We have updated our predictions for COVID-19 infections and deaths by October 1, 2020 and a new prediction for November 4, 2020. We had predicted in June that there would be 3,887,718 COVID-19 infected patients in the United States. Our estimate, based on 3,887,718 infections on October 1 (inclusive) was that we would have 170,492 deaths. Based on a decreased crude death rate and uncontrolled increases in the number of infections the last two weeks, our new prediction for October 1, 2020 is that we will have a total of 6,689,398 infections and a total of 183,725 deaths (+ or – 1,328 deaths). By November 4, 2020 we predict there will have been a total of 8,124,504 infections and 203,241 total deaths (+ or – 1829 deaths). With rapidly changing infections and an unstable crude death rate, our reassessment of infection and death predictions will occur again in 2 weeks.
On October 1, we predict there will be 3,887,718 COVID-19 infected patients in the United States. Our estimate, based on 3,887,718 infections on October 1 (inclusive) would be that we will have 170,492 deaths. Depending on whether the death rate changes, we could have upwards of 205,266 deaths, but we feel confident, based on our modeling, that the number of deaths will be closer to 170,492. We will be reassessing these numbers every 7 days.
For daily COVID-19 updates, follow Dr. Wright on Twitter!Follow @dcwrightmd
By our way of counting, this is Day 161 of the COVID-19 pandemic. To date, we have neither a vaccine nor a widely available drug to effectively treat or prevent this infection. Our first USA case was identified in Washington State on Day 21 of the pandemic. In those next 140 days (20 weeks) the United States, as of 6/08/20, had 2,007,499 known COVID-19 PCR positive infected patients and 112,469 deaths, giving us a death rate of 5.6%. We had 18,905 new cases and 16,923 people in serious or critical condition on that day. That was the twentieth consecutive day that we’ve had over 16,900 people in serious or critical condition in the United States. We have 1,315,537 more COVID-19 positive infected patients than any other country in the world. The five countries other than the United States with the most cases (Brazil, Russia, Spain, the United Kingdom, and India) have a total of 1,991,945 cases combined, which is 15,544 fewer cases than in the United States.
Four rapidly expanding “hot spot” countries on 6/07/20 are India with 257,486 infections and 10,864 new infections, Peru with 186,515 infections and 4,757 new infections, Russia with 467,673 infections and 8,849 new infections and Brazil with 691,962 infections and 18,375 new infections.
Our Updated COVID-19 Projections
The University of Washington’s Institute of Health Metrics (IHME) said on 4/28/20 that we would have a total of 74,000 deaths in the USA by August 5, 2020. In contrast to this, we analyzed the case and death data using our two methods again on 5/22/20. We estimated that we would reach 2,000,000 infected patients by June 7th (in 15.4 days, 369 hours or 2.2 weeks) and have between 17,710 and 20,513 new deaths for a total number of deaths between 115,357 and 118,156. The actual numbers by the morning of June 8th were 2,007,499 and 112,469 deaths (Worldometers). We use the Worldometers numbers rather than the Johns Hopkins numbers because Worldometers includes Veteran deaths in VA facilities, deaths in the US Military, deaths in Federal Prisons, and deaths in the Navajo Nation.
Our estimates of the number of COVID-19 deaths on June 7th were higher than the actual deaths by 2,888 deaths or 2.57%. We think this overestimation of the number of deaths might be because of hyperimmune plasma use, Remdesivir use, use of both or possibly better critical care at US hospitals. Other possibilities might be decreasing virulence of COVID-19 or flaws in our predicted models of deaths. Our modeling of the number of infected patients was off by 0.37% or 7,499 additional infections.
All of our past predictions from 4/28/20, 5/03/20, 5/08/20 and 5/22/20 for time to reach 2,000,000 infections and the estimate of the number of deaths are listed in the following chart:
A month ago, the University of Washington re-projected the number of deaths by August 4, 2020 to be 134,475. When we checked their website on 5/23/20, they had revised this number to 143,357.
We don’t usually project out 2 months for total infections and deaths, but if we did, using our methodologies, in our new projections over the next 58 days we would predict that by August 4, 2020 inclusive in the United States we will have 3,264,069 COVID-19 infected patients and a total of between 165,307 and 182,836 deaths. If the death rate (now 5.60%) decreases further, these estimates of the number of deaths will be too high.
