeing a big increase in those confirmed going to the hospital which bodes well for recovery vs. death.

7 day Moving Average daily deaths is creeping back up for the US

I know many people don’t want to believe that covid is pervasive but the data has been indicating this for months as noted several times in the morning report. Once you accept that – then the more you test the more you will confirm – that’s a fact. It does not preclude that it is not still spreading but the testing – particularly the antibody test- DOES not mean covid is spreading more. CDC own estimates are now at 5-8% exposed – https://www.npr.org/sections/coronavirus-live-updates/2020/06/25/883520249/cdc-at-least-20-million-americans-have-had-coronavirus-heres-who-s-at-highest-ri

“To date, 2.3 million Americans have had confirmed coronavirus infections, but by the CDC’s estimates, the real number could be at least 20 million.”

“"In the beginning, there wasn’t a lot of testing that was done of younger, asymptomatic individuals," Redfield said. "So I think it’s important for us to realize that we probably recognized about 10% of the outbreak by the methods that we used to diagnose between the March, April and May."

Big news and headlines across country about how bad Houston confirmations are rising does not put it into context that confirmations are still at less than 1% of the population confirmed. IF the CDC is right then we will confirm ~200K more which is 7X where we are now if we continue to test – and that’s just math. The metric to watch is hospitalization and deaths.

Once again let me reiterate yesterday conclusion the big confirmations are function of US human behavior to rising temps – we all went inside closed windows and recirculated the air to the point viral load hit a level to infect people. This is why Seattle and San Fran didn’t see a big rise as per the southern states and cities. Closing beaches and parks do not make sense. Policing beaches and parks to have social distancing is okay but the same folks hanging together in beach likely to hang together inside a house which is worse. In fact lets put a mandate the human population from morning to midafternoon has to be outside and my hypothesis is that we will reduce the spread plus end up being healthier – https://academic.oup.com/jid/article/doi/10.1093/infdis/jiaa334/5856149

“While it has been reported previously that UVC can inactivate aerosolized coronaviruses

[33], the present study is the first to demonstrate that simulated sunlight, with UVA and UVB levels

similar to natural sunlight, is also able to inactivate airborne coronaviruses.”

Unfortunately for the south humidity really didn’t have an impact vs. sunlight

“present study suggest that any such effect (humidity) would be relatively minor in comparison to the effect of sunlight.”

Vitamin D – sunlight – https://www.qnis.org.uk/blog/covid-vitamin-d/

“Between April and September, the sun shining on the skin can form vitamin D. However, sunshine must be at a steep angle, usually around lunchtime, when your own shadow is shorter than your body length.”

“this vitamin plays a vital role in the regulation of both the innate and adaptive immune systems; boosts our virus-fighting cells; and, dampens down the harmful overreaction of inflammatory responses, such as cytokine storms”

There IS a mechanical solution without mandating people to be outside that can likely be just effective. Fresh air HVAC system along with UVC filtration system plus taking vitamin D will likely give you all the above.

Another pervasive spread evidence – https://www.nature.com/articles/s41586-020-2488-1

“42.5% (95% CI 31.5-54.6%) of the confirmed SARS-CoV-2 infections detected across the two surveys were asymptomatic (i.e. did not have symptoms at the time of swab testing and did not develop symptoms afterwards).”

“We found no statistically significant difference in the viral load of symptomatic versus asymptomatic infections (p-values 0.62 and 0.74 for E and RdRp genes, respectively, Exact Wilcoxon-Mann-Whitney test). This study sheds new light on the frequency of asymptomatic SARS-CoV-2 infection, their infectivity (as measured by the viral load) and provides new insights into its transmission dynamics and the efficacy of the implemented control measures.”

I have confirmed from people I know in the medical community that the recent surge in Houston was more hispanic – https://abc13.com/6286162/?

“Numbers reported from Harris County and Houston show at least 9,100 of the 30,729 positive cases are attributed to Hispanics. That is the highest number linked to a certain race or ethnicity in the area.

A new report from the CDC said Hispanics are four times more likely to need to be hospitalized because of the virus than a white, non-Hispanic person.

"If you look at death rates, 37 percent, so a little more than one out of three deaths, are from Hispanics, but they only represent 18 percent of the population so they are over represented in deaths as well," Catherine Troisi, an infectious disease epidemiologist with UTHealth said.

“"They may be more likely to live in multi-generational households, so higher population and older seniors who would be at higher risk if they got infected," Troisi said.

She said that Hispanic and Latin people are predisposed to underlying health inequities.

"Like diabetes, which is higher among the Hispanic population, and we know that is a risk factor," Troisi said.

Several experts pointed out that Hispanics are typically falling under the "essential worker" category and have not been able to isolate throughout the pandemic.”

Good news! Go T-Cells! – https://medicalxpress.com/news/2020-06-immunity-covid-higher-shown.html

“New research from Karolinska Institutet and Karolinska University Hospital shows that many people with mild or asymptomatic COVID-19 demonstrate so-called T-cell-mediated immunity to the new coronavirus, even if they have not tested positively for antibodies”

“"Advanced analyses have now enabled us to map in detail the T-cell response during and after a COVID-19 infection. Our results indicate that roughly twice as many people have developed T-cell immunity compared with those who we can detect antibodies in."”

"Our results indicate that public immunity to COVID-19 is probably significantly higher than antibody tests have suggested," says Professor Hans-Gustaf Ljunggren at the Center for Infectious Medicine, Karolinska Institutet, and co-senior author. "If this is the case, it is of course very good news from a public health perspective."

T-cell analyses are more complicated to perform than antibody tests and at present are therefore only done in specialized laboratories, such as that at the Center for Infectious Medicine at Karolinska Institutet.

"Larger and more longitudinal studies must now be done on both T cells and antibodies to understand how long-lasting the immunity is and how these different components of COVID-19 immunity are related," says Marcus Buggert.

Brazil and US making up for the weekend lull both over 1K deaths

Wow didn’t expect this NY surge to the leader board in the US at 629 deaths. Several days reports celebrating NY low death numbers. I did a quick search and did not find any revision notice.

Almost all of NY deaths in NY city 626

Harris county view – lets see what it looks like in two weeks right now fatality rate dropping to 1.2%

Hospitalization rates are still low for AZ and FL

Latest surge puts Brazil out of the decline curve