December 7, 2020 Dr Peter Van Houten
54rd update on the SARS II Corona Virus – Three weeks from last update
Exponential Growth of Viruses
This has been covered before, but viruses do not spread in a linear way – 1, 2, 3, 4, cases….
Exponential growth is doubling each day, 1 case, 2 cases, 4 cases, 8 cases, 16, 32, 64, etc….
The 1918-19 influenza pandemic showed us that the second wave was more severe than the first wave of infection. Seeing waves in viral illnesses is expected.
Thanksgiving Holiday “surge”
Takes about 2 weeks for case counts to go up after gatherings and exposure. To see if hospital cases go up as a result of Thanksgiving, it will be a couple more weeks after that.
Nevada County (about 100Kpop)
# of cases between March 9 and Nov 9 (8 months) – a little over 700 cases
In the last 4 weeks, Nov 9 – until now, there have been an additional 850 cases. Doubled.
Most states in the US and countries in Europe, are experiencing the same kind of explosive growth.
Need to remember that we are trying to balance three aspects:
1) Case Count
2) Health of Hospital system – poor outcomes escalate when the hospitals are overloaded. Those cases that may have good outcome when staffing and supplies are plentiful, may not survive when supplies and staffing are scarce.
3) Economy – more people relying on food banks to feed their family
Statistics
Nevada County (about 100k pop)
1570 cases, as of Friday afternoon. Up from 822 just 3 weeks ago.
Western NC – over 1000 cases Eastern NC – 525 cases
Case Positivity Rate: 5.4%, up from 3.3% An average daily positivity rate (over 14 days): 18.9%
3 weeks ago it was 4% – so 1 out of 5 tests is positive. This is a vast increase.
Hospital in NC is now under surge. 5 people in the ICU currently.
Looking at the zip code area where Ananda Village is: 77 cases 3 wks ago, now 184
Deaths in county: 16, up from 8 Most new deaths are in nursing homes. All the nursing homes in NC have new cases.
Case Fatality rate: 1%, pretty stable
Sierra County (3100 pop)
24 cases, up from 11
Hospitalizations: 2, up from 0 No deaths
Case positivity rate averaged over 14 days is 5%
Yuba County (80Kpop)
2400 cases up from 1800 Deaths 11, up from 10, Hospitalized: 16 9 in ICU
CPR – 8.5% Averaged over 14 days is 20%
Placer County (400Kpop)
7800 cases, up from 5200 (Their surge was a bit sooner than NC) Deaths 74, up from 63
CPR 5%, 14 day average is 12.3% CFR 1%
Auburn Area
600 cases up from 380
Population statistics
NC: 1600 cases per 100K pop
Sierra: 800 cases per 100K pop
Placer: 2000 cases per 100K
Yuba: 3000 per 100K pop
California: 3500 per 100K pop
US: 4600 per 100K pop
California (40million pop)
1.4 million cases up from 1.1 million 3 weeks ago
CPR: 5.6% up from 5.0% Averaged over 14 days: 8.1%
Deaths: 20K up from 18.3
Hospitalizations: 11,000 ICU 2400
Cases per day: 15,000 One day reported 30,000 new cases in a single day
US (330 mill pop)
15 million cases, up from 11.4 million
Over 26,000 in critical care, up from 15,000 3 weeks ago
Cases per day: over 200K
CPR: 7.3% up from 6.7%
Cases per 100K: 4600
Deaths: 290,000
Worldwide
68 million cases up from 55 mill
Deaths: 1.6 million
Critical Care: 110,000
Cases per 100K pop: 870 (better than the US)
Mexico (130 million pop)
1.2 mil cases up from 1 million
Lack of testing: only 3 million tests (US has done over 200 million)
CPR: 36%
CFR: 10% and holding
Deaths: 110,000 up from 100K
Cases per 100K pop: 900
India
10 mil cases up from 9 mil
Deaths: 140,000 up from 130,000
CPR: 7% and stable
Public Health Department Updates from last 3 weeks
They have divided the state into five regions and the region for NC and Ananda is called “Greater Sacramento Area”. The region is in “widespread” status. Don’t want to let the hospitals get any more loaded. Would like to have at least 15% ICU capacity that is not being used. Stay at home orders right now, will likely become a lockdown soon to preserve the hospitals and ICUs.