State of California
As of 6/07/20, the State of California has 131,319 total infections, 2,279 new infections, 4,653 total deaths. On 6/07/20, California reported 4,506 hospitalized COVID-19 patients (on that day) and 1,301 patients in the ICU. If California were a country, it would rank 18th in total number of cases in the world (above China) and 14th in total deaths (above Mexico). It would rank 4th in the world in ICU patients (between Brazil and Iran).
As of 6/07/20, Monterey County has 763 total COVID-19 infections, 12 new infections and 11 total deaths (3 new deaths since our last report on 5/24/20). An unknown number of deaths (< 11 according to CPHD) have been reported at a skilled nursing home in Salinas (Windsor The Ridge Rehabilitation Center). COVID-19 infections in Healthcare workers at two other skilled nursing facilities in the cities of Monterey and Soledad have been reported to CPHD. Two infected State prison employees have been reported in a state prison in Soledad.
We have expanding numbers of infections in eight zip codes 93901 (Salinas, 54 total infections), 93905 (Salinas, 233 total infections), 93906 (Salinas, 144 total infections), 93907 (North County, 31 total infections), 93926 (Gonzales, 28 total infections), 93927 (Greenfield, 67 total infections), 93960 (Soledad, 49 total infections) and 93930 (King City, 63 total infections). We continue to have new infections and deaths in our county that are not occurring in our neighboring agricultural counties Santa Cruz and San Benito Counties. We have five times the number of deaths that Santa Cruz and San Benito County have. We are not yet seeing infections in Pacific Grove, Carmel, Pebble Beach, Carmel Highlands or Carmel Valley. The differences in total infections in parts of our county compared to these other counties, valleys and cities have not been explained by public health officials.
Coronavirus in prisons: See which area of the San Joaquin Valley is the most impacted https://www.fresnobee.com/news/local/article243315226.html
Protest held at Avenal State Prison after COVID-19 outbreak inside facility https://abc30.com/protest-avenal-state-prison-covid-19/6235421/
Chicago coronavirus: Autopsy shows Chicago infant died of COVID-19 in March, ME says https://abc7chicago.com/illinois-coronavirus-cases-chicago-update/6241173/
Marginalized communities across the globe have been disproportionately affected by the COVID-19 pandemic. Over the next week we’ll be spotlighting some of these communities and providing links to organizations that are working to help them access medical care, economic relief, and other essential services. We invite you to LEARN by reading about these communities and their unique challenges during the pandemic, DONATE to organizations that are helping, and ADVOCATE by signing petitions and contacting your government officials.
Civil Rights Activists and Communities of Color
Over the past few weeks, millions of anti-racist activists have taken to the streets to protest and seek justice for George Floyd, Breonna Taylor, Ahmaud Arbery, Tony McDade, and other victims of police violence. On May 31, the Associated Press estimated that more than 4,000 people across the country had been arrested over several days of demonstrations. As they exercised their first amendment rights, activists bravely risked both exposure to COVID-19 and injury at the hands of police and white supremacists. Now, many sit in jails unable to afford bail. We know that the risk of COVID-19 infection is much higher in institutional settings like jails and prisons, so it’s imperative, for their safety, that anti-racist activists be freed on bail as soon as possible.
- Campaign Zero
- Black Lives Matter: What Matters
- I-TEAM: Bail doubling for some protesters arrested over the weekend
- How a Minnesota Bail Fund Raised $20 Million
- My Brother’s Keeper Alliance Town Hall with President Obama
- National Bail Fund Network
- Grassroots Law Project
- Minnesota Freedom Fund
- The Liberty Fund
- LGBTQ Fund
- Know Your Rights Camp
- Public Goods – A Mutual Aid Project for Minneapolis Public Housing Residents
- Covid-19 Mutual Aid Network – Los Angeles
- Black Lives Matter – Los Angeles
- Peoples City Council Freedom Fund
- SF Community Support
- Colorado Freedom Fund
- Atlanta Solidarity Fund
- Northwest Community Bail Fund
- Take Action Chapel Hill
- Nashville Community Bail Fund
- Louisville Community Bail Fund
- Detroit’s Bail Fund
- Vegas Freedom Fund
- New Orleans Safety and Freedom Fund
- Petition: Justice for George Floyd
- Petition: Justice for Breonna Taylor
- Petition: #JusticeForBre
- Petition: Justice for Ahmaud
- Petition: Justice For Tony McDade
- Black Lives Matter Petitions
- Instructions for Contacting Officials (BLM)
- 5 Calls: Support The House Resolution To Condemn Police Brutality
- Reclaim the Block
The Navajo Nation and Other Indigenous Communities
First, we acknowledge that our clinic is located on stolen Costanoan Rumsen Carmel Tribal land. The Rumsen were among many indigenous peoples whose lives were forever changed by genocidal acts of enslavement, kidnapping, rape, child separation, and displacement perpetrated by the governments and civilians of Spain, Mexico, and the United States in the 18th and 19th centuries. In 1864, a large group of the Costanoan Rumsen Carmel Tribal people relocated from the Monterey Bay area to the Prado-Chino area in Southern California, and many of their descendants still reside in Pomona, California. Other descendants include the Ohlone Costanoan Esselen Nation.
