Why did I not report on Moderna results – here is a very well written response – https://www.independent.co.uk/voices/coronavirus-vaccine-covid-19-cure-doctor-moderna-novavax-oxford-a9523091.html

“77 percent of vaccines for infectious diseases make it through Phase I, but only 33 percent make it through the entire process overall.”

“45 patients who received the vaccine, the data on “neutralising antibody data are available only for the first four participants in each of the 25-microgram and 100-microgram dose level cohorts.” In other words, that means that when it comes to finding out whether the vaccine elicits an antibody response that could potentially fight the coronavirus, they only had data on eight patients.”

“the only data Moderna alluded to were from mice. Not only are there huge differences between mice and men, but history also proves that success in animal models is often not replicated in human studies. This is especially the case for Moderna’s messenger RNA vaccine, which would be the world’s first to ever reach the market if it passes clinical trials.”

“In many ways, the vaccine almost behaves like an RNA virus itself except that it hijacks your cells to produce the parts of the virus, like the spike protein, rather than the whole virus. Some messenger RNA vaccines are even self-amplifying. That means they encode not only the protein antigen of interest to elicit an immune response but also produce their own RNA dependent RNA polymerase, so that they can force the cell to replicate more copies of it. At that point, it will be hard to convince conspiracy theorists and anti-vaxxers that a self-amplifying messenger RNA vaccine is not an artificially created self-replicating virus. In fact, public acceptance of this new paradigm is not something to be easily dismissed nor taken for granted. There are unique and unknown risks to messenger RNA vaccines, including the possibility that they generate strong type I interferon responses that could lead to inflammation and autoimmune conditions.”

“Let’s base our excitement and exuberance on the actual facts and evidence and data rather than our labile emotions and feelings. We are all in this together, and that includes poor people in America and poor people in poor countries around the world who deserve an eventual coronavirus vaccine that is safe, effective, and — last but not least — affordable.”

A US micro study – Arkansas Church event – https://www.cdc.gov/mmwr/volumes/69/wr/mm6920e2.htm?s_cid=mm6920e2_w

Nothing earth shattering that the other micro studies didn’t note. Indoor prolong gathering with likely simple ventilation – very unfortunate they didn’t delve into this – is not a good decision to protect against infection. Indoors poor ventilation creates a perfect breeding ground for the virus.

“Among 92 attendees at a rural Arkansas church during March 6–11, 35 (38%) developed laboratory-confirmed COVID-19, and three persons died. Highest attack rates were in persons aged 19–64 years (59%) and ≥65 years (50%). An additional 26 cases linked to the church occurred in the community, including one death.”

“as of April 22, 61 confirmed cases (including eight [13%] hospitalizations and four [7%] deaths) had been identified in persons directly and indirectly associated with church A events.”

The conclusion shouldn’t be to end practices like this – it should be to question how to make it better. How to make it like a 14 hour flight so no one gets impacted (yesterday note). I suspect this can be solved with a modern fresh air HVAC unit with UV filtration system AND better practice of social distancing and wearing mask.

Another antibody test indicating infection rate of general public 4% – LA County – https://jamanetwork.com/journals/jama/fullarticle/2766367

“In this community seroprevalence study in Los Angeles County, the prevalence of antibodies to SARS-CoV-2 was 4.65%. The estimate implies that approximately 367 000 adults had SARS-CoV-2 antibodies, which is substantially greater than the 8430 cumulative number of confirmed infections in the county on April 10.3 Therefore, fatality rates based on confirmed cases may be higher than rates based on number of infections. In addition, contact tracing methods to limit the spread of infection will face considerable challenges.”

The percentage is too high to think you can contain it is the perspective I have been having for quite some time. The prevalence means Sweden approach may be the wises in the long run unless we come up with a treatment plan or vaccine in less than 6 months.

When will the media learn to not jump on subject matters they know little about or at the VERY LEAST just report don’t add bias…. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162746/

Reporting FDA says a drug could be harmful is not reporting – ALL drugs even vitamins can be harmful – it’s the probability of harm they should note – that’s reporting….

Will they apologize for delaying research or causing deaths which perhaps could be preventive? AND for what to make fun of a person they don’t like – why be so childish and promote a person you don’t like?

“We implemented PEP with HCQ safely under proper monitoring and no patients were diagnosed with COVID-19 additionally. Randomized clinical studies are needed to evaluate if PEP is an effective option for outbreak response against COVID-19 in LTCHs.”

“Long-term care hospitals (LTCHs) are vulnerable to cluster outbreaks. Because patients in LTCHs need continuous intimate cares, it is difficult to find facilities and healthcare personnel for their separate isolation care in a large outbreak situation. Furthermore, they are the risk group if infected. Although several drugs have been proposed as treatment regimens, there are no data on the effectiveness and safety of post-exposure prophylaxis (PEP) for COVID-19. On February 23, a hospital social worker at a LTCH in Busan was diagnosed with COVID-19 after attending a religious service of Shincheonji 7 days earlier and inpatients and hospital staff were exposed to her. We are sharing our experience of the outbreak response in the LTCH including PEP using hydroxychloroquine (HCQ).”

“We started PEP with HCQ for patients and careworkers, on February 26 (Supplement Fig. 1). Physicians and pharmacists were educated about potential adverse events. HCQ was administrated orally at a dose of 400mg daily until the completion of 14 days of quarantine. A checklist for common adverse events was distributed (Supplement Fig. 2). The study was approved and informed consent was waived by the Institutional Review Board of Pusan National University Hospital (H-2003-014-089).”

“Postmortem PCR tests with URT specimens were performed for 2 patients who died during quarantine period and the results were negative. Two mortality cases, a 96 years old male and an 84 years old female with Alzheimer disease, had been receiving the end of life cares. For the remaining 191 patients and 121 hospital staff who had been tested negative first for COVID-19, follow-up PCR tests were conducted one or two days prior to discontinuing 2 week-period of quarantine and all were negative.”

Not to claim this as a solution for all – but to deny this option with generally a limited COST (both in terms of $ and adverse reaction) would be negligent. From Dr. Kory testimony – https://www.hsgac.senate.gov/imo/media/doc/Testimony-Kory-2020-05-06-REVISED.pdf:

“1- The Declaration of Geneva of the WMA binds the physician with the words, “The health of my

patient will be my first consideration,”

2- International Code of Medical Ethics declares that, “A physician shall act in the patient’s best

interest when providing medical care.”

3- Article 37 of the WMA declaration of Helsinki, titled: “Unproven Interventions in Clinical Practice”

It reads, and I paraphrase: “In the treatment of an individual patient, where proven interventions do

not exist, a physician may use an unproven intervention if in the physician’s judgement it offers hope

of saving life, re-establishing health or alleviating suffering.”

