Monday October 5, 2020

Sars2 Coronovirus Pandemic Informational Update with Dr. Peter, Jyotish and Devi, from Ananda Village, in Nevada County, CA

Update #50

Our schedule will now continue on the 1st and 3rd Mondays of each month.

Statistics – Population based per 100K. Number comparisons are based on today as compared with 2 weeks ago.

Nev. County – (as of Oct. 2) Population about 100K. NC is at 543 total cases, up from 506. Western Co. 337 cases, up from 310. Eastern Co is at 206.

Case Positive Rate (CPR) is still stable at 2.7% . In Ananda’s and Nevada City’s zip code area, we are at 45 total cases, up from 41. We have a CFR of 1.3% We’re such a small population so even one death changes the CFR goes up easily with one extra person. Nevada County has had a total of 7 deaths. 3 people are hospitalized.

Counties surrounding Nevada County

Sierra County – 3100 population. Still 6 cases total. Case positive rate is stable at 1%. No new cases recently. No deaths.

Yuba County – 80,000 population – Now close to 1200 cases, last time they were at 1100. CFR close to 3.3% ; 9 deaths total, up from 7. 4 people in hospital.

*Placer Co. 400,000 population, includes the town of Auburn – now over 3600 cases, up from 3466. Case positive rate is at 3.7% 49 total deaths, up from 41. Town of Auburn specifically – had 277 cases, up from 269.

Looking at Population based cases – in last 2 weeks, Nev. Co. 543 per 100K, Sierra Co. 193 per Placer Co. has 907 per 100K, Yuba Co. 1500 per 100K. California has 2100 cases per 100K.

*California – Population 40 million – 833K total cases up from 786K. Case positivity rate in CA continues to fall to 5.4% from 5.8%. 16K deaths from 15K.

Case fatality rate still stable at 1.9 % based on lab testing and confirmed cases.

USA as whole – 330,000,000 pop. Cases at 7.6 million, up from 7million. The daily case gain has been about 30 – 45K new cases per day. (considerably better than when we were getting 70K per day) Deaths 215K up from 204K. Average about 300 – 1000 deaths per day. CPR 6.8%. For US we are seeing 2300 per 100K population.

World Wide – we now have 36 million cases and 1.1 million deaths. Population based numbers: 450 cases per 100K people.

Mexico – Population of 129 million (less than 1/2 US) Up to 760K up from 700K cases 79K deaths up from 7000. Case Positivity Rate is still extremely high but down from 46% to 38%. Case Fatality Rate – stable and high at 10.3%. Similar to early Italy and New York.

India Population (4 x size of US) is 1.3 billion – 6.6 million cases up from 5.4 million total cases. Having 70 to 90K new cases per day. Recorded deaths is 103K up from 88K. recording about 1000 deaths per day. CPR is stable at 8.4%, Population CPR is 478 cases per 100K.

This is a good year to get a flu vaccination, even if you don’t normally get one. Even among health care providers, in previous years they haven’t all taken flu shots. This year it’s looking like about 90% of them will be getting the flu vaccine, which helps protect everyone. CDC says which flu shot you get doesn’t matter much, just get one. There is a special formula for those 65 and older – The High Potency Vaccine – it does seem to give a somewhat better immune response in those 65 and older. It has a slightly higher side effect profile, so it’s a balance. Most important is to get a flu shot, regardless of what type is available.

For everyone in the Ananda community, you can get the vaccine at the clinic, however they don’t carry the high potency vaccine. CVS and other pharmacies do have the high potency vaccine. The clinic is offering during any scheduled visit. They are also offering a Walk-in flu shot clinic: Mondays 2-3pm, and Thursdays 9 – 11am. Most insurances cover it completely. If you don’t have insurance we are offering it very inexpensively.

Public Health Department and Community Health and Primary Care Physicians.

The state has not given any special guidelines yet, on Halloween.

*Clarification: How the statistics are counted to include Covid-19 as the cause of death. In the US someone will only be counted as a death because of Coronavirus, if the Covid-19 appears as one of the causes of death on the death certificate.

People may have additional things happening, even if they have Sars2Cov. Even if Covid could be a key player in the final cause of death a person but the person’s death was, say, a heart attack, they may not be counted in the Covid-19 statistics, even though the clotting or cardiac damage may have been caused by the Covid-19 virus.

If someone was released from hospital, and died a couple weeks later, they would not be counted as a Covid death, the death cause would be stated as whatever the final system failure was. We have some examples of this sort of thing in Nevada County.

When Vaccine for Covid-19 comes available, the first group offered it will be front line health care workers and care facility staff. This will include dentists, medical assistants, etc.

We’re not clear on how a vaccine will be received. “I will not recommend a vaccine if I wasn’t willing to get it myself.”

Part of recommendation of getting a flu vaccine, it is possible to get influenza and Sars2Cov simultaneously, since they are different viruses. We don’t want to start having a “Twin-demic.”

Late Dec. Jan, and Feb, starts diminishing in March. We start getting our sentinel cases in October/November. We may have an earlier flu season than usual (this is laboratory confirmed influenza and not just viruses going around that we casually call “flu” – Lisa) It takes a couple of weeks for the vaccine to become protective after you receive it.

Schools in Nevada County – are having Hybrid schooling – some in-person visits and some online. Only 1 case so far in the county. A child became symptomatic during the school day, was tested positive, and the students in the class were put into quarantine. No one became infected by them.