The Navajo Nation extends into the states of Utah, Arizona, and New Mexico, covering over 27,000 square miles and has a population of over 173,000. On May 18, CNN reported that the Navajo Nation had surpassed New York state for the highest COVID-19 infection rate in the US, despite having some of the strictest non-pharmaceutical interventions in place. The All-Pueblo Council of Governors and Navajo Nation leaders have asked the public to stay away from tribal lands and nearby recreational areas (like the Grand Canyon) during the pandemic to limit spread of the virus.
- Navajo Nation surpasses New York state for the highest Covid-19 infection rate in the US (CNN)
- Navajo Nation Sees High Rate Of COVID-19 And Contact Tracing Is A Challenge (NPR)
- Native tribes still haven’t received the stimulus relief money they were promised (Vox)
- Navajo Nation Loses Elders And Tradition To COVID-19 (NPR)
- Native Americans being left out of US coronavirus data and labelled as ‘other’ (The Guardian)
- Navajo Department of Health
- Navajo Nation Government Website
- Seeding Sovereignty
- The Red Nation Podcast
- Navajo Nation COVID-19 Relief Fund
- Navajo Water Project
- Navajo and Hopi Families’ COVID-19 Relief Fund
- Far East Navajo COVID-19 Response Fund
- Northern Diné COVID-19 Relief Effort
- Emergency Mobile Pantry in Zuni, NM
- Crownpoint COVID-19 Relief Food Drive
- The Pueblo Relief Fund
- The Red Nation
- Protect Native Elders
In this post:
- The United States still leads the world in COVID-19 cases and deaths.
- We have no effective available oral treatment or preventative drugs, vaccines or hyperimmune intravenous immunoglobulin for COVID-19. Potential therapies are probably 6 to 9 months away.
- Despite the data, in the United States our political leaders , federal agencies, and many state public health officials have decided to open back up our country.
- In California, although ICU numbers have been stable the last 7 days, COVID-19 cases and deaths are still on the rise. The majority of reported cases (50.8%) are in the 18-49 age group.
- We examine the 1918 flu pandemic’s impact on different age groups and compare it with this year’s COVID-19 data in California, concluding that closing schools early was wise and reopening in August would be deadly.
- We continue to recommend staying home whenever possible, wearing a mask in public, and staying 6 feet apart from people outside your household. We outline suggestions for businesses and organizations seeking to reopen more safely, highlighting the dangers of congregating in buildings with poor ventilation (which is most buildings).
- In Monterey County, agricultural workers, health care workers, and first responders are among the occupations most impacted by COVID-19. More than half of COVID-19 patients in the county have no known pre-existing medical condition.
- The incomplete nature of the data collected from California’s skilled nursing homes is problematic.
- Based on our modeling, we expect to have 2 million COVID-19 infections and 115,357 deaths in the United States by June 7.
- By August 4, 2020, at our current rate of new COVID-19 infections and deaths, we anticipate 3,337,190 COVID-19 infected patients and a total of 192,613 deaths.
By our way of counting, this is Day 145 of the COVID-19 pandemic. To date, we have neither a vaccine nor a widely-available drug to effectively treat or prevent this infection. Our first USA case was identified in Washington State on Day 21 of the pandemic. In those next 124 days (17.7 weeks) the United States, as of 5/22/20, had 1,645,099 known COVID-19 PCR positive infected patients and 97,647 deaths, giving us a still rising death rate of 5.94%. We had 24,197 new cases and 17,109 people in serious or critical condition on that day. That was the fourth day in a row that we’ve had over 17,000 people in serious or critical condition in the United States. We have 1,314,204 more COVID-19 positive infected patients than any other country in the world. The five countries other than the US with the most cases (Brazil, Russia, Spain, the United Kingdom, and Italy) have a total of 1,422,095 cases combined, which is 223,004 fewer cases than in the United States.