Wear the mask in social settings indoor…. https://fightcovid19.hku.hk/hku-hamster-research-shows-masks-effective-in-preventing-covid-19-transmission/

“In the first experiment, no surgical masks were placed between the two cages. In the second one, a surgical mask was placed closer to the healthy hamsters. In the third experiment, the mask was placed closer to the infected, as if the healthy ones or the infected were wearing masks.

With no partition in between the cages, two-thirds of the healthy hamsters were infected a week later. In the following two experiments with masks in between, the infection rates were lowered to one-third and one-sixth respectively.”

Well the good times end – with US deaths back up 1574 – and Brazil not far behind 1130

NY leading the way at 219

On a county level NY is not sticking out relative to Los Angeles County CA and Cook County IL.

Looks like a revision to France.

Brazil is still growing in death rate. Mexico perhaps is flattening out.

Today there is a plenty of good news – so buckle up and enjoy the update.

Clearly politics is so much more involved than it needs to be – case in point is the reporting on HCQ. So many media reports are noting HCQ as dangerous and fatal drug….relative to other drugs it is well known drug used for decades to treat malaria and lupus – the side effects and who should use it is well known so its danger is being exaggerated in the press. The other hilarious connection is there is some big money grab made by Trump – HCQ is manufactured by over 11 companies – it is generic drug! And Zinc well its like vitamin C….IF he really wanted to make money go pick a drug that is patented. Can we really hate someone so much we would spite our own self and society?

Good news – https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v1.full.pdf

“Conclusion: This study provides the first in vivo evidence that zinc sulfate in

combination with hydroxychloroquine may play a role in therapeutic management for

COVID-19.”

Same critique as the other HCQ study – this is statistical review not a study. HOWEVER unlike the other ones this one did include and focused on the addition of zinc which is what the doctors in France was noting.

“The addition of zinc sulfate did not impact the length of hospitalization,

duration of ventilation, or ICU duration. In univariate analyses, zinc sulfate

increased the frequency of patients being discharged home, and decreased the need

for ventilation, admission to the ICU, and mortality or transfer to hospice for patients

who were never admitted to the ICU. After adjusting for the time at which zinc sulfate

was added to our protocol, an increased frequency of being discharged home (OR 1.53,

95% CI 1.12-2.09) reduction in mortality or transfer to hospice remained significant (OR

0.449, 95% CI 0.271-0.744).”

Perhaps plane travel is “safe”. This study shows many long flights taken by sick people but they don’t highlight any significant spread in the plane unlike restaurant, gym, or office studies. Is it because the plane is relatively “safe” or was they didn’t study it hard enough? I am going to be optimistic and hope its because it is safe. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30314-5/fulltext

“Patient 0, who was an employee of the Chinese branch of a German company based in greater Munich, travelled from Shanghai to Munich by aeroplane on Jan 19, 2020, to facilitate workshops and attend meetings in the company building. The day after arrival (Jan 20, 2020), patient 0 felt chest and back aches—which she reported to be unusual—and took a single dose of medicine containing paracetamol. The patient reported fatigue during her whole stay in Germany and attributed the symptom to jetlag. After an overnight flight back to Shanghai on Jan 22, the patient felt feverish. With a self-measured temperature of 38·6°C and cough on Jan 24, the patient visited a physician’s office on Jan 25. The patient tested positive for SARS-CoV-2 on Jan 26 and was hospitalised the next day. The clinical situation in both parents also deteriorated during the primary case’s stay in Germany and both were laboratory-confirmed with COVID-19 later.7 The German company was informed of the primary case’s infection in the morning of Jan 27, 2020, and immediately informed its employees as well as the local health authority.”

“A Chinese colleague (patient 13) of patient 0 accompanied them in multiple activities while in Germany. Patient 13 travelled back to China with patient 0, developed symptoms on Jan 27, and tested SARS-CoV-2 positive a few days later.”

“Patient 12 departed for vacation to Spain 3 days later (Jan 28). After Spanish authorities were informed, patient 12 was isolated in hospital on Jan 30 and diagnosed with COVID-19.”

“Extensive contact tracing involved the international flights from Munich to Shanghai (patient 0 on Jan 22, 2020) and from Munich to Tenerife (patient 12 on Jan 28, 2020). As of May 2, no further cases have been identified among flight passengers or other (personal) contacts.”

I would really like more details on the flight HVAC system. Clearly IF airline trip for 14h and 15 min travel time in an enclosed environment can contain the virus from not spreading compared to the restaurant, gym, and office building that has been highlighted – we need to replicate this!

Here is an interesting approach – a quasi treatment/vaccine – https://www.france24.com/en/20200519-scientists-in-china-believe-new-drug-can-stop-pandemic-without-vaccine

“A drug being tested by scientists at China’s prestigious Peking University could not only shorten the recovery time for those infected, but even offer short-term immunity from the virus, researchers say.”

“"When we injected neutralising antibodies into infected mice, after five days the viral load was reduced by a factor of 2,500," said Xie.

"That means this potential drug has (a) therapeutic effect."

The drug uses neutralising antibodies — produced by the human immune system to prevent the virus infecting cells — which Xie’s team isolated from the blood of 60 recovered patients.

A study on the team’s research, published Sunday in the scientific journal Cell, suggests that using the antibodies provides a potential "cure" for the disease and shortens recovery time.

Xie said his team had been working "day and night" searching for the antibody.

"Our expertise is single-cell genomics rather than immunology or virology. When we realised that the single-cell genomic approach can effectively find the neutralising antibody we were thrilled."

He added that the drug should be ready for use later this year and in time for any potential winter outbreak of the virus, which has infected 4.8 million people around the world and killed more than 315,000.”

“Using antibodies in drug treatments is not a new approach, and it has been successful in treating several other viruses such as HIV, Ebola and Middle East Respiratory Syndrome (MERS).

Xie said his researchers had "an early start" since the outbreak started in China before spreading to other countries.”

Great news on the update US deaths still under 1K at 785. Brazil is not looking good at 735.

NY did lead the way for the US again but at amazingly low 107

County view still highlights Cook county IL being the concern along with Orange County CA. PA is starting to show deaths beyond Phil. Area – Berks county.

The states opening up are seeing drops in Death now – more surprisingly is the confirmation numbers are not rising.

Brazil is about to take over US as the leader in daily deaths. Russia continues to report confirmations but barely any deaths.

Brazil, Mexico, and India still rising in the 7 day MA daily death chart. Pakistan and Peru has been able to plateau.

Another great informative study from S. Korea – at a gym! – today TX opens up gyms – https://wwwnc.cdc.gov/eid/article/26/8/20-0633_article

“Vigorous exercise in confined spaces should be minimized during outbreaks.

…On February 25, a COVID-19 case was detected in Cheonan, a city ≈200 km from Daegu. In response, public health and government officials from Cheonan and South Chungcheong Province activated the emergency response system. We began active surveillance and focused on identifying possible COVID-19 cases and contacts. We interviewed consecutive confirmed cases and found all had participated in a fitness dance class. We traced contacts back to a nationwide fitness dance instructor workshop that was held on February 15 in Cheonan.

