The most talked about is the “reinfection” I purposely did not want to discuss this yesterday as I wanted more numbers to work with but so many people are talking about it and sensationalizing the results. https://www.npr.org/sections/coronavirus-live-updates/2020/04/17/836747242/in-south-korea-a-growing-number-of-covid-19-patients-test-positive-after-recover

The key part of this article which is not being highlighted from multiple “news sources” – “Another possibility is that tests are picking up dead virus particles that are no longer infectious or transmissible. KCDC director-general Jeong Eun-kyeong said Friday that viruses collected from six relapse cases could not be cultivated in isolation, signifying that they are either dead or too small in number. But some relapsed patients may have living viruses that make them sick. As of Friday, at least 61 developed symptoms, albeit mild.” “KCDC has also mentioned errors in testing or sample collecting as potential causes.”

Even CNN noted in the middle of their article – cant grab you to read if they start off with the boring conclusion – https://www.cnn.com/2020/04/17/health/south-korea-coronavirus-retesting-positive-intl-hnk/ “In each of these cases, scientists tried to incubate the virus but weren’t able to — that told them there was no live virus present.

Like many countries, South Korea uses a reverse transcription polymerase chain reaction (RT-PCR) to test for the virus. The RT-PCR test works by finding evidence of a virus’s genetic information — or RNA — in a sample taken from the patient.

According to Kwon, these tests may still be picking up parts of the RNA even after the person has recovered because the tests are so sensitive.”

Just like vaccines which uses a weakened or kill form – this could be what we have here – and people do observe mild symptoms when given vaccine for the regular flu. The newness of the test and the mass testing effort done by S. Korea clearly leaves some room for test error to. In addition given these patients recovery – perhaps they were more brazen in their habits and repicked up the virus and the body was in the process of eliminating it – hence mild symptoms. The most controlled testing of re-infection still is the monkey study done in China – https://www.biorxiv.org/content/10.1101/2020.03.13.990226v1.full.pdf Where they conclude “In this study, our results indicated that the primary SARS-CoV-2 infection could protect from subsequent

exposures, which have the reference of prognosis of the disease and vital implications for vaccine design. Importantly, the unsuccessful rechallenge in NHP models suggested that the re-positivity from discharged patients could not be due to reinfection. It needs to consider more complicated issues to find out the causes”

There is a pessimistic potential for reinfection but to be fair and balance I think equally if not more there is optimism in that the “reinfections” are not what is claimed in the headlines.

Not the best source of news but it’s a worthy subject to consider the stress factor of poverty and eventually to THINK is there a better approaches perhaps for next time – https://gulfnews.com/amp/world/asia/india/the-human-cost-of-indias-coronavirus-lockdown-deaths-by-hunger-starvation-suicide-and-more-1.1586956637547?

Can we find the limiting factor in the healthcare supply chain and focus on minimizing that vs. locking the whole sectors…are there smarter ways – particularly “SMART”quarantine – perhaps have healthscreening for known issues that cause hospitalization find those and quarantine those – a way to phase back in?

US Poverty Death Rate

https://www.sciencedaily.com/releases/2011/06/110616193627.htm

The investigators found that approximately 245,000 deaths in the United States in the year 2000 were attributable to low levels of education, 176,000 to racial segregation, 162,000 to low social support, 133,000 to individual-level poverty, 119,000 to income inequality, and 39,000 to area-level poverty.

Overall, 4.5% of U.S. deaths were found to be attributable to poverty — midway between previous estimates of 6% and 2.3%. However the risks associated with both poverty and low education were higher for individuals aged 25 to 64 than for those 65 or older.

"Social causes can be linked to death as readily as can pathophysiological and behavioral causes," points out Dr. Galea, who is also Gelman Professor of Epidemiology. For example, the number of deaths the researchers calculated as attributable to low education (245,000) is comparable to the number caused by heart attacks (192,898), which was the leading cause of U.S. deaths in 2000. The number of deaths attributable to racial segregation (176,000) is comparable to the number from cerebrovascular disease (167,661), the third leading cause of death in 2000, and the number attributable to low social support (162,000) compares to deaths from lung cancer (155,521).

In 2000 31 million considered poverty – so death rate 0.8%. This is not an argument for free for all but a search for a “SMART” quarantine approach – perhaps there are not any but if you don’t question you will never know. S. Korea is worthwhile country to learn from – see below notes.

Positive news

Who would of thought Napolean Dynamite was on to something – https://arynews.tv/en/study-llama-blood-antibodies-coronavirus/ “New study reveals llama blood contains antibodies for combating coronavirus” “The antibodies, first used in HIV research, have proved effective against a viruses such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) in the past.”