The largest high school in Nevada County will split the student population in half, having half the school population come for in-person classes Mon/Tues, and the other half Thurs/Fri, with video conferencing for the rest.

Difficulties of Keeping Medical Offices Open – many support staff in medical offices have children at home doing schooling, or have become ill. Our clinic has ongoing employment available, if anyone is interested. It’s a great place to work and we follow very good safety procedure. Always happy to have people from the Village working there.

How Sars2Cov Spreads – Super Spreaders and Super Spreading Events

Is a learning experience- the dynamics on how it spreads is different than influenza. They are both respiratory viruses. Wearing masks protects everyone from both.

How influenza spreads person to person is more predictable, and how likely they are to pass it to someone else.

Sars2 Coronavirus is more capricious. It’s a bit more random. “Super-spreaders.” refers to how it can be spread more robustly by a handful of individuals, than by everyone who is infected. It explains why we have circumstances such as Lombardy Italy, where one region was extremely hard hit and other places weren’t nearly as hard hit.

A number of cases worldwide where there have been high concentrations and high levels of fatalities, like NY, Lombardy Italy, Spain, Wuhan China, Quito Ecuador – where people were dying in front of the hospitals because they were so overwhelmed.

Then we look at how we are experiencing it in CA. We’ve had a significant outbreak in CA, but hospitals have not been overwhelmed.

Super-spreader individuals and events – There are individuals who are more likely to pass the virus for reasons we don’t understand. Super spreading events seem to happen in crowded conditions, especially a poorly ventilated indoor space where people are not wearing masks, or very few are.

For perspective, let’s take an example of an influenza – say with an RO of 2. If 10 people had seasonal flu, R0 of 2, each of the 10 people would likely infect 2 other people. This means we end up with 20 new cases. It’s a homogenous transmission.

With Sars2Cov, we have an RO of 2. For the example – 10 people have it. 8 people don’t end up spreading to anyone else. 2 of those individuals give it 10 people each. We still end up with 20 people infected. The RO is the same, but these two viruses have very different characteristics. With many “super-spreaders”, it can spread it to so many more people.

Contract Tracing – our technique has been designed for Influenza. We go back 48 hours only, to identify everyone the newly infected person has had contact with. These contacts go into quarantine and monitor them for illness.

Tracing for super-spreader Sars2Cov infection – they are contagious 5 days before they became symptomatic. It changes how we ought to be doing our contact tracing. We need to look at how this person originally contracted the virus, because they may have contacted it through a superspreader themselves. South Korea is trying to work backwards to see where someone was first exposed, rather than going back only 48 hours. We ought to be doing this.

Super-spreader Cluster focused on an event at the White House – Presidential Debate and a large outdoor function at the White House in the Rose Garden where many participants were not wearing masks or paying much attention to physical distancing. That could have been a superspreader event. We’re now at the high 20’s for positive tests by those attending, including the president, his wife, senators, reporters, press secretary. It shows how a single event can behave this way. We’re early in understanding what happened in this.

It’s also possible the super-spreading event was during the prep for the presidential debate, and then they went to the White House event.

President Trump – I noticed during the debate the President’s face was perspiring – he may have been having symptoms already. Peter noticed it but thought it was probably the stress of the stressful situation. Sweating is a common early symptom of having a virus.

The President’s Treatments – Having only the news reports that are being released, we can be unsure about what is really being done to treat the President. It’s difficult to get accurate information.

He is over age 70 – a risk factor, and he’s somewhat overweight, both higher risk factors. He doesn’t have high blood pressure, coronary artery or pulmonary disease. He had some fever, some shortness of breath, and O2 saturation had fallen a couple times after hospitalization. This puts him in the mild to moderate level of the Covid-19 illness.

He was treated with Vitamin D, Zinc – helpful in blocking the Bradykinin cascade, gave Melatonin which has found to be helpful, Famodatine (Pepsid) for stomach acidity, nasal cannula O2 as a supplement, and additional Polyclonal antibody made by Regeneron.

They produce antibodies for viruses – they identify the antibodies that appear to be neutralizing to a specific virus, and are able to manufacture them and make a combination cocktail that can be infused by IV. Similar to using Convalescent Plasma.

The Regeneron cocktail is just Covid antibodies so it’s specifically targeted for Sars2Cov. It is given as a single infusion and is good for several weeks and the antibodies stick around for quite a while. This would be very expensive.

He also received Remdesivir – needs to be given daily, and seems to speed recovery but doesn’t have affect on mortality. $3000 for a course or more. He has also received steroids (Dexamethasone) which is only good for people who’ve had shortness of breath and O2 level changes. Steroids are given for inflammation, and given in tapering doses over many days until discontinued.

He probably did not get Hydroxychloroquine, it would have been too late for it to be helpful. No mention of using Ivermectin. Peter will be watching to see what all they use, as time goes by.

We don’t know exactly when the president had his first symptoms. This would tell us a lot about where he may have acquired it. It’s usually a week before someone shows their first symptoms and become hospitalized. There can be a few days where people begins to feel better, then they can move into getting very sick.

Jyotish and Devi – No more new cases in Vrindavan at the Yogananda Home, and everyone seems to be asymptomatic. Ended at 9am. Next broadcast in 2 weeks.