Fitness dance classes set to Latin rhythms have gained popularity in South Korea because of the high aerobic intensity (2). At the February 15 workshop, instructors trained intensely for 4 hours. Among 27 instructors who participated in the workshop, 8 had positive real-time reverse transcription PCR (RT-PCR) results for severe acute respiratory syndrome coronavirus 2, which causes COVID-19; 6 were from Cheonan and 1 was from Daegu, which had the most reported COVID-19 cases in South Korea. All were asymptomatic on the day of the workshop. By March 9, we identified 112 COVID-19 cases associated with fitness dance classes in 12 different sports facilities in Cheonan (Figure). All cases were confirmed by RT-PCR; 82 (73.2%) were symptomatic and 30 (26.8%) were asymptomatic at the time of laboratory confirmation. Instructors with very mild symptoms, such as coughs, taught classes for ≈1 week after attending the workshop (Appendix). The instructors and students met only during classes, which lasted for 50 minutes 2 times per week, and did not have contact outside of class. On average, students developed symptoms 3.5 days after participating in a fitness dance class (3). Most (50.9%) cases were the result of transmission from instructors to fitness class participants; 38 cases (33.9%) were in-family transmission from instructors and students; and 17 cases (15.2%) were from transmission during meetings with coworkers or acquaintances.

Among 54 fitness class students with confirmed COVID-19, the median age was 42, all were women, and 10 (18.5%) had preexisting medical conditions (Appendix Table 1). The most common symptom at the time of admission for isolation was cough in 44.4% (24/54) of cases; 17 (31.5%) case-patients had pneumonia. The median time to discharge or end of isolation was 27.6 (range 13–66) days after symptom onset.

Before sports facilities were closed, a total of 217 students were exposed in 12 facilities, an attack rate of 26.3% (95% CI 20.9%–32.5%) (Appendix Table 2). Including family and coworkers, transmissions from the instructors accounted for 63 cases (Appendix Figure 2). We followed up on 830 close contacts of fitness instructors and students and identified 34 cases of COVID-19, translating to a secondary attack rate of 4.10% (95% CI 2.95%–5.67%). We identified 418 close contacts of 34 tertiary transmissions before the quarantine and confirmed 10 quaternary cases from the tertiary cases, translating to a tertiary attack rate of 2.39% (95% CI 1.30%–4.35%).

The instructor from Daegu who attended the February 15 workshop had symptoms develop on February 18 and might have been presymptomatic during the workshop. Evidence of transmission from presymptomatic persons has been shown in epidemiologic investigations of COVID-19 (4,5).

Characteristics that might have led to transmission from the instructors in Cheonan include large class sizes, small spaces, and intensity of the workouts. The moist, warm atmosphere in a sports facility coupled with turbulent air flow generated by intense physical exercise can cause more dense transmission of isolated droplets (6,7). Classes from which secondary COVID-19 cases were identified included 5–22 students in a room ≈60 m2 during 50 minutes of intense exercise. We did not identify cases among classes with <5 participants in the same space. Of note, instructor C taught Pilates and yoga for classes of 7–8 students in the same facility at the same time as instructor B (Figure; Appendix Table 2), but none of her students tested positive for the virus. We hypothesize that the lower intensity of Pilates and yoga did not cause the same transmission effects as those of the more intense fitness dance classes.”

Since no guidelines being well advertised and no phase in quarantine being proposed these are the following notes from all the data and studies we have read….The goal is to reduce your exposure to the virus in order to not get you infected. Being in the presence of Zero covid-19 virus likely impossible unless you quarantine with restrictions.

Everyone must weigh their risk/reward – those with multiple comorbidities should note their risk is much higher. Key comorbidities: Hypertension, Obesity, Diabetes, and other immune compromise issue. IF you only have 1 or none of those you are in good shape for not dying – multiple comorbidities you will have to go to highest level of protections – suggest quarantine. In regards to age – one could be a 60 old who is much healthier than a 30 year old. Personal assessment is needed – however the data is clear which is not much different than other issues (e.g. respiratory or circulatory disease) – the older you are the more the chances you are going to die. See the table below from CDC data.

Suggestive Protective Guidelines in Order

1. Reduce exposure time particularly if indoors. Hypothesis is most infections are actually coming from someone you know as most are indoors and talking with friends/relatives. In general someone doesn’t talk a long time with a stranger. Reducing meeting/talking with someone under 2 min would be advisable. The kitchen staff in the Chinese restaurant did not get sick – they typically don’t talk or stay in the main restaurant area but do deal with all the dishes etc…
2. Wear a mask….very controversial for some reason – but think of it as a seat belt. Is the inconvenience worth not getting this virus even if it doesn’t impact you – who wants to be the carrier – and until more is known you probably don’t want to get it if you don’t have to.
3. IF you must meet/talk to people for extended period then doing it outdoors during a sunny breezy day is advisable. IT IS A FACT that UV does disrupt viruses. IF the sunlight is strong enough that’s another issue – but these suggestion is about reducing risk. The dilution of the air and the UV light will likely be beneficial to reduce the viral load. An alternative to this is to go to places that have a fresh air HVAC unit along with UV light filtration system. These systems do exist and should be promoted as BEST protections for restaurants, stores, or any gathering places.
4. Proper hygiene (wash hands, clean surfaces, etc..) will support your immune system so not tackling multiple issues e.g. common cold, rotavirus, etc…

Socializing or working out in a gym without fresh air HVAC and UV filtration seems very high risk to me. Same with restaurants – is the benefit there vs. takeout given the risk?

We did drop below 1000 deaths in the US – 808. In fact even Brazil (456) update is small so likely it is a Sunday effect.

NY leading the way still (183)

Country charts – the death chart looks really good. No significant reporting other than East and West Coast and cook county IL. Hopefully this means we are doing much better treating the disease.

Even though Russia confirm cases keep growing their deaths stay low. What are they doing? Is it as simple as stating false reporting? Why would they do that?

France 7 Day MA deaths jumped up….

Lots of discussion on source of the virus… https://www.nzherald.co.nz/world/news/article.cfm?c_id=2&objectid=12332538

“the study says genetic examination of four samples containing the virus from the seafood market to those taken from the Wuhan patient are "99.9 per cent" identical. This suggests it came from infected visitors or vendors, indicating "Sars-CoV-2 had been imported into the market by humans". The authors confirmed to the Mail on Sunday they had found no evidence "of cross-species transmission" at the market.

They cite a paper by Chinese scientists, published this month in Zoological Research journal that, after examining samples from infected patients, has also inferred the virus was brought into the market.

These new studies dovetail with another work by Chinese scientists published in the Lancet, which found only 27 of the first 41 confirmed cases were "exposed" to the market – and only one of four initial cases in the first two weeks of December.”