Shortening of Quarantine Period
CDC came up with modifications for those who think they have had an exposure. Has been 14 days and now they are saying that on a “case by case” basis, that could be shortened to 10 days. This may mean missing about 1% of cases. It is still preferable to be quarantined for 14 days, which would be safest.
If it was shortened to 7 days, with at least one negative test between 5 and 7 days of after exposure, that could be another option. A PCR test or Rapid Antigen Test – if negative you could leave quarantine for 7 days. This would result in 12% more cases.
It is difficult and inconvenient to quarantine, and this is an attempt to recognize that and get people back to work, but with a surge happening, it may not be a good time.
Medical Appointments
Most medical appointments are virtual or partially virtually, with decreased contact with the physician unless absolutely necessary. Emergency rooms are doing this more and also outside visits are more common now.
Nursing Homes
All nursing homes in NC are having trouble with virus infections now. Elderly are high risk, and they often do not have the classic symptoms. They may only have loss of appetite and fatigue.
California will open a new facility in the Sleep Train sports arena in Sacramento. This will be a convalescent area for those in recovery who can’t go home but do not need to be in the hospital. NYC is now dealing with the fact that some Covid patients were discharged to nursing facilities which resulted in elderly residents being infected.
Optumserve PCR Nasal Testing
Offered in NC, turn around is 4-7 days. Must make appt online.
Monoclonal antibody bamlanivimab
NC local hospital now has 5 doses on hand. Given in single dose treatment, given IV over 2 hours.
“Hard to pronounce, hard to deliver”. Saved for over 65, other high risk, factors, and want to keep out of the hospital.
Polyclonal antibody regeneron (the one given to Pres.Trump)
Also available – effective treatment
Vaccine distribution
Will probably begin middle of Dec. Two vaccines: Pfiser vaccine (requires very cold temp for storage) and Moderna vaccine (can be stored more normal refrigerator cold). Both novel vaccines, new. Over 95% effective. Some transient side effects in the first 24 hours.
Given to highest risk first – nursing homes and hospital staffs. Then essential services, medical personnel, first responders, etc. Not clear how many people want to have it. Then it may become required for air travel, employment, etc.
CVS and Walgreen’s will be part of distributing vaccines when more widely available.
Surge is filling hospital systems
Regional Center for Covid 19, Mercy San Juan complex, is completely full. This means other hospitals can’t refer to that facility.
Fire Dept is changing their first response for medical issues – they will not transport now in NC. Just ambulance services will transport. Hospital PPE supplies is good – over 90 days.
Local NC hospital has 16 ventilators. 8 hi flow O2 systems. Staffing is a concern.
Right now, most of hospitals are not allowing visitors.
Schools
Cases in most of the schools. Kindergarten and younger do very well with Covid. Most of the schools in NC will stay closed after Thanksgiving break and won’t open until January. That will be two 14 day cycles (28 days) to be safe after the holiday.
Curfew – not supposed to be out after 10 pm – 5 am, except for essential services. Not being enforced.
Currently restaurants in NC are suing the county because of closure orders.
Californa OSHA will come out with new recommendations with Covid considerations.
Significant outbreak sources are break rooms in businesses – recommended that masking be enforced and best to eat outside or another place with no one else around, open windows.
CDC travel advisory
For winter – recommending against travel for anything other than essentials. Could consider getting tested 1-3 days before travel and testing 3-5 days after. Quarantine for at least 7 days with a negative test before coming out of quarantine if you must travel.
Ivermectin – still a potential outpatient oral medication. Cheap, well tolerated. Dosing is simple.
Jyotish and Devi – no news.
Q: Have N RNA vaccines been done before? What about long term safety studies? Should we be concerned about the lack of knowledge?
A: No, this is a novel approach. We do not have long term studies. There is concern about the lack of experience and knowledge in this field? I (Dr Peter) will probably take the vaccine because it it my duty to take care of people.
Q: Will the virus mutate and nullify the effectiveness of the vaccine?
A: Great Question! Remember the story of the virus that got into the minks and transmitted back to humans – that was a mutation. Don’t know if the vaccine would work.
Q: Do we have any information about the virus in other colonies?
A; No, I haven’t been in touch with colony leaders. I will talk about that next time.