Breath analyzer test under a minute underdevelopment – https://m.jpost.com/health-science/diagnosing-the-coronavirus-in-under-a-minute-with-israeli-tech-625123/amp

Sweden approach looks to be way too early to conclude much – if anything S. Korea has the gold star – https://www.bloomberg.com/amp/news/articles/2020-04-19/sweden-says-controversial-covid-19-strategy-is-proving-effective?

Sweden should have lower numbers than many European country as their population density is lower – also testing per capita is lower. S. Korea on the other hand their approach to epidemic deserves great praise given how dense their population is and the amount of testing done per capita.

Weekend data always suspect – wishful thinking the downward gains are real

If you want some silver lining the positive/tested are flat lining for many states – so it could mean the method of testing is consistent – but overall no one is near NY level of 40%. Texas is at 10% and at 0.67% per capita tested now.

On a state basis NY has tested more than anyone in the world on a per capita bases. Worldwide testing data not consistent – but below chart gives a depiction on what is going on. France is very far behind in terms of testing (red line).

Lets hope the weekend lull is real – even Brazil looking to flatten out now. Sweden still looks to going up though.

I found the issue with NY data – you will hear in the press the flattening of NY while our data does not show it (nor John Hopkins) – https://abcnews.go.com/Health/wireStory/ny-virus-deaths-550-time-april-70225279

You will see in the article they state 13K deaths whereas we are closer 18K – “Nearly 13,000 New Yorkers in all have died since the state’s first coronavirus case was reported March 1, the governor said. The state total doesn’t include more than 4,000 New York City deaths that were blamed on the virus on death certificates but weren’t confirmed by a lab test.”

The concern now is understanding the 4K – is that category growing or is that just some back dated deaths? Are they expected to be tested or will they just be ignored?

Perhaps started all the way back in Sept. 19 and origin more complex than a seafood market according to this article – https://metro.co.uk/2020/04/18/coronavirus-may-started-september-scientists-say-12576961/

More asymptotic issues – in this stat 100% asymptotic – 146/397 at a homeless shelter – https://wercfm.iheart.com/content/2020-04-18-cdc-reviewing-stunning-covid-19-test-results-at-boston-homeless-shelter/?Keyid=socialflow&Pname=local_social&Sc=editorial

I take Vitamin C, Zinc drops (every other day), B12, and Vitamin D drops – support of Vitamin D – https://www.cnet.com/google-amp/news/the-surprising-role-vitamin-d-plays-in-your-immune-health/

Also less than $1 per dose

“"Some studies have shown that vitamin D deficiency is even associated with greater risk of self-reported upper respiratory tract infections," Tolentino says. Further, "low serum levels of calcidiol [a form of vitamin D] are also associated with higher susceptibility to infections like tuberculosis, influenza, and viral infections of the upper respiratory tract," Tolentino says.”

“There are three ways to get vitamin D: through food (since it is naturally occurring in some food), from direct sun exposure on your skin and through supplements.”

Let the public go to beach and parks responsibly? Or we just conclude they cant as much as they cant choose to eat the right foods?

Solar Radiation does help but its not that strong of an indication as we all wish it was….states tested per capita at least 1% to 2%…The figure below could be better if I had actual this year data – this comes from a solar database so its an avg solar radiation for the year by county rolled up to the state – but so far there is an intuitive relationship. R^2 0.13.

As mentioned in past report HVAC design is crucial – there are several takeaways we can deduce from this report – https://wwwnc.cdc.gov/eid/article/26/7/20-0764_article

Viral load matters – staff did not get sick but those sitting in certain airflow spots. HVAC with UVC which is available should be more prevalent vs in labs, nursing home, hospitals, and certain dog facilities. One can add a UVC to your existing AC – replace the bulbs every 1-2 yrs. Spacing and design of restaurants and temp settings should be considered in restaurants.

“The key factor for infection was the direction of the airflow. Of note, patient B3 was afebrile and 1% of the patients in this outbreak were asymptomatic, providing a potential source of outbreaks among the public (7,8). To prevent spread of COVID-19 in restaurants, we recommend strengthening temperature-monitoring surveillance, increasing the distance between tables, and improving ventilation.”

Simple treatment option – lay on stomach – need to practice sleeping like this now – https://amp.cnn.com/cnn/2020/04/14/health/coronavirus-prone-positioning/index.html?

Supporting our industrial animal/food supply chain leads to consequences such as this – as margin compression is so focused in industrialization – https://www.npr.org/sections/coronavirus-live-updates/2020/04/17/837530494/workers-advocate-says-south-dakota-pork-plant-delayed-action-on-coronavirus?

“At least 634 employees at the Smithfield Foods facility have tested positive. The facility normally employs 3,700 people, but has stopped meat processing indefinitely after requests by the city’s mayor and South Dakota’s governor.”

“We’ve heard from employees that they consider themselves to be inches apart. That lunchrooms held 500 employees at a time. And that was still occurring until mitigation efforts were being taken the week of April 6.”