This article is interesting as they note confirmation on test in France in November – https://bgr.com/2020/05/16/coronavirus-patient-zero-france-finds-evidence-pointing-to-november/

“…latest proof comes from France, a country that already obtained evidence that said a COVID-19 patient was admitted to a hospital in Paris in late December at a time when no one knew about the disease. That patient had not traveled to China or anywhere else. The doctors who tested his samples months after his hospital visit were unable to explain where he got the virus from. And now, new evidence says the virus may have been circulating in France as early as mid-November, more than a month before the first confirmed case in Paris.

Just like the doctors from Paris who started looking at past cases to discover patients who exhibited COVID-19-like symptoms, a team of researchers in the northeastern French city of Colmar started looking at X-ray results that would be consistent with CT imagery of confirmed COVID-19 patients. The team identified two X-rays from November 16th and 18th that showed symptoms consistent with atypical pneumonia that often presents with COVID-19 cases.”

Now why would China still want to push the message it came from the wet market when they can jump on any of these stories?

Perhaps we will be below 1000 deaths if we could just extend the weekend more… even Brazil dropped…but I am afraid this is just a weekend data feed.

NY still leading the way 171 deaths. Confirmation starting to be evenly spread out beyond East Coast with TX and CA making a larger pieces of the pie.

Highest confirmation uptick is actually in Orange County CA and Cook County IL. Interesting to see confirmed cases in the Panhandle of Texas growing.

US still leading the bulk of confirmation and deaths when comparing to other countries

Brazil and Mexico on 7 day MA still growing.

How people are getting sick was noted in yesterday report – I am highly thinking it is not primarily contact but respiratory absorption. The choir study just released confirm many of my hypothesis – https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e6.htm?s_cid=mm6919e6_e&deliveryName=USCDC_921-DM28169

“On March 17, 2020, a member of a Skagit County, Washington, choir informed Skagit County Public Health (SCPH) that several members of the 122-member choir had become ill.”

“The choir, which included 122 members, met for a 2.5-hour practice every Tuesday evening through March 10.”

“No choir member reported having had symptoms at the March 3 practice. One person at the March 10 practice had cold-like symptoms beginning March 7. This person, who had also attended the March 3 practice, had a positive laboratory result for SARS-CoV-2 by reverse transcription–polymerase chain reaction (RT-PCR) testing.”

“In total, 78 members attended the March 3 practice, and 61 attended the March 10 practice (Table 1). Overall, 51 (65.4%) of the March 3 practice attendees became ill; all but one of these persons also attended the March 10 practice. Among 60 attendees at the March 10 practice (excluding the patient who became ill March 7, who also attended), 52 (86.7%) choir members subsequently became ill. Some members exclusively attended one practice; among 21 members who only attended March 3, one became ill and was not tested (4.8%), and among three members who only attended March 10, two became ill (66.7%), with one COVID-19 case being laboratory-confirmed.

Because illness onset for 49 (92.5%) patients began during March 11–15 (Figure), a point-source exposure event seemed likely. The median interval from the March 3 practice to symptom onset was 10 days (range = 4–19 days), and from the March 10 practice to symptom onset was 3 days (range = 1–12 days). The odds of becoming ill after the March 3 practice were 17.0 times higher for practice attendees than for those who did not attend (95% confidence interval [CI] = 5.5–52.8), and after the March 10 practice, the odds were 125.7 times greater (95% CI = 31.7–498.9). The clustering of symptom onsets, odds of becoming ill according to practice attendance, and known presence of a symptomatic contagious case at the March 10 practice strongly suggest that date as the more likely point-source exposure event. Therefore, that practice was the focus of the rest of the investigation. Probable cases were defined as persons who attended the March 10 practice and developed clinically compatible COVID-19 symptoms, as defined by Council of State and Territorial Epidemiologists (6). The choir member who was ill beginning March 7 was considered the index patient.”

“Among the 61 choir members who attended the March 10 practice, the median age was 69 years (range = 31–83 years); 84% were women. Median age of those who became ill was 69 years, and 85% of cases occurred in women. Excluding the laboratory-confirmed index patient, 52 (86.7%) of 60 attendees became ill; 32 (61.5%) of these cases were confirmed by RT-PCR testing and 20 (38.5%) persons were considered to have probable infections. These figures correspond to secondary attack rates of 53.3% and 86.7% among confirmed and all cases, respectively. Attendees developed symptoms 1 to 12 days after the practice (median = 3 days). The first SARS-CoV-2 test was performed on March 13. The last person was tested on March 26.

Three of the 53 patients were hospitalized (5.7%), including two who died (3.8%). The mean interval from illness onset to hospitalization was 12 days. The intervals from onset to death were 14 and 15 days for the two patients who died.”

“Among persons with confirmed infections, the most common signs and symptoms reported at illness onset and at any time during the course of illness were cough (54.5% and 90.9%, respectively), fever (45.5%, 75.8%), myalgia (27.3%, 75.0%), and headache (21.2%, 60.6%). Several patients later developed gastrointestinal symptoms, including diarrhea (18.8%), nausea (9.4%), and abdominal cramps or pain (6.3%). One person experienced only loss of smell and taste. The most severe complications reported were viral pneumonia (18.2%) and severe hypoxemic respiratory failure (9.1%).

Among the recognized risk factors for severe illness, the most common was age, with 75.5% of patients aged ≥65 years. Most patients (67.9%) did not report any underlying medical conditions, 9.4% had one underlying medical condition, and 22.6% had two or more underlying medical conditions. All three hospitalized patients had two or more underlying medical conditions.”

Okay so what does this all mean to me – like all good studies there are still some questions to be answered – this place of practice did the cleaning people get infected – who else goes to this place did they get infected – IF NOT which probably is likely else why wouldn’t they have gone further – then it is not a contact disease – similar to the Chinese restaurant and S. Korean building study.

The implication of this is that PROLONG exposure to people breathing is the real concern. Mitigation to reduce viral load in the air is very possible through ventilation using fresh air systems / non recirculation – also to add a UV filtration system to HVAC will likely reduce viral load.

Age once again played a key factor along with comorbidity. Fatality rate here is 3.8% – but all had multiple health issues – likely following the protocol I noted before this event would have not happened given the age of the choir. Highly contagious and the more time the more your chances expand of being infected.

The OPENING up of states without AT LEAST guidelines – but highly recommend strict policy of phasing in society is a mistake. Once this hits a certain demographic in a certain setting its blown up and if people infected are social they only spread it to more hotspots.

There are positives in this – PROLONG exposure is the key– a simple sidewalk passerby is not likely going to result in anything – potentially being in a room where a sick person was a day ago for 2 min (elevator ride) would not do anything either – and IF you are not seated near or where recirculated air is blowing on you in a room with a sick person you will not likely get sick.

What is PROLONG? Perhaps we can use the restaurant case since that is the shortest time out of all these settings given Choir 2.5 hr, Call Center likely 8+ hr. https://scholarship.sha.cornell.edu/cgi/viewcontent.cgi?article=1849&context=articles Perhaps another reason why Asian countries fared better – less time dining.

