November 16, 2020 Dr Peter Van Houten

53rd update on the SARS II Corona Virus – Two weeks from last update

“Honey Badger” – phrase coined by an epidemiologist to refer to Corona virus that does not want to be contained. Appears to be a second wave/resurgence across the country.

Takes about 10-14 days to see the results of events that spread the virus. Uptick in cases following Halloween.

11/13/20 US had 187k new cases. Record numbers also in Europe and British Isles. They seem to be a week or two ahead of the US.

Viruses replicate exponentially, not linearly. Cases lead to clusters, clusters lead to explosion of cases. Individuals are infectious to other before they become symptomatic. We have been thinking being reasonably careful is enough, but we may have to go back to being much more aware outside of our own housing “bubbles”.

Statistics (rounding numbers a bit for simplicity)

Nevada County: 822 cases / up from 580 4 weeks ago. Approx 820 cases per 100k population

Hospitalized: 4-5 cases per day, 1 in ICU

Case Positivity Rate: 3.3%, up from 2.8% In 95959 zip code, the number of cases has go up to 77 from 51. Deaths steady at 9. Case Fatality Rate 1.1% Deaths take a while to see after the case rate goes up. About 1-2 weeks from the event the hospital rate goes up, then 2 more weeks the deaths go up.

Sierra County: Jump in cases. Have been at 6 cases for months. Now 11 cases. Case positivity 1.1%.

Approx 350 cases per 100k pop

Yuba County: 1550 cases / up from 1250 cases 4 wks ago. Case Positivity 5.4% up from 4.6%. Deaths stable at 10. (Peter realized he misreported this number on the last update)

Approx 1950 cases per 100k pop

Placer County: 5200 cases / up from 3900 cases. Case Positivity stable 3.7% Deaths 63 / up from 52

Approx 1300 cases per 100k pop

Auburn Area: 390 cases / up from 296

California: 2600 cases per 100k pop

1.1 mil cases / up from 875k, Case positivity 5.0% stable, Deaths 18k up from 17k

US: 3400 cases per 100k pop

11.4 mil cases / up from 8.4 mil, ICU cases (had been going down. 15K cases 4 weeks ago.)

Now 20k cases. Cases per day – (had been 30-50k per day) High of 187k in one day last week

More testing is being done and there are some false positives, but most cases being found needed to be found. Case positivity rate is staying pretty stable at 6.7%.

Worldwide: 55 mil cases / up from 40 mil just 4 weeks ago. Deaths 1.3 mil / up from 1.2

700 cases per 100k population

Mexico: 1 mil cases / up from 850k, Deaths 100k / up from 86k, case positivity 39%, Case fatality 10%. 800 cases per 100k pop (maybe related to low testing)

India: 1.3 billion pop. 8.8 mil cases / up from 7.54 mil, new cases 30 – 50k per day, deaths 130k up from 114k. Case Positivity 7.1% down slightly from 8%. 650 cases per 100k pop.

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Nevada County Public Health weekly meeting

One outbreak in a church setting and one outbreak in a daycare setting. Slow uptick in cases started in early October. Washo County in Nevada (next to CA border) had a surge in cases with 30% increase. One of their hospitals is using a level on their parking garage for patients.

Tiered levels in California for risk and restrictions: most counties probably going back to more restrictions

Yellow – tier one, minimal

Orange – tier two, moderate

Red – tier three, substantial

Purple – tier four, widespread

Asking people to please wear a mask, don’t go anywhere if you are sick, make sure you are monitoring yourself and getting tested if you could be sick.

Workplaces that have good controls in place are having very few cases. Most of the cases are due to poor controls in one aspect of the workplace, or one person who comes to work sick.

Probably an increase in all viruses in the winter. People indoors more, closed windows and harder to be outside where it is safer.

If someone is tested positive with PCR nasal swab technique – why can’t they be tested weekly until they are negative and cleared to go back out to work? The problem is that weeks after being sick and contagious, someone can have inactive virus in their nose that is picked up on a swab. It’s not helpful to do repeated tests. Better to go by time and symptoms. 10 days out from positive test – no fever and no other symptoms means the chance of being infectious is very small.

Vaccines: Two new vaccines reporting positive results. Pfizer vaccine and Moderna vaccine. New kind of novel vaccine using N Rna to create the immune modulators needed. Pfizer vaccine needs to be stored at -80 degrees, the Moderna vaccine can be stored in a standard freezer at – 20 degrees.

These are both two shot series given 4 weeks apart. Johnson and Johnson close to releasing a one dose vaccine.

Hoping to start giving to healthcare workers in December. Possible that we can reach the goal of getting to large part of the population by summer.

Nevada County hospitalization rate is higher than normal. Hospitals are full or close to full, which is true of many hospitals in the state. California was assisted by federal workers a few months ago and now those federal workers are helping the states in the midwest with the surges they are having there.

Minks and SARS II Corona Virus

Some domestic cats, lions, ferrets, have been known to be able to catch the virus from humans. They were only able to spread to the same species, not back to humans. But now the mink population in Europe have developed an explosive epidemic of the Corona virus. In Denmark it has jumped back into humans. The particular mutation is the D614 G, which seems to be more infectious than other mutations. Not sure how the vaccines being developed will affect this mutation. They are now culling the population of many of those minks.

Testing in Nevada County:

Continue to be open and testing 180 tests per day. Increase in demand for testing. Looking for getting an antigen test as well. Still in line to get an Abbott PCR machine.

PCR nasal swabs results in 2-4 days usually. Turn around time may be longer. Good idea to isolate until you have a result.

Schools in NC:

Elementary schools grade 6 and younger, are doing well. The young children don’t seem to spread the virus readily. One outbreak in a high school football team.

Eating in common areas:

Continuing to recommend that people avoid break rooms, where people are eating around others. Suggesting that meal breaks be taken away from others or outside or in your car. Closed rooms with no ventilation and no masks are high risk.

Traveling to California:

Self quarantine for 14 days, can be around immediate family. First responders are exempt to this requirement.

In counties moving to purple tier from orange tier – Should not even be outdoors without masks and high risk people should not attend events even outdoors.

Mental Health complications caused by virus and neurologic changes:

Around 20% of people who have had symptomatic COVID19 infections have significant mental health disorders. Most common is an anxiety disorder. Virus can cause changes in the brain.

New monoclodal antibody got an emergency authorization from the FDA.

Give as single infusion of specific neutralizing antibodies of one type that have been synthetically created. Given by IV over a period of 3 hours. Given to people who are sick and symptomatic. Same infusion centers where people get chemo and other treatments and those are a high risk population.

This creates problems. Only good in first 10 days of symptoms. Limited supply.

Seems to be helpful – readmission rate for complications is much less.

Preventive Nasal Spray

Lipopeptide nasal spray acts as a molecular blocking mechanism in your nose. Being studied in ferrets. Looking at doing tests in humans. Current form works for 24 hours. Maybe use once a day as a preventive?

Antigen tests

This type of test is a rapid test – low cost and a little less sensitive. Can test someone repeatedly to make sure of results. Slovakia is having success with this.

Jyotish and Devi:

Some cases in the Italy sangha. Trying to be very careful.

Some cases in the India sangha also. Only one hospitalization.