Given the interconnected nature of our society certain OLD ways of practice should be resolved – such as healthcare and doctors ability to care that stops at state borders. Hopefully some good will come out of this. Unlike laws which do differ border to border – I don’t see human health changing once you hit a state line – https://reason.com/2020/04/15/physicians-should-be-allowed-to-practice-across-state-lines-and-not-just-during-a-pandemic/?

Reiteration – don’t get yourself to the ventilator stage – at that point the odds fall precipitously – https://www.dailymail.co.uk/news/article-8230775/amp/Is-proof-live-saving-ventilators-actually-deathtraps.html?

The numbers presented in this report focused on youth infected was interesting – https://medicalxpress.com/news/2020-04-covid-possibly-children.amp?

“According to the North American registry, Virtual PICU Systems, 74 children in the U.S. were admitted to PICUs between March 18 and April 6, signaling an additional 176,190 children were likely infected during this timeframe.” Very annoying how they make a statement without any proof or validation of the extrapolation. This implies those that go PICU represent 0.04% of those infected. Once confirmed a youth have a 0.04% chance to go to ICU. Where did the number come from?

More support the cat is out of the bag hypothesis – https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/?

“Nearly one third of 200 Chelsea residents who gave a drop of blood to researchers on the street this week tested positive for antibodies linked to COVID-19, a startling indication of how widespread infections have been in the densely populated city.”

“At least 39 residents have died from the virus, and 712 had tested positive as of Tuesday, a rate of about 1,900 cases per 100,000 residents, or almost 2 percent.

But the Mass. General researchers ― who excluded anyone who had tested positive for the virus in the standard nasal swab test ― found that 32 percent of participants have had COVID-19, and many didn’t know it.”

“The doctors used a diagnostic device made by BioMedomics, of Morrisville, N.C., to analyze drops of blood. It resembled an over-the-counter pregnancy test and generated results on the street in about 10 minutes. Although the test hasn’t won the approval of the Food and Drug Administration, Iafrate, the principal investigator, said Mass. General determined it’s reliable.”

Obesity is a big risk for Covid-19 hospital admission– take advantage of quarantine get healthy – https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa415/5818333

“Patients aged <60 years with a BMI between 30-34 were 2.0 (95% 1.6-2.6, p<0.0001) and 1.8

(95% CI 1.2-2.7, p=0.006) times more likely to be admitted to acute and critical care, respectively,

compared to individuals with a BMI <30 (Table 1). Likewise, patients with a BMI >35 and aged <60

years were 2.2 (95% CI 1.7-2.9, p<.0001) and 3.6 (95% CI 2.5-5.3, p=<.0001) times more likely to be

admitted to acute and critical care compared to patients in the same age category who had BMI <30.”

US death difference subsided as the NY numbers are back down – but perhaps weekend lull.

Testing in NY now over 3%. Results still haven’t changed much so they must be still testing the same type of people. Positive/tested finally broke 40% but just barely.

Interestingly S. Korea and US are at the same level of testing per capita. The real issue isn’t about testing straight up – its doing “SMART”testing. Mobilize the testing unit go to the hot spots. Trace using phone records the positive tested there locations for the past few weeks – map it all on map and mobilize the testing units to the hot spots.

Hubei-China the state where Wuhan resides shows a large addition of deaths 1300.

Probably another worthy stat that should be tracked is not just the solar radiation but the fact how much people get into the sun. Many say sun/temp is not the key and they point to countries in middle east as example – but if they have a lifestyle where they cover up and shun the sun can they really be used as evidence against the sun/temp having a positive impact.

Australia has tested 1.5% of population yet only 67 deaths with 6547 confirmed – both very low per capita stats. Southern hemisphere benefits – plus a more outdoorsy lifestyle?

Good news – Italy, Spain, Iran, Switzerland, State of Washington, all still tracking down. Bad news – Brazil, MA, CA,IL, MX, Ireland, Sweden

Bar chart stats/demo fans – enjoy chart below – I have a couple of holes I need to fill in. Overall there is a metric here why a country has 500+ death. The more you have of age,bmi,and population density – its not going to look pretty.

The big statistical discussion is the results from the Santa Clara testing – unfortunately supports my hypothesis that the cat is out of the bag – https://abcnews.go.com/Health/antibody-research-coronavirus-widespread/story?id=70206121&cid=clicksource_4380645_4_three_posts_card_hed

“The first large-scale community test of 3,300 people in Santa Clara County found that 2.5 to 4.2% of those tested were positive for antibodies — a number suggesting a far higher past infection rate than the official count.”

“Based on the initial data, researchers estimate that the range of people who may have had the virus to be between 48,000 and 81,000 in the county of 2 million — as opposed to the approximately 1,000 in the county’s official tally at the time the samples were taken.”

“"There has been wide recognition that we were undercounting infections because of lack of testing or patients were asymptomatic," Brownstein said.”