So the Chinese study did not tell the time of dining – https://wwwnc.cdc.gov/eid/article/26/7/20-0764_article – but they did note lunch so perhaps it was a Short event – 27.6 minutes. Therefore if you are going somewhere and you don’t know the people in the room and it is enclosed with no advance HVAC system I would limit your time to under 30 min. Perhaps a mask would give you more time given the potential to reduce viral load.

I would strongly advise against going to a restaurant setting or any gathering without knowing more on how the HVAC system is designed or stay more in outdoor settings – even if you are super healthy – I am sure most don’t want to be carriers at least not yet until more is known. It would seem you are likely to survive covid-19 but what are the after math –

“According to the latest research, about one in 20 Covid patients experience long-term on-off symptoms.” https://www.theguardian.com/world/2020/may/15/weird-hell-professor-advent-calendar-covid-19-symptoms-paul-garner

No one wants to be that 1 in 20 – not yet at least.

However given all that multiple businesses can resume assuming preventative actions are taken. Guidelines/rating systems for places can be instituted and a phase quarantine policy would keep the numbers manageable along with a mobile testing unit to pinpoint problems. Opening up state without some guideline and just phasing in store types is throwing away the economic disaster already implemented. Covid-19 is out there and when concentrated is highly contagious – but generally not lethal particularly when healthy.

US continues to flatten out on deaths 1632 – Brazil on the other hand continues to rise 963

NY is back in the lead 237 deaths

On a county view you cans see the pockets that Covid is impacting – it is not a macro disease.

US is now over 3% per capita tested. France and NY are now testing positive only 7% of the time.

Brazil and Mexico continues to rise.

Lets start off with some good news…

New antibody test found to be 100% accurate by Roche – https://www.sciencefocus.com/news/new-coronavirus-test-highly-specific-and-100-per-cent-accurate/

“Public Health England (PHE) said that last week the scientific experts at its Porton Down facility had carried out an independent evaluation of a new antibody blood test developed by a Swiss pharmaceutical company.

The examination found that Roche’s serology test was “highly specific” and had an accuracy of 100 per cent.

The findings have been hailed as a “very positive development” in combating the coronavirus outbreak.

The test is designed to help determine if a patient has been exposed to the virus that causes COVID-19 and whether they have developed antibodies against it.

The detection of these antibodies could help to indicate if a person has gained immunity against the virus.”

Note Roche is also active on late stage treatment via http://www.pmlive.com/pharma_news/fda_approves_roches_actemra_covid-19_trial_1329887

T cells found in covid-19 patients which indicate long term immunity – https://www.sciencemag.org/news/2020/05/t-cells-found-covid-19-patients-bode-well-long-term-immunity?utm_source=newsfromscience%3Dflipboard%3Dflipboard2460878

“Now, two studies reveal that infected people harbor T cells that target the virus—and may help them recover. Both studies also found that some people never infected with SARS-CoV-2 have these cellular defenses, most likely because they were previously infected with other coronaviruses.

“This is encouraging data,” says virologist Angela Rasmussen of Columbia University. Although the studies don’t clarify whether people who clear a SARS-CoV-2 infection can ward off the virus in the future, both identified strong T cell responses to it, which “bodes well for the development of long-term protective immunity,” Rasmussen says. The findings could also help researchers create better vaccines.”

Interesting connection with Vitamin D and obesity – note all the vitamin D articles of the past – https://www.ncbi.nlm.nih.gov/pubmed/10966885

“Obesity-associated vitamin D insufficiency is likely due to the decreased bioavailability of vitamin D(3) from cutaneous and dietary sources because of its deposition in body fat compartments.”

To the scary news which I am sure will spread – “study shows you can spread coronavirus just by talking” – https://bgr.com/2020/05/14/coronavirus-tips-speaking-can-spread-covid-19-so-wear-a-mask/

Clearly they will lead with that but you got read the rest to get it tempered and also they still have not quantified the level of coronavirus needed to infect you – it is not just 1 particle that will get you sick.

““This study doesn’t directly test whether the virus can be transmitted by talking, but it builds a strong circumstantial case that droplets produced in a normal close conversation would be large enough and frequent enough to create a high risk of spreading SARS-CoV-2 or any other respiratory virus between people who are not wearing face masks.””

The above article along with this article and the current experiences from NY to the Chinese restaurant and S. Korean Building study one can deduce certain activities likely causing spread and as the article notes it’s not likely who you think – https://www.mercurynews.com/2020/05/14/coronavirus-who-gave-you-covid-19-its-not-who-you-think/

“A study from Shenzhen, China found that 11.2% of household contacts developed COVID-19, compared to 6.6% for all close contacts. Another study from China had similar findings: When checking the contacts of 105 COVID-10-positive individuals, the researchers found 16% of contacts in the same household tested positive for the virus.

An Illinois woman with symptoms spread the virus to her husband. Of the other 347 actively-monitored close contacts that interacted with these two patients, 43 developed symptoms and none tested positive for the coronavirus.

Family gatherings: In Chicago, the coronavirus was most likely spread from one infected person to other people — not from the same household — at a funeral in February and a birthday party three days later. Both events were several hours long and the infected individual, who had symptoms, embraced others and shared food. In total, this single individual caused six confirmed and nine probable COVID-19 cases.

Group gatherings: Public health officials believe that one infected individual spread the virus to choir members in Skagit County, WA. Of the 61 people who were at a 2.5-hour choir practice in early March, there were 32 confirmed and 20 probable COVID-19 cases.

Restaurants: In a restaurant in Guangzhou, China, one infected individual may have spread the coronavirus to customers at two neighboring tables. The tables overlapped for about an hour. The report’s authors think that infectious droplets spread between the tables via airflow from the restaurant’s air conditioning system.

Homeless shelters: In early April, tests in a Boston homeless shelter showed that the virus had infected 147 residents, or 36% of the shelter’s population.”

I agree with the article based on the evidence – the chances of a random person giving you the virus seems much more remote than a month ago. I would even speculate the contact transfer is not that great and its more likely air transfer at certain viral load which matters more. The reason I hypothesized this is the fact none of the waiters in the building got sick in the Chinese study and clearly they are moving dishes in and out. The S. Korean building even though they shared elevators/lobby no major out break beyond 11th floor. In the eleven floor most on one side of the building even though they share restroom and elevator waiting and travel time to floor equivalent. NY lockdown was so long yet confirmation rising so perhaps grocery store visits are long enough – or more likely people are visiting relatives who they believe have also been quarantined only to realize either they were asymptomatic for long periods or that someone in the chain wasn’t quarantine. Staying inside with people you cannot 100% confirm quarantine is not a good recipe as viral load builds and talking and having a long conversation in a non circulated fresh air room will eventually lead to infection. The risk is indoors not outdoors. Blaming random people is not the issue unless you spend a long time with that random person breathing in their exhausted air AND they are infected.

