October 19, 2020
Update with Dr Peter Van Houten
Statistics – last update was 2 weeks ago
Overall, there are fewer symptomatic cases out of the total people who are tested with PCR nasal testing, compared to March/April time period. There may be some false positive tests and there may be testing happening on people who have already had the virus and no longer contagious.
Nevada County (100K pop) 581 cases/ up from 543, most in the western part of the county. 8 deaths. Case Fatality Rate 1.4% Case Positivity Rate in NC: 2.7% stable; 581 cases per 100K pop
95959 zip code (Ananda Village and portion of Nevada City): 51 cases / up from 45
Sierra County (3100 pop): 6 cases, CPR <1%, no deaths, no new cases; 193 cases per 100K
Yuba County (80K pop): 1250 cases / up from 1200; CPR 4.6% up from 3.2%, 10 deaths; 1566 per 100K
Placer County (400K pop): 3900 cases / up from 3600; CPR 3.6%; deaths 52 / up from 49; 970 per 100K
California (40 mil pop): 2187 cases per 100K
875K cases / up from 833K
CPR: 5.1% falling from 5.4%; deaths 17K up from 16K,
Long Haulers: rough estimates that about 10% of cases may have long term effects and disabling symptoms over a long period of time. May have 90K people who become long haulers in California.
USA (330 mil pop): 8.4mil cases / up from 7.6mil; increasing to 50 – 75,000 new cases per day; deaths 225,000 up from 215K; 68 deaths per 100K pop; deaths per day approx 300 – 900 (has dropped a bit); CPR 6.7% dropped from 6.8%; 2500 cases per 100K
Worldwide: 40mil cases up from 36mil; deaths 1.2mil up from 1.1mil; 516 per 100K
Mexico (129 mil pop): 847K cases up from 760K; deaths 86K up from 79K (about 500 per day); CPR 39%; CFR 10.2% stable; not able to effectively test
India (1.3bil pop): 7.5 mil cases up from 6.6 mil; 60 – 70K new cases per day; deaths 114K up from 103K; deaths per day 500 – 1000 range; we may never get a full estimate; CPR 8% down from 8.4%, 545 per 100K
Looking at 2 of the hardest hits states in the US and comparing to other countries:
New York (20mil pop): 184 deaths per 100K *a true medical catastrophe
New Jersey (9mil pop): 172 deaths per 100K
compare to Belgium (11mil pop): 90 per 100K
and Bolivia (11mil pop): 72 deaths per 100K
Weekly Meeting with Public Health and Providers in Nevada County
Several weeks with no new outbreaks in nursing homes
Case Positive Rate: now in yellow zone (minimal)
County is in the Orange zone (moderate) right now and may be able to move to Yellow (minimal) if numbers keep going in the right direction. Yellow zone means more options.
Main mode of spreading Covid is through droplets, but it is clear that some cases are being spread by aerosal. Virus particles floating in the air. Being in closed, poorly ventilated spaces is problematic. Must keep at least 6 feet apart in those conditions.
Possible vaccine by the end of the year. Made available in tiers, with high exposure risk first (first responders and seniors) If vaccine offered in Jan or Feb, it wouldn’t be until summer before those who want it will have it. How long until we don’t have to wear masks? 9 – 12 months after people are immunized. Maybe middle of 2022? Things may look different by then.
People who have tested positive and get retested in less than 90 days, are not considered a new infection. If it is past 90 days, then it would be considered a reinfection. Recommend a viral culture at that time.
After testing positive – after 10 days without fever; no anti fever meds; and with improving symptoms, you are allowed to go back to work safely (without retesting).
Rapid Testing Abbott ID machine (which Dr Peter’s clinic will be getting soon): results are now seen as equal to an “in laboratory” test. They can start contact tracing immediately without waiting for a confirmed test that would take much longer. Better sensitivity. Some false positives. Best for people who are symptomatic and not “peace of mind” testing.
Antigen testing: still primarily being handed out to nursing homes for rapid testing. Some false positives.
From the MMWR (Morbidity and Mortality Report for US) Arizona – when they had a big uptick in cases and responded with increased compliance of mask use, the case rates dramatically decreased. Used as an example of how masks are important.
There have been some cases of people getting Covid, who were wearing masks and some people are using this as data that says masks don’t work. But these were people with higher than normal exposure, such as health care workers. Self reports of wearing masks are also questionable. This is not evidence that masks do not work.
Schools in NC are doing well. Nevada Union now opening to limited in person instruction.
No cases of influenza yet in NC, but some cases in California. Good time now to get immunized.
More people getting flu shots this year. Many places doing free clinics.
CDC not recommending one vaccine over another. The “high dose” vaccine may have a better immune response for those 65 or older. Available at pharmacies. Good idea if you are exposed to public a lot, or high risk.
Oregon and Nevada getting hard hit by Covid and there is concern it will move over into California.
**Please stay home and don’t expose others if you have ANY symptoms of an infectious illness.**
Probably a good time to stock up a bit on consumable products, before the winter hits and possible uptick in cases.
One way to look at fatalities from Covid is to look at “excess deaths” which is a technique used to compare average baseline deaths during a time period in the past with the same time period in the current year. For example: March – July of 2020 there is 20% excess deaths (225,000) over previous years in that time frame. About 2/3 of those deaths could be directly attributed to Covid, and 1/3 may be unconfirmed cases or other reasons, such as people being fearful of going to the doctor during lockdown.
How many people in the US have already contracted Covid and are recovered? Serologic testing can show antibodies. One large study with 30,000 subjects (dialysis patients who have regular blood testing). This population is high vulnerability and have higher exposure than most people. Found less than 10% had antibodies. Not enough for herd immunity.
India: Right now they are at 60 – 70K new cases per day. A bit of improvement for that country.
Superspreaders: The Sars II Corona virus has an odd way of spreading that is different from influenza. It is not evenly spread, with each person infecting one or two others. Covid is spread in a much more concentrated fashion, with just a handful of people spreading the balance of the cases.
New study showed that just 8% of the cases caused 60% of new infections. Or 7 out of 10 cases were not linked to any transmission. The more even transmission is called “deterministic” and the more random distribution is called “stochastic”.
Another reason to wear a mask and protect others, in case you are one of those who can spread the disease to many others.
Remdesiver has been shown shorten hospital stays but not change mortality. 3 days of treatment is as effective as 5 days.
Regeneron antibody treatment (President received) has emergency approval by FDA. Trying to make widely available.
Perfect storm of conditions?
Covid: hard to know how it is going to go through the winter. Fewer deaths because we are getting better at treating. But may go up because people will be inside more.
Economics: Stimulus – may have repurcussions
About 60% have gone back to work, but the 40% that is left may never return to work or business.
Political: Division, controversy
Best not to get too caught up in the news.
Jyotish and Devi: They talk with Ananda India frequently. India statistics not reliable. They are doing well.
Q: N95 masks are hard to find and expensive. K95, made in China, are reasonable alternative?
A: These are needed for health care workers, dental offices, etc. The K95 are an alternative. A face covering, cloth or surgical masks, is what is important. The difference is not so critical if you are not in high risk situations.
Don’t use the ones with exhaust valves – that defeats the purpose of the masks.
Q: Is testing at 5 days helpful for shortening quarantine?
A: Good to pay attention to the time frames because testing is not perfect. If symptomatic, test now.
If quarantining after a trip and not symptomatic, day 5 and day 11 works well.