“Bendavid said the research, which has not yet been peer-reviewed, suggests that the large majority of the county, around 95%, is still without antibodies and for getting people back to work “what that means for things like, are we going to wait for people to get infected or get antibodies in order for them to get back to work… knowing that well upwards of 90% of the population doesn’t have antibodies is going to make that a very difficult choice."

My hypothesis comes from the Princess Diamond result plus the tight correlation between tested and confirmed case. With such tight correlation – its not random walk – even after significant quarantine measures the correlation stayed the same – which means the quarantine was a failure or people have it already or we keep testing the same folks– my hypothesis went with lots of people already have it and also noting that Princess Diamond ended up at 20% infected. Unfortunately we are seeing some higher numbers now from aircraft carriers – upwards to 40%. The Princess Diamond population density is 10X of NY county so it shouldn’t get that bad. On a state basis population density is the best demographic measure right now on confirmed/per capita R^2~0.4 NY approaching as a state 3-4% confirmed similar to Santa Clara is clearly not unreasonable. Santa Clara density is much less than NY county but compared to NY state it is much more dense. This would produce around 800K infected – only ¼ of the currently confirmed. The path to death would not be straightforward as much of the death/confirmed is not corrected for the denominator of confirmed. Unfortunately the deaths in NY has already passed the death calculated using Princess Diamond level of mortality rate IF we assume the infected level at 4% (800K x .0125)=10K deaths (currently reported 17K deaths). Germany has tested 2% of population and currently at 3% death/confirmed so if we go with that level this produces 24K death for NY ….Spain also 2% tested – 10% death/confirmed that puts NY ~80K. S. Korea 2% death/confirmed. I do hope I do get a null hypothesis on those confirmed.

All states show strong trend for confirmed/population rising linearly with testing.

NY continues to show large death per day numbers. The rest of the world seems to have tempered their numbers. Not sure what is going on in NY. It would be nice to get detail death data so we can analyze what is going on.

Testing continues to wise Rhode Island now caught up to NY for testing per capita.

Back to the climb of daily deaths for NY. Rhode Island looks to be starting to surge in deaths.

Global view is currently looking better than the US other than S. America countries. India has some high confirmation but their death numbers are still low relatively speaking.

Let start of the day with the headline and corresponding market share jump for Gilead – https://www.statnews.com/2020/04/16/early-peek-at-data-on-gilead-coronavirus-drug-suggests-patients-are-responding-to-treatment/

As noted in yesterday report on HCQ big complaint was the lack of no neutral control group “with no neutral control group for comparison, there is no conclusive proof that patients recover because of his treatment. As a result, it has not been authorised for use except in certain conditions in hospitals.” – well look at the Gilead article near the bottom – “The lack of a control arm in the study could make interpreting the results more challenging.” Strange shouldn’t it also get the same beat down then? Washington Post headlines below – it would suck if we are playing politics or worse yet economic maximization.

What is involved in a neutral group – well from what I surmise you would have to volunteer to a 50% chance you will not get treatment – hmmm who would bet on those odds with this virus?

Did some quick math HCQ dosage less than <$1 (multiple manufacturers) Remdesivir pill ~$1000 (1 manufacturer) – it better be 1000X more effective!

HCQ negative report – which actually highlights some reason the HCQ looks bad – its effectiveness is not designed for after inflammation – https://www.medrxiv.org/content/10.1101/2020.04.10.20060699v1.full.pdf

I am not a HCQ advocate per say but the mechanism on how it engages with better absorption to zinc makes sense to me. Clearly like any drugs you need to balance the side-effects with what you expect to get from the drug – hence the doctor role https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182877/

Value of Zinc – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2277319/

Another treatment approach – also makes sense it terms of disinfection – I use a ozone generator to disinfect and remove odor (USE WITH CAUTION) – https://www.ptcommunity.com/wire/texas-right-know-calls-us-consider-covid-19-ozone-therapy-after-it-shows-promise-italy

Ozone paper – 2011 – noted Nikola Tesla was a proponent – he patented the first ozone generator in the US – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312702/

Another vitamin C supported reference – https://www.click2houston.com/health/2020/04/17/local-hospital-using-experimental-drug-treatment-in-hopes-of-saving-lives-of-covid-19-patients/?

BTW also <$1 a dose….

More papers supporting the issue of our lifestyle. Given we are forced to isolate perhaps forcing a diet would be less restrictive? Make the grocery story only have unprocessed foods and/or limited process foods. The sad but funny thing is when I go grocery shopping – the vegan frozen items are available – kale/spinach always available….we have some personal accountability….would I like the chocolate pie – for sure – but I know its not good for me…. https://www.europeanscientist.com/en/article-of-the-week/covid-19-and-the-elephant-in-the-room/

“in 2009 61% of patients admitted to hospital in California that died from H1N1 Influenza A were obese, which was 2.2 times more than the prevalence of obesity within the state population.”