Before the daily update I delved into some key Asian countries including Russia and we observed the following conclusion – zero confirmation goal is likely unobtainable – however mitigation of death – hence healthcare system – is certainly possible – plus we need to investigate more thoroughly the difference in these countries vs. US before just concluding they are masking their numbers.

There are moments of zero cases for Vietnam, Taiwan, China, Japan – but it could be a reporting issues. On a 7 day moving average the only country to go to zero was Vietnam.

Death view is really amazing in context of Europe and the US. Vietnam has a total of 312 confirmed cases – NOT 1 DEATH.

Russia death is growing of recent – but even their fatality rate is low 0.9% – and their death per capita is amazingly low given the amount of testing done 0.0016% – which is the highest among all these countries. If we even double the current value 0.0032% and used this in our herd immunity example we are talking about previously – under 10K death.

US under 2K again. Brazil deaths are relatively high 759

NJ is leading in the death figures not NY at 232. IL is leading in confirmation. This is a state I would probably not recommend opening up without strict measures.

Texas death is rising and has hit a new 7 Day MA peak. However to connect the current death with the recent opening would mean the infection was quite fast. I really think it would be unfair to equate these deaths to opening just yet.

Brazil, Mexico, and Ecuador are going to show some bad number for awhile they are in the ramp stage.

Brazil is the leader in 7 day MA daily death difference if the US is broken out by state.

The testimony(https://www.hsgac.senate.gov/covid-19-how-new-information-should-drive-policy) from Dr. Inglesby has been haunting me – he is against herd immunity largely because of the numbers he alluded to:

“Some have proposed allowing the disease to spread until the point where the country has

achieved “herd immunity”. Epidemiologic estimates are that it will require on the order of 70%

of the population to be infected to achieve herd immunity. 70% of the US population is about

people 233 million people. Most studies that have been done calculate the infected fatality

rate to be in the .5 to 1% range. For example, this Lancet analysis concluded that there was an

infected fatality rate of .66% in China. If .5% of 233 million people were to die from this illness

in the US, that would be 1,165,000 deaths.”

The Lancet study he refers to – https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30243-7/fulltext#tbl1

I don’t think ANYONE in the herd immunity would suggest the elder not be quarantined – to use 0.66% is EXTREMELY misleading.

Less than 60 age is 0.145! IF we go even lower less than 50 it is 0.10% – now we have 6X difference than Dr. Inglesby testified number – 233K

To reduce the number more – also ask to quarantine comorbidities we know are fatal with Covid-19 (Hypertension, Diabetes, BMI>30) – https://jamanetwork.com/journals/jama/fullarticle/2765184?guestAccessKey=906e474e-0b94-4e0e-8eaa-606ddf0224f5&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=042220

In fact if you HAD ONLY 1 comorbidity this would be reasonable to be able to go out – only if you had more than 1 you should quarantine.

So we can reduce the 233K to potentially less than 23K deaths! This will be below auto fatalities a year (33.6K). Clearly implementation will not be perfect and not everyone will listen – but at the same time there will be extra cautious people in fear. This could be a manageable number – the initial goal of all this quarantine was not 0 deaths or 0 spread – but to not overwhelm the healthcare system putting doctors in a position to choose who dies. A herd immunity with smart measures can do this without the ENTIRE population who has not done anything to merit quarantine result in being quarantined.

Visiting and taking care of the elderly and those with multiple comorbidity can still be done. Strict guidelines will need to be in placed to do this – but it is all technically feasible once you know who needs to be quarantined – in fact it can be done more effective than it is now. There are still many elderly and multiple comorbidity having to go groceries and other things. Once we know not everyone quarantines we can have a new industry/service to take care of this group with strict appropriate guidelines.

This study highlights Vitamin D again but also looks into the issue of sunnier regions doing worse. They identified the northern states fortified foods with Vitamin D. And as I have noted before just because its more sunny doesn’t mean people go outside. – http://imj.ie/vitamin-d-and-inflammation-potential-implications-for-severity-of-covid-19/

Rhode Island is over 9% per capita tested now.

They have detail information available – https://ri-department-of-health-covid-19-data-rihealth.hub.arcgis.com/

Even though cases are more towards the <50– they are not being hospitalized or showing up in the death figures.

52% less than 50 =6154

20% <50

54 hospitalized

Only 4% fatalities less than 50

Fatality rate = 19/6154=0.3% Unfortunately no comorbidity data to calculate a smaller fatality rate.

60% of death at longterm care facility.

US numbers below 2K again. Brazil growing

NY still leading the way for the US but at much smaller number (193)

Opened states nothing to note yet…

Brazil and Mexico with large growing deaths with hardly any testing is quite concerning. Russia testing and low deaths are amazing. Perhaps BCG?

Brazil and Mexico showing up as the leaders in the 7 day MA daily difference. Japan is showing another up tick but not at there previous peak. Interesting to note going to zero after 100+ days would seem to be an unachievable goal.

I want to highlight a point made in yesterday must watch/read – https://www.hsgac.senate.gov/covid-19-how-new-information-should-drive-policy

2:45 Dr. Kory highlights the fact the virus is at least 2 stage. First stage is the viral replication – this is where it gets into your soft tissue and replicates and you get your sore throat fever etc…all outpatient issues – the next stage is the inflammation stage this is where you visit the hospital. He notes both HCQ and Remdesivir needs to be take before the hospital and makes no sense to analyze and dose those in the second stage. Of course his solution was discussed yesterday – MATH+

Gilead Science strikes a licensing agreement with 5 generic drugmakers – “royalty-free” –https://www.cnbc.com/2020/05/12/remdesivir-coronavirus-treatment-gilead-strikes-deal-to-make-drug-in-127-countries.html

What is not clear is if they force a set price? $1000/dose – previously – can these companies have free will to charge what they believe is fair? 10 day treatment via IV.

Interesting to realize around ½ of Sweden death could be attributed to poor care at nursing home – which cannot directly be attributed to covid-19 policy approach. In fact it looks like significant negligence could be the issue https://www.thejakartapost.com/news/2020/05/12/sweden-adjusts-controversial-covid-19-plan-after-care-homes-crisis.html

“Sweden said prosecutors had started an investigation into the high death rate at a care home. Half of those over 70 years old who have died from COVID-19 in Sweden lived in nursing homes, according to national statistics at the end of April. As of Monday, the country had registered 3,256 COVID-19 related deaths.”

If reduce the deaths by half they are much closer to their neighboring states but still higher in terms of death/capita and death/confirmed. As compared to overall Europe they would be below the middle of the pack with the adjusted metric. This highlights a place where other countries can do better than Sweden IF they choose their approach.

US below 2K. Brazil surpass UK in deaths.

Il is leading in confirmed cases now.

Open states death not changing too much. Confirmation slightly up but not near previous peaks – but confirmation shouldn’t be the focus – death should be and if we have better treatments now it will be less concerning as noted by Dr. Kory in the testimony.

NY is a clear outlier in the covid-19 issue. NY now under 10% confirmed per those tested.

Sweden testing data looks to have gotten revised dropping their death/testing back down below France. Brazil and Mexico still look alarming.

Brazil is now highest daily death change on 7 day moving average only – behind UK – IF US states are broken out as countries vs. aggregated.

MUST WATCH AND MUST READ STATEMENTS – https://www.hsgac.senate.gov/covid-19-how-new-information-should-drive-policy

In (italics) are my comments – others are notes from the testimony and audio

Pierre Kory, M.D., M.P.A.

Critical Care Service Chief

Associate Professor of Medicine

University of Wisconsin School of Medicine and Public Health

https://www.hsgac.senate.gov/imo/media/doc/Testimony-Kory-2020-05-06-REVISED.pdf

“We are at war”…supportive care not right approach-

Even though his protocol is named MATH+….this is purely coincidence of our public site covid19mathblog.com

MATH+

steroid therapy (methyprednisolone therapy – Methylprednisolone was granted FDA approval on 24 October 1957) is the right approach – anti-inflammatory

Vitamin C

Blood thinner

Avoid incubation – disease makes it worse

Push back from CDC….people are not coming to hospital early enough…fear is causing patients coming in late now….

David L. Katz, M.D., M.P.H.

President

True Health Initiative

https://www.hsgac.senate.gov/imo/media/doc/Testimony-Katz-2020-05-06.pdf

98-99% cases are mild

Different diseases for different populations

The national policy objective should be total harm minimization (1-3) and establishment of a safe “all clear” for all population groups

Closed the barn door when all the horses were out…

Supporter of herd immunity

DON’T NEED MILLIONS OF TEST (but you got to test smart – just like polling)

Hopeful widespread

We can do better than Sweden

GET HEALTHY – use risk calculators to get people to care about longterm health issues! Making lemon from lemonade!

Tom Inglesby, M.D.

Director, Center for Health Security

Bloomberg School of Public Health

John Hopkins University

https://www.hsgac.senate.gov/imo/media/doc/Testimony-Inglesby-2020-05-06.pdf

A Kaiser Family Foundation report concluded that 37.6% of adults 18 and older in the U.S. (92.6

million people) have a higher risk of developing serious illness if they become infected with

coronavirus, due to their older age (65 and older) or health condition.

(there are ways to substantially reduce this number in a two week time period – a two week change in diet with exercise can be done)

Against Herd immunity

Some have proposed allowing the disease to spread until the point where the country has

achieved “herd immunity”. Epidemiologic estimates are that it will require on the order of 70%

of the population to be infected to achieve herd immunity. 70% of the US population is about

people 233 million people. Most studies that have been done calculate the infected fatality

rate to be in the .5 to 1% range. For example, this Lancet analysis concluded that there was an

infected fatality rate of .66% in China. If .5% of 233 million people were to die from this illness

in the US, that would be 1,165,000 deaths.

Q&A Failure to help nursing home is tragic.

Avik Roy

President

Foundation for Research on Equal Opportunity

https://www.hsgac.senate.gov/imo/media/doc/Testimony-Roy-2020-05-06.pdf

… conventional wisdom now claim

that we must continue lockdowns for as long as we can’t test the entire population for

COVID-19, and have an effective treatment, and develop herd immunity, and produce a vaccine. All of this, we are assured, can take place in the next 12 to 18 months.

But what if it takes us 12 to 18 years to develop a vaccine? We have never developed a

coronavirus vaccine before. The best scientists in the world have been trying to develop a

vaccine for HIV for nearly 40 years, and we still don’t have one. Effective non-vaccine

treatments may arrive sooner, but when? And is it realistic to stick 6-inch swabs up the

nostrils of millions of Americans, every day, until that happens?

Treating UTAH OK like NY is not reasonable.

Businesses can deep-clean their surfaces and

provide hand sanitizer and masks to their workers and customers. People can wash their

hands regularly, and minimize close contact with strangers. This is, in fact, what East Asian

countries did after the original SARS outbreak in 2003, and it enabled them to gradually

return to normal life, despite the absence of a vaccine or effective treatments.

John P.A. Ioannidis, M.D.

C.F. Rehnborg Professor in Disease Prevention

School of Medicine

Stanford University

https://www.hsgac.senate.gov/imo/media/doc/Testimony-Ioannidis-2020-05-06.pdf

Highly dependent on age – children and middle age adults similar to flu

Typically very benign but has potential to be devastating in particular situation.

we need to defend hospitals and nursing homes with strict infection control and hygienic measures; universal and periodic testing of all personnel; and quarantine for infected and exposed personnel

we should reassure most citizens – those of younger ages without serious preexisting conditions – that they are at very low risk.

unrealistic to expect COVID-19 deaths to stop accruing before reopening. Deaths may happen 3 weeks after infection, and modern medical technology can maintain some people on mechanical support even for months.

The pace of re-opening may differ across locations, depending on their evolving levels of infection, hospital capacity, and population vulnerability structure. While treatment advances and vaccine efforts may be successful eventually, lockdown measures cannot be prolonged until we find treatments and vaccines that save many lives, since such breakthroughs may take a long time (or may even never happen). For example, remdesivir has shown promising results in shortening duration of disease, but no conclusive evidence yet for saving lives.

In Q &A with Romney (did a very good job balancing questions concern)– discuss gradient of risk relative to flu and covid-19 and also talk about specificity of working areas. (very good response to explain S. Korea and Taiwan success)

Scott W. Atlas, M.D.

David and Joan Traitel Senior Fellow

Hoover Institution

Stanford University

https://www.hsgac.senate.gov/imo/media/doc/Testimony-Atlas-2020-05-06.pdf

Transplants from living donors are down 85 percent from the same period last year. Missed biopsies of now undiscovered cancers number thousands per week. That doesn’t include the latest reports of skipping two‐thirds to three‐fourths of cancer screenings, most childhood vaccinations, and treatment for new strokes and known cancer.

In the Covid‐19 epicenter New York City, higher immunity is likely, although undoubtedly muted by the extreme isolation policies, as more than 20 percent of those tested had antibodies. A similar finding was reported in Boston. That fact has been incorrectly portrayed as an urgent problem requiring mass isolation. On the contrary, infected people are the immediately available vehicle for establishing widespread immunity. By transmitting the virus to others in lower‐risk groups who then generate antibodies, pathways toward the most vulnerable people are blocked, ultimately eradicating the threat

In Detroit’s Oakland County, 75 percent of deaths were in those over 70; 91 percent were in people over 60, similar to what was noted in New York. And younger, healthier people have virtually zero risk of death and little risk of serious disease – as I have noted before, under one percent of New York City’s hospitalizations have been patients under 18 years of age, and less than one percent of deaths at any age are in the absence of underlying conditions.