Four rapidly expanding “hot spot” countries are India with 118,226 infections and 6,198 new infections on 5/21/20, Peru with 108,769 infections and 4,749 new infections, Russia had 317,554 infections and 8,849 new infections on 5/21/20, and Brazil had 310,921 infections and 17,564 new infections. Today we’ll focus our discussion on the State of California and Monterey County.
State of California
As of 5/21/20, the State of California has 88,488 total infections, 3,624 new infections, 3,624 total deaths and 110 new deaths. On 5/21/20, California had more new deaths than any other state, with the exception of New York and was 7th in total deaths in the United States, having just surpassed Connecticut’s deaths. On 5/21/20, California reported 4,735 hospitalized COVID-19 patients (on that day) and 1,310 patients in the ICU. If California were a country, it would rank 13th in total number of cases in the world (above China) and 17th in total deaths (between Russia and India). It would rank 10th in new deaths in the world on 5/21/20. It would rank 7th in the world in ICU patients (between Spain and the UK). As of 5/21/20, California reported conducting 1,421,127 COVID-19 tests, which represents 3.57% of California’s population of 39.78 million. However, we know that some people have been tested more than once, so in fact, less that 3.57% of the population has been tested for COVID-19.
So what can these numbers suggest to us about what public policies would be prudent at this time for California? Here’s what we think:
Keep School Buildings Closed to Protect Youth and the Elderly
From the beginning of the pandemic, it was messaged to us by public health officials and politicians alike that COVID-19 disproportionately affects folks 65 and over and those with underlying health conditions, leading young healthy folks to believe that they would not be infected or become seriously ill. This made it more difficult for young working people to accept the stay-at-home order as the new way of life, and many are counting down the days, hours, and minutes until they can return to work in person, get their hair and nails done, and return to their local bars, restaurants, gyms, and sporting events.
However, if we look at the data on which age groups are most affected by COVID-19, we see a much different picture. In California, as of 5/21/20, the age group with the largest number of confirmed infections is people 18-49 years of age, with 44,953 infections, compared to 21,461 people 50-64 and 17,864 people 65 and up. The 0-17 age group has 4,049 cases. (Incidentally, the 0-17 age group is also the least-tested group.) We know that 7,908 of those 65+ folks are residents in skilled nursing facilities are infected with COVID-19, so when you take those folks out of the equation, there are only 9,956 other people over the age of 65 infected in California. Deaths in skilled nursing facilities make up 39.5% of the COVID-19 deaths in California. The point is that people over 65 who are not in skilled nursing facilities are not getting infected at the same rate as younger people. Now, it might be a coincidence, but we can’t help noticing that the two age groups that we have essentially mandated stay home since mid-March (school-aged children and senior citizens) have the lowest numbers of infections. Perhaps preventing infections is not as complicated as folks are making it out to be.
A standard Influenza respiratory epidemic has a U-shaped death curve (see dotted line 1911-1917 curve below), meaning that you have very young and very old people dying. What happened in the 1918 Influenza pandemic is that they had a W-shaped curve (see solid line below). The peak in the middle happened to be people between the ages of 20 and 40.
If we look at the data from the 2020 COVID-19 pandemic in California, plotted by age group, we can see some similarities and some key differences from the 1918 pandemic. By closing schools and telling older people to stay home in California, we’ve decreased the number of COVID-19 cases in both groups, effectively losing the left arm of the W and flattening out the right arm from the 1918 Influenza graph.
Thanks to early implementation in California of non-essential business closures, school closures, stay-at-home policies, social distancing, and use of masks, we’ve been able to avoid some of the hardships that folks experienced in the 1918 Influenza pandemic.