“obese adults shed influenza A virus 42% longer than non-obese individuals suggesting an additional role in transmission.”

“In Nature states that “patients with type 2 diabetes and metabolic syndrome might have to up 10 times greater risk of death when they contract COVID-19” and has called for mandatory glucose and metabolic control of type 2 diabetes patients to improve outcomes.”

“Public Health England have said now is the best time to quit smoking, citing research from China concluding that smokers were 14 times more likely to get severe disease after contracting COVID-19.”

“25-50% of those with type 2 diabetes can significantly improve glycaemic control, blood pressure and send their condition into remission from a variety of interventions including a low refined carbohydrate diet (without needing to count calories) within weeks to months respectively.”

While you are quarantined watch Forks Over Knives, Fat Sick and Nearly Dead

Spent so much time figuring this big jump in US death 4591 – hence late release!….70% all in NY – got to be some massive revision. Some sources don’t have this number yet – but John Hopkins does.

NY catching up with MI in terms of death/confirmation with latest revision

Well there goes NY downward curve potential on the 7 day moving avg daily death difference.

Adding testing data by country – you can see the US is still catching up on per capita basis but not severely behind.

BMI – we are not #1 at everything – 3rd place for Men BMI – Kuwait and Saint Lucia beat us

More hope is coming. The are so many approaches now that similar to modern day business in the age of information – it is going to be about being able decipher the barrage of information to make the most effective decision.

Interesting treatment approach – https://www.richmond.com/special-report/coronavirus/a-richmond-doctor-s-dramatic-story-of-covid-19-infection-hospitalization-and-survival/article_750722ad-7918-544d-bc4d-798d456033f6.amp.html?

“There’s a growing belief in the medical community that it isn’t the coronavirus itself that kills a patient, but the patient’s extreme inflammatory response.”

“Jones compares the body’s response to a forest fire. It’s not too difficult to extinguish a match. But once the match has been dropped and the brush begins to burn and the fire spreads, the devastation is more extensive and the resources needed to stop the fire are more substantial. Jones thinks the treatment many COVID-19 patients are receiving needs to occur in an earlier stage. On March 27, he administered to Brown a medicine called Actemra, a brand of tocilizumab, which disabled Brown’s inflammatory response by blocking specific cytokines called interleukin-6 or IL-6. Actemra hasn’t been approved to treat the coronavirus but it has shown promising results across the U.S. and in China. Roche, the Swiss maker of the drug, received $25 million from the U.S. Biomedical Advanced Research and Development Authority last week to accelerate the drug’s trial. The medicine is traditionally used to treat rheumatoid arthritis. Brown was in Stage II of the disease, about to cross the line into Stage III, in which the viral response gives way to a dangerous inflammatory response. The forest fire was about to ignite. So Jones infused the medicine in Stage II before Brown’s inflammatory response went haywire. The theories Jones had developed years ago as a fellow at VCU were being put to use and the results were dramatic. Work he had begun years ago was culminating in this case.”…but it wasn’t just that drug….”Jones prescribed one other unconventional treatment — intravenous vitamin C. He had called Dr. Alpha “Berry” Fowler, a professor of medicine at Virginia Commonwealth University who runs the lab where Jones was a fellow. Fowler suggested the vitamin C.

Vitamin C isn’t an approved treatment for the coronavirus, either, and it isn’t recommended by Bon Secours. But the playbook for treating COVID-19 is being written on the fly, and Fowler says there’s a growing amount of anecdotal evidence that vitamin C might be effective in treating COVID-19. Fowler is hoping a clinical trial to approve the use of vitamin C in COVID-19 patients will begin this summer. A large amount of vitamin C is injected — 4,000 to 5,000 times the normal amount in the bloodstream. Whether it was the timing of the Actemra, the vitamin C or the combination of medicines that saved Brown is unknown.”

“In 45 minutes he began to feel a change. Within two hours his discomfort had subsided. His fever diminished and his heart rate slowed.

On March 28, Brown received a second dose of Actemra. A day later, a Sunday, he felt well enough to go home. The day after that he did go home. In three days he had gone from his body almost being overrun by the disease to leaving the hospital.

“I’ve never seen anybody recover as quickly as he did with that level of disease,” Jones said.”

Only 2 patients but interesting results – https://www.jpost.com/HEALTH-SCIENCE/New-Israeli-COVID-19-treatment-seemingly-successful-with-first-two-patients-624722

“One of the two patients was in the ICU and even considered for intubation, but within days of the experimental drug being administered, they were released. The patients received the opanagib treatment while receiving the standard care for coronavirus, which includes hydroxychloroquine (HCQ) as background therapy. Opanagib is a "new chemical entity," according to RedHill, which is administered orally and performs "anticancer, anti-viral and anti-inflammatory activities." ”

Plasma treatment – “passive vaccine” – also showing promise – https://www.jpost.com/HEALTH-SCIENCE/29-year-old-among-first-to-be-treated-with-MDA-passive-vaccine-624353

“the plasma is being used to create a “passive vaccine,” based on the assumption that those who have recovered from COVID-19 have developed special antivirus proteins or antibodies in their plasma, which could therefore help sick patients cope with the disease.

Passive immunization is when you are given those preformed antibodies. An active vaccine, in contrast, is when you are injected with a dead or weakened version of a virus that tricks your immune system into thinking that you’ve had the disease, and your immune system creates antibodies to protect you.”

“Before being able to donate plasma, a patient must wait 14 days from the time he or she was confirmed negative for coronavirus via two separate swab tests.

Last month, Shinar said, the FDA approved a similar protocol in the US.”

Placenta Therapy – not bad results so far – https://m.jpost.com/HEALTH-SCIENCE/Israeli-COVID-19-treatment-shows-100-percent-survival-rate-preliminary-data-624058/amp?

“Not only have all the patients survived, according to Pluristem, but four of them showed improvement in respiratory parameters and three of them are in the advanced stages of weaning from ventilators. Moreover, two of the patients with preexisting medical conditions are showing clinical recovery in addition to the respiratory improvement.”

Another proponent on HCQ – it seems to have gotten very polarized only because Trump said something – if he hadn’t would it be this controversial? http://www.rfi.fr/en/france/20200416-coronavirus-disappearing-controversial-marseille-doctor-didier-raoult

“High-profile virologist Didier Raoult, a leading proponent of the controversial drug chloroquine as a treatment for Covid-19, says the virus is disappearing in Marseille.”

“He maintains that an anti-malaria drug, hydroxychloroquine, combined with the antibiotic azithromicyne, is an effective treatment for Covid-19 patients, if used before they need intensive care.”

“He has published results from his use of this approach which show considerable success but with no neutral control group for comparison, there is no conclusive proof that patients recover because of his treatment. As a result, it has not been authorised for use except in certain conditions in hospitals.”

“Numerous other trials on hydroxychloroquine are underway but so far none which tests his exact approach. It is unclear why his critics in the scientific community have not conducted such trials, to prove or disprove its effectiveness. Instead the impression is given of a scientific community which is unwilling for some reason to explore certain options versus a maverick burnishing a reputation.”

Bad news – it looks to perhaps not just be a respiratory issue – evidence of brain infection – https://www.wired.com/story/what-does-covid-19-do-to-your-brain/

““The medicines we use to treat any infection have very different penetrations into the central nervous system,” says S. Andrew Josephson, a neurologist at UC San Francisco. Most drugs can’t pass through the blood-brain barrier, a living border wall around the brain. If the coronavirus is breaching the blood-brain barrier and infecting neurons, that could make it harder to find effective treatments.”

“Analyzing health records from 214 patients admitted to the Union Hospital of Huazhong University of Science and Technology, the team found that 36.4 percent of those patients showed signs of nervous-system-related issues”

Article on ventilator statistics – still even in the best case you don’t want to get to this stage – https://www.mcclatchydc.com/news/coronavirus/article242008566.html

“Chinese government’s center for disease control and prevention found the mortality rate for COVID-19 patients admitted to intensive care units was far lower, between 49% and 61.5%, and that those who were provided with intubated ventilation may have received it too late to make a difference.”

“In Britain, the Intensive Care National Audit and Research Centre recently released its first tranche of data on mortality rates for patients with COVID-19, the disease caused by the novel coronavirus, admitted throughout the month of March to intensive care units, where most patients require forced oxygen for help breathing. The audit found that 79% of critical COVID-19 patients who had entered ICUs were still there fighting off the disease after weeks of breathing through mechanical ventilation.”

“Mortality rates remain high where the outbreak is first peaking in the United States. Doctors in New York City, the center of the U.S. epidemic, have said that roughly 80% of coronavirus patients on ventilators have died.”

Obviously sports venues not the most important thing right now – but the article highlights a new normal expected in the future – https://www.post-gazette.com/sports/pirates/2020/04/15/Dr-Anthony-Fauci-sports-return-MLB-baseball/stories/202004150179

“According to a recent poll by Seton Hall University’s Stillman School of Business, 61% of sports fans and 72% of all respondents said they wouldn’t attend a sporting event until a coronavirus vaccine has been developed. That likely won’t happen until next year at the earliest.”

Ha wish I was wrong but I think the bandana is coming back – its much more comfortable than the fabric mask in my opinion – https://twitter.com/NYGovCuomo/status/1250472598720430086?s=09

Well McKinsey & Co. found a way to capitalize on this hopefully they do better than their M&A arrangements – not only corporate execs can use them as excuses but now politicians – https://mobile.reuters.com/article/amp/idUSKCN21Y01V?

Let me end the article summary with my plea to all of you to take care of yourself – https://www.eurekalert.org/pub_releases/2020-04/uovh-cem041520.php

“80% of confirmed COVID-19 patients have mild symptoms with no need of respiratory support. The question is why. Our findings about an endogenous antioxidant enzyme provide important clues and have intrigued us to develop a novel therapeutic for ARDS caused by COVID-19.””

“Research suggests that even a single session of exercise increases production of the antioxidant, prompting Yan to urge people to find ways to exercise even while maintaining social distancing. "We cannot live in isolation forever," he said. "Regular exercise has far more health benefits than we know. The protection against this severe respiratory disease condition is just one of the many examples."”

A big jump in deaths for US and France. France data is very erratic. CT, CA, MA hit new max daily death difference.

MA death change looks like a catch up since yesterday delta was 0

Michigan death to confirm the highest in country 6.85%

Washington currently the only state on downward trend in death changes.

India continues to ramp up in confirmation.

With latest update France broke their downward trend for daily death changes.

Now that you got all that…go exercise for 10min!

There are a lot more articles discussing the “airborne” nature of the virus – supporting the fear and increasing social distancing. – https://www.cidrap.umn.edu/news-perspective/2020/04/study-finds-evidence-covid-19-air-hospital-surfaces

They note 4 meters (13 feet) – however a very important sentence not mentioned in much of the press is the second paragraph – “While the findings of the environmental sampling study do not indicate the amount of live virus, if any, or precisely determine the distance of aerosol transmission, the authors say that they confirm that the virus spreads in aerosols in addition to large respiratory droplets.” The efficacy of infection at 13 ft vs. 6 ft or 1 ft is not study – as we discussed before poison content is important.

This is a study done on Diamond Princess – https://www.medrxiv.org/content/10.1101/2020.04.09.20059113v1

Conclusion – “We infer that the ship central air conditioning system did not play a role, i.e. the long-range airborne route was absent in the outbreak. Most transmission appears to have occurred through close contact and fomites.” Social distancing would help reduce the odds of fomites (objects) interaction.

Do you want to go grocery shopping? I always thought the first week of grocery panic was quite irrational given one was scared of getting infected yet went right to probably the most likely place to get it. I do believe we could have been smarter here and implemented days in week for certain people with last names for designated days. One could have easily been able to guesstimate the splits by using local school data. I still think they should implement this IF we continue with quarantine. https://www.livescience.com/amp/how-coronavirus-spreads-grocery-stores.html?__twitter_impression=true

Bad news…Harvard expert (who knows what that means) says continue into 2022 perhaps into 2024 –

Unintended consequences….perhaps also supports my “SMART”quarantine concept – “The model also showed the consequences of too much isolation. A 20-week period of social and economic shutdown was so effective at reducing virus transmission “that virtually no population immunity was built”, which in turn intensified the next peak in the roller coaster of disease and death.”

https://www.scmp.com/news/world/united-states-canada/article/3079932/coronavirus-outbreaks-may-continue-2022-harvard?

Load impact noted here in Amperon study – weekly peak load drops are quite significant – https://amperon.co/blog/covid-19-impact-on-global-energy-markets/

Cant ignore the data – perhaps noncoincidental but these countries did do a good job overall in terms of death numbers per capita – so far. Taiwan noted for the SMART quarantine approach – Iceland so far has 10% of population tested! 0.5% per capita confirmed yet death rate 0.002% – https://www.forbes.com/sites/avivahwittenbergcox/2020/04/13/what-do-countries-with-the-best-coronavirus-reponses-have-in-common-women-leaders/#910c2a13dec4

Houston chart noticed the underlying condition notation:

US total the daily death total beat the previous daily peak – 2227. Once again concern from weekend catch up.

Besides workflow issues – There is also a Maryland revision. Daily data points are suspect. NJ new daily death peak. I still think they end up worse than NY in many metrics.

There are lot more states now that have tested over 1% of the population. LA just surpassed NY in terms of testing per capita.

There are certainly more hope in LA (light blue below) than in NY (orange below) given a turn in the positive/Finish tested results taking a turn (third chart below). This means they are likely testing samples that are beyond the typical symptom. They are also flattening out at 0.5% of the population being confirmed. Deaths are not as exponential as NY.

India is rapidly rising. Looks like UK might be at the top on the 7 day moving avg daily death basis.

FDA approves saliva test – https://www.rutgers.edu/news/new-rutgers-saliva-test-coronavirus-gets-fda-approval

Rutgers is right in the heart of the issue. Hopefully they can deploy this quick and show its efficacy – decent game changer.

Another study on patients in NY – this one based on 4103 patients – conclusion once again quarantine if old and/or obese. https://www.medrxiv.org/content/10.1101/2020.04.08.20057794v1

“In the decision tree for admission, the most important features were age >65 and obesity;..”