If under 18 and in good health, you have nearly no risk of serious illness from Covid‐19. Exceptions exist, as they do with virtually every other clinically encountered infection, but that should not outweigh the overwhelming evidence to the contrary. Again, standards for consciously protecting elderly and other at‐risk family members or friends, including teachers in higher‐risk groups, should still be employed.

There is no scientific reason to insist that people remain indoors.

implement prioritized testing for three groups: nursing home workers, health care workers and first responders, and patients in hospitals with respiratory symptoms or fever. Widespread testing for the whole population is not a predicate for reopening as above. And contact tracing is not as valuable after a disease is already widespread, even though it would be an important part of the overall preparation for potential future outbreaks.

I am proponent of Guidelines to the public and business owners – perhaps a rating scale of “cleanliness/hygiene” for businesses. Those that invest in a fresh air HVAC UVC should get X points, those that offer hand sanitizer and mask wearing get Y points, those that keep the density of people below # per sq ft get Z points, those using approved chemicals for cleaning and clean 2 times a day get W points, those that have temp scanners before entry get T points — let people weigh their risk to visit certain places – let business owners get something for their investment to make their places safer!

Nursing home stats – https://freopp.org/the-covid-19-nursing-home-crisis-by-the-numbers-3a47433c3f70

“39 percent of U.S. COVID-19 deaths have occurred in nursing homes and residential care facilities.”

Another paper – need to go outside and/or take vitamin D- https://link.springer.com/article/10.1007/s40520-020-01570-8

“In conclusion, we found significant crude relationships between vitamin D levels and the number COVID-19 cases and especially the mortality caused by this infection. The most vulnerable group of population for COVID-19, the aging population, is also the one that has the most deficit Vitamin D levels.

Vitamin D has already been shown to protect against acute respiratory infections and it was shown to be safe. It should be advisable to perform dedicated studies about vitamin D levels in COVID-19 patients with different degrees of disease severity.”

Unfortunately the data source today is having problems so we cannot show the latest update. However the above is a lot to go through. I highly recommend it – critical thinking is needed.

Where are the testing advancements we discussed about in the beginning – here is another handheld device to test in Covid in minutes – https://www.brusselstimes.com/all-news/belgium-all-news/health/110770/dutch-company-makes-chip-capable-of-detecting-coronavirus-in-minutes/

These devices are needed sooner than later.

“The company said that their technology, which is not yet ready for commercialisation, has the potential to roll-out large-scale and rapid testing “anywhere in the world, without expensive and time-consuming lab facilities.”

Another commodity boom coming – plasma – https://www.npr.org/sections/health-shots/2020/05/11/852354920/market-for-blood-plasma-from-covid-19-survivors-heats-up

Donating is a noble cause – but when they are generating significant revenue and not philanthropically distributing your plasma it only makes sense you at least figure out where you would like to donate.

“global market estimated to reach $35.5 billion by 2023.”

Modifying the BCG vaccine – the article seems to admit the BCG is effective in upper respiratory infections. https://www.dw.com/en/can-a-tuberculosis-vaccine-help-combat-covid-19/a-53388220

“"In controlled studies, it has been shown that BCG can indeed protect against viral respiratory infections. BCG stimulates innate immunity, and this can be used to build a defense against viral respiratory infections. Based on this, we know that our new vaccine should have a similar effect,"”

“"We’re not talking about millions, but about 10 to 100 million doses in a short time. This is also very important, because the tuberculosis vaccine BCG is quite scarce, and the World Health Organization is now concerned that infants in countries with TB will not be able to be vaccinated," Kaufmann says”

“"When the COVID-19 crisis emerged, some scientists looked directly at whether COVID risks were lower in countries where BCG vaccination is mandatory, i.e., whether there were fewer cases of disease than in countries without BCG vaccination. And, indeed, a connection was found here," says Kaufmann.”

The article is not clear why they need to modify the BCG – doesn’t explicity say this modification is better. Shouldn’t they just spend the time and effort to prove BCG is effective and figure a way to scale BCG – it has already been used for decades…

India app focus – https://www-technologyreview-com.cdn.ampproject.org/c/s/www.technologyreview.com/2020/05/07/1001360/india-aarogya-setu-covid-app-mandatory/amp/

“Millions of Indians have no choice but to download the country’s tracking technology if they want to keep their jobs or avoid reprisals.”

“Two months ago, India’s app for coronavirus contact tracing didn’t exist; now it has nearly 100 million users. Prime Minister Narendra Modi boosted it on release by urging every one of the country’s 1.3 billion people to download it, and the result was that within two weeks of launch it became the fastest app ever to reach 50 million downloads.

“We beat Pokémon Go,” says a smiling Arnab Kumar, who is leading development of the service for the Indian government.”

“India’s app, though, is a massive all-in-one undertaking that far exceeds what most other countries are building. It tracks Bluetooth contact events and location—as many other apps do—but also gives each user a color-coded badge showing infection risk. And on top of this, Aarogya Setu (which means “a bridge to health” in Hindi) also offers access to telemedicine, an e-pharmacy, and diagnostic services. It’s whitelisted by all Indian telecom companies, so using it does not count against mobile data limits.

What the app lacks also sets it apart. India has no national data privacy law, and it’s not clear who has access to data from the app and in what situations. There are no strong, transparent policy or design limitations on accessing or using the data at this point. The list of developers, largely made up of private-sector volunteers, is not entirely public.”

“While India is the only democracy to make its contact tracing app mandatory for millions of people, other democracies have struck deals with mobile phone companies to access location data from residents. In Europe, the data has largely been aggregated and anonymized. In Israel, law enforcement focused on the pandemic has used a phone tracking database normally reserved for counterterrorism purposes. The Israeli government’s tactics have been the subject of a legal battle that made its way up to the country’s Supreme Court and legislature.”

One of the best daily death report for US under 1K – but it’s a Sunday lull so don’t get your hopes up. Russia confirmation rises but deaths are very limited. Interesting CNN report on Russia doctors falling out of windows not sure what to make of it – https://www.cnn.com/2020/05/04/europe/russia-medical-workers-windows-intl/index.html?

NY didn’t even show up in top 3 with only 29 deaths but lead with confirmations.

On the US testing front lots of testing is done (2.6% per capita). Unfortunately most of these testing is done voluntarily and at bulk places not pinpointed and mainly not beyond symptomatic patients. My concern is poor allocation of limited testing equipment – testing counties without any hotspots is a waste as noted in several studies the virus is focused. In addition the test are still not free therefore there is still a hurdle rate for people to take the test. In order to “SMART” test and quarantine making a barrier for testing is not going to help focus and find the areas to quarantine. Interesting that FL and TX are following similar curve. No matter what more testing ends up with more confirmation – so far the lowest in positive/tested with over 200K tested is TN at 6%.

Global View – interestingly Qatar has one of the highest confirmation/population 0.78% – but death rate very small 0.06%

Good news for AZ back off the peak on the 7 day MA daily deaths. WA is going back up. India, Brazil, and Mexico continue to hit new peaks.