40 Million Plus 1 ... and NYC on the Brink of a Precipice. October 5 weekly Epi Update.

Although there have been 7.4 million reported infections in the United States with the virus that causes Covid, estimates suggest that the number of actual infections is about 40 million, at least. The infection of President Trump is the most prominent, and one of the most telling.

My thoughts are with the President, First Lady, their family, and all others infected with and affected by Covid. The President’s infection is a reminder that Covid is an ongoing threat. No one is safe – not even heads of state – until everyone is safe.

Risk of severe illness and death increases steadily with age. A 74-year-old has approximately a 3% chance of death. Once it became clear that he had symptoms, the estimated risk increased to about 10%. If he had a clear indication for hospitalization (moving him to Walter Reed was clearly the responsible thing to do, whether or not he had an indication for hospitalization), the risk could be as high as 25%. The risk is even higher in males than females, and higher in people who are obese, and lower with good care. 85-90% of those infected in their 70’s will have no, mild, or minor illness. Of those with symptoms in this age group, 90% recover.

People who get prompt medical care, including oxygen, likely have better outcomes. Remdesivir may reduce the duration of illness. The data on convalescent plasma is contradictory. Monoclonal antibodies, which the president received, are promising (especially early in illness) but unproven. Dexamethasone, which the president also received, may reduce the risk of death by about a third, but is generally thought to be most helpful late in the course of illness, when a patient’s own immune system, rather than the virus, is causing much of the harm.

Testing is only useful as part of a comprehensive strategy. What’s important isn’t how many people are tested or how often, but what is done with testing to reduce risk. Testing doesn’t replace wearing a mask, watching your distance from other people, and washing your hands.

It’s a plain truth that face masks protect others, and almost certainly protect yourself as well. The more people who wear masks when we’re near others, the safer we’ll all be. Did the extensive testing done at the White House give a false sense of security? Absolutely.

We need to rebrand contact tracing. Let’s call it what it is: supporting people who have Covid and those who were exposed to it. Could Vice President Biden and Chris Wallace be at some risk from the debate? Maybe. The louder someone talks, the greater chance the virus will spread.

Every person infected with Covid is a step backwards in our effort to slow the pandemic and reopen society. We’re nowhere near herd immunity, and getting there without a vaccine would cost hundreds of thousands of lives and millions of jobs.

We must better prevent and treat this virus. We’re all in this together, and the better we prevent and fight it, the more lives we can save, and the sooner and safer we can get to the new normal.

Overall in the US, most states had increases in Covid spread during the month of September. 

The new trend feature on Covid Exit Strategy is helpful, although the trends are discouraging.

The only states with reassuringly low rates of Covid are Maine, Vermont, New Hampshire, and perhaps Connecticut. Many states, such as Florida, are opening despite persistently high positivity rates, and will inevitably have further increases in the coming weeks. These actions raise the question: is this action, which will increase cases in a month, intentional or just neglect of science?

Closer to (my) home, NYC is on the edge of a precipice. We’re seeing extensive and ongoing spread in religious communities and likely beyond, meaning there’s a very high risk of a resurgence. Here are the positivity rates in hotspots, according to Governor Cuomo (Media statements from the city government have shockingly lacked basic information on the number of people tested and positive cases, as well as on trends).

For more than a month, NYC has had 300 or so diagnosed cases a day, but we still lack basic information about how the city is doing. We need to know:

• What proportion previously identified as contacts and were in quarantine already?

• For how many was the source identified?

• Average time from symptom onset, or test taking, to isolation?

• Are cases isolating? Contacts quarantining?

It’s challenging to work with a religious community that doesn’t trust the government. How about hiring 1,000 people from the community through acceptable intermediary organizations to fight Covid? The key is to start ASAP, standardize training and performance monitoring, and get community buy-in.

Gandhi’s birthday was Friday. I think about his call to empathy and to recognize that our enemy is hatred. We’re all connected. Unless we work together to fight Covid, the virus will continue to have the upper hand.