Vietnam success story – propaganda? – https://www.scmp.com/news/asia/southeast-asia/article/3079598/coronavirus-whats-behind-vietnams-containment-success

“At times Vietnamese responses to the crisis have been severe. Official signs in Ho Chi Minh City warn that those not wearing a face mask who are found to have infected another person with a dangerous disease could face up to 12 years in prison. On March 10, a Vietnamese man was handed a nine-month prison sentence for aggressively refusing to wear a mask.”

“Official statistics show there are currently more than 75,000 people in quarantine or isolation. The country has so far conducted more than 121,000 tests, from which only 260 cases were confirmed.

As yet, there have been no virus-related deaths, and infection rates remain significantly lower than in South Korea, Singapore and even Taiwan – all of which have been widely praised in global media for their effective responses to the pandemic.”

US continues to lead in the death daily category. France, Spain, and Italy all now in the 500’s.

NJ confirmation/tested rate is the highest nearly 50% – still slightly climbing. You can see the second chart below – shows the initial surge of positive for test which shows testing limited to the very sick, but eventually the testing expands somewhat and so far man states have stabilized on the confirmation/tested.

No state has really turned on a 7 day moving avg daily death other than Washington.

Looks like the major European countries who had it bad have turned the corner – but still have others not reach peak UK, India, Brazil, Belgium, Ecuador, Ireland, Japan, Mexico, Peru, Russia, Romania, Saudi Arabia, Turkey, Ukraine, UAE

Turkey death already at 2494 and accelerating at around 100 deaths a day.

Zoom in of the 7 Day Moving Avg Daily Death

Article:

This is really big that Apple and Google collaborating…. https://www.inc.com/jason-aten/apple-googles-covid-19-tracker-is-a-game-changer.html

Time for acceptance big brother is watching if you choose to have a cellphone.

“The basic concept is that you would be able to download an app that would ping off other mobile phones that you come into proximity with.

If you were to later test positive for Covid-19, you could indicate as much on the app, which would then notify the owners of the other devices you came in contact with that they were potentially exposed.”

“the Bluetooth technology that Apple and Google are working on isn’t that different than what Apple already is using for its Find My service. That service uses Bluetooth to send out signals, even when your device has no service, or isn’t connected to the internet. Those signals are relayed by other close-by devices, which then forward them to Apple’s servers. Since the entire system is end-to-end encrypted, not only can’t bad guys get access to your location or personal information, not even Apple could identify your device location. Only your Find My account. The technology behind contact-tracing works in a similar way.”

Hmmmm could we also use this technology to expand advertising relationship to people who associate with each other….or find hot spots for hate crimes….meetings of clubs…etc…

Today I wanted to delve into the message of testing and that testing should be the priority….to a point I agree IF this is focused on ONLY to understand the extent.   However when we do polling/sampling we DON’T do everyone because there is diminishing return as the results don’t change typically at some point.  When the curve of those confirmed per testing keeps producing consistent results testing to confirm the inevitable could be misallocation of capital (human and monetary).

NY obviously done the best in terms of testing (2.2% per capita now tested).  The difference between the data curve fit from 0.5% per capita to 1% per capita to the data from 1% capita to 2.2% – the difference in projection for confirmation testing 500K is less than 1%.  Consistent results for everyone being tested – unless perhaps they keep testing the same sample over and over- then we are not learning much.

Now using the testing to identify hot spots and actively tracking and pinpointing areas to quarantine like S. Korea – that’s one thing.  However this is not being done – we seem to be testing in order to get the data to understand the extent.  You don’t need to test ALL to understand the extent – but you do need to get up to a certain percent to get a good understanding on the volume infected – NY and NJ case that’s around 1%.  Interestingly if you trust the data… estimates 43% of NY is infected if all 19 million tested.  15 states over 1% per capita now.  However some of those states you are not seeing a flattening yet Delaware, Rhode Island….Whereas states such as TX at 0.5% per capita tested has been quite consistent.  Current data for TX expected 7-10% of population infected.

Delaware curve looks scary as they have tested over 1% but no break in increasing test…

Continued discussion on https://covid19.healthdata.org/united-states-of-america/colorado  Still not right in my opinion….does this chart look like its peaked- Colorado 7 day avg daily difference…  The only positive thing on Colorado their confirmed case per tested has broke similar to TX at 0.5% tested.  Still very low testing and doesn’t show peaking as suggested by the site.

Weekend reporting subject to lack of reporting….

NY and NJ potentially reach peak for deaths per day.

Based on 7 day moving avg. daily death difference Italy, Spain, Iran, Germany, NY – all peaked.   The new areas of rising UK, Belgium, and India.  The UK PM was lucky as the death/confirmed in UK approaching Italy over 12%.