However, social distancing is not possible in schools–period. Getting children to wear masks safely and wash their hands with soap and warm water before touching their faces, their food, or their classmates is impossible. We won’t even go into how difficult it would be to keep student bathrooms sanitary. Moreover, large class sizes and inadequate ventilation systems (both of which are the norm in California public schools) are not conducive to safe social distancing. In order to make classrooms workable for social distancing, California schools would likely have to triple their teaching staffs, expand facilities, and spend millions of dollars updating air conditioning systems and adding HEPA filter systems. Furthermore, we’ve already been told that school budget cuts are inevitable at this point. Therefore, from our perspective, the only solution for safely educating our children during the next two years of this epidemic would be distance learning. Many school districts are currently surveying parents to collect their input on plans for the upcoming school year. Parents would be prudent to request that their districts offer distance learning for students of all ages.
Wear a Mask in Public
All people should wear masks in public at all times. There is very compelling scientific evidence that masks decrease the incidence of respiratory infections by preventing people’s respiratory droplets from circulating in shared air. We can see correlations between mandated mask-wearing policies and lower numbers of COVID-19 infections and deaths in countries across Asia like Japan, Vietnam, and Taiwan. There are certainly other factors in play that have helped these nations control the spread of COVID-19, like having more socially-distant ways of greeting people, better early education campaigns for COVID-19, prior experience with the SARS epidemic, increased travel restrictions, experimental pharmaceutical interventions (like Japan’s favipiravir) and better contact tracing. However, it’s worth noting that in some countries where most of these factors were not present, masks have been a game-changer, keeping cases and deaths relatively low. Take, for example, the Czech Republic, which mandated face masks in public in late March (along with closing borders, prohibiting public gatherings, and shuttering non-essential businesses). With a population of approximately 10 million, as of 5/23/20, Czechia (as it is also known) had 8,890 total reported cases of COVID-19 and just 314 total deaths. That’s 830 cases per million people and 29 deaths per million, and constitutes a death rate of about 3.5%. In Portugal, whose population is also around 10 million, masks in public were recommended but not required back in April. As of 5/23/20, Portugal had 30,471 total reported cases and 1,302 total deaths. That’s 2,987 cases per million people and 128 deaths per million, for a death rate of 4.3%. Even if we rewind to May 1, before Portugal began partially reopening businesses, we see it had a total of 24,987 cases and 1,007 deaths (death rate 4%), which is 2,450 cases per million and 99 deaths per million. Compare this to Czechia on May 1 with 7,737 total cases and 240 deaths (death rate 3.1%) That’s 722 cases per million and 22 deaths per million. This is not to say we think that mandated mask wearing is solely responsible for the differences in Portugal and Czechia’s numbers, but it certainly couldn’t hurt.
Avoid Gathering in Enclosed Spaces, Regardless of Restriction Easing
Biologist Erin Bromage from the University of Massachusetts Dartmouth makes some valid points about infection risk in her blog post published on May 6, which was inspired by Jonathan Kay’s April 23 piece in Quillette on COVID-19 superspreader events. We won’t go into detail on the specifics of superspreader events in our post today, but we do have a few things to say about what you can do to stay safe as cities begin to reopen selected businesses and public spaces.
The keys to preventing transmission of infection are personal protective equipment, washing hands with soap and warm water, and adequate ventilation. Unfortunately, most businesses and public buildings, like schools (see above), restaurants, bars, gyms, and salons (and even many doctor’s offices and hospitals) do not have the HEPA filtered air systems that are required to prevent the spread of COVID-19 and other viruses like influenza. Sanitizing surfaces, erecting barriers, setting up fans, and opening windows will not resolve the air issues in these locations. The reality is, there are few safe buildings when it comes to COVID-19.
So what are our recommendations for folks who are determined to dine out, get a haircut, join a yoga class, or attend a religious service as soon as their local governments allow it?
Small businesses need to rethink how they provide services to their patrons. Restaurants, rather than looking for ways to make poorly-ventilated indoor dining rooms safer, should be focused on offering outdoor dining. Hairdressers, barbers, and nail technicians should consider making use of their parking lots to provide their services in the open air, or performing services for their clients in their backyards. Gym owners, likewise, could look for opportunities to move classes outdoors.
Places of worship should continue to offer services online and should consider outdoor services, where people should wear masks and stay six feet apart. Drive-in services might also be possible for churches with large parking lots, leaving at least one parking space vacant between cars. Of course, some practices, like the distribution of wafers and grape juice or wine for communion, would remain high-risk, whether conducted indoors or outdoors. The bottom line is it’s not safe to be in a public place near people from outside your household who are eating, talking, or singing without wearing masks.
If you’re going to be around people from outside your household and have the choice to do so outdoors rather than indoors, outdoors would be a significantly safer choice. This is not to say that it’s prudent to have a large backyard barbecue or any large gathering of people outdoors. It’s still best to limit gatherings to no more than 10 people. Stick to video chatting with friends and family who have high risk for exposure to COVID-19 (like essential workers).
In Monterey County, 40% of the infections are in folks who work in agriculture and 9% of infections are in health care workers and first responders. In 210 (57%) of the cases, patients had no known pre-existing medical conditions. How are people getting infected? In Monterey County, 51% of reported cases are epidemiologically linked to a confirmed case, 43% of cases are community acquired, and 6% are travel-related. In theory, if a county is doing an excellent job of contact tracing, the percentage of community acquired cases would be very low–because cases would be quickly identified and folks could be quarantined before infecting others. The fact that 43% of the cases in our county are community acquired suggests we should be doing better case contact tracing and increase testing for everyone, but especially for essential workers, particularly those who come in close contact with the public. We ought to be testing all agricultural workers, health care workers, and first responders.
In California, the state public health department reports infections and deaths in skilled nursing facilities. It’s worth noting that since April 23, on any given day, only between 81% and 95% of California’s skilled nursing facilities have reported their COVID-19 cases and deaths to the state health department. On its website, California Department of Health lists data for COVID-19 infections and deaths for 16 of Monterey County’s skilled nursing facilities. Based on this data, one 103-bed facility, Windsor The Ridge Rehabilitation Center in Salinas (zip code 93906) has reported cases in health care workers and patients. They are also listed as having patient deaths. Because the state of California does not report specific numbers of deaths and cases in skilled nursing facilities unless the number is greater than 11, we do not know how many of the cases and deaths in our county are associated with this facility–the report says fewer than 11. We also reviewed the California Department of Health skilled nursing COVID-19 data base (May11, 2020) and found a total of nine Windsor facilities in California with COVID-19 cases. The site with the most infections was in Solano County where 25 healthcare workers and 60 patients were infected with fewer than 11 deaths. The Monterey County Health Department has not disclosed the number of cases or deaths in the Salinas skilled nursing facility in our county. This data should be made available to the public. In addition, if it has not already been done, all staff and patients at this facility should be tested for COVID-19 by PCR on a routine basis. The state of New York has mandated that each nursing home will test each healthcare provider twice a week for COVID-19. This seems a reasonable approach to any facility with any healthcare provider or patient infection. A more proactive approach would be to test all healthcare providers and patients in skilled nursing facilities.
Our Updated COVID-19 Projections
The University of Washington’s Institute of Health Metrics (IHME) said on 4/28/20 that we would have a total of 74,000 deaths in the USA by August 5, 2020. In contrast to this, we analyzed the case and death data using our two methods again on 5/22/20. We estimated that we will reach 2,000,000 infected patients by June 7th (in 15.4 days, 369 hours or 2.2 weeks) and have between 17,710 and 20,513 new deaths for a total number of deaths between 115,357 and 118,156.
All of our predictions from 4/28/20, 5/03/20, 5/08/20 and 5/22/20 for time to reach 2,000,000 infections and the estimate of the number of deaths are listed in the following chart:
A few weeks ago, the University of Washington re-projected the number of deaths by August 4, 2020 to be 134,475. When we checked their website on 5/23/20, they had revised this number to 143,357. (Musical chairs, anyone?)
We don’t usually project out 2 months for total infections and deaths, but if we did, using our methodologies, we would predict that by August 4, 2020 in the United States we will have 3,337,190 COVID-19 infected patients and a total of between 192,613 and 199,229 deaths. If the death rate (now 5.94%) increases, these estimates of the number of deaths will be too low.
On 5/01/20, the FDA finally approved Gilead’s Remdesivir for intravenous treatment of COVID-19 infected patients. Since we initially recommended approval of this drug, another 97,600 Americans have died. Gilead is donating a large amount of drug for free. Unfortunately, it now appears that the government will be involved in the distribution of the drug, which means that university medical centers, hospitals in rural counties, and outpatient clinics like ours will probably not have the opportunity to treat our patients with Remdesivir. If it were up to us, this drug would be sold through normal drug distribution channels. Hopefully use of Remdesivir and/or plasma therapy will alter reported deaths in the next two months. We’re not optimistic based on the United States government’s performance during the first 145 days of the COVID-19 pandemic.
We have no effective available oral treatment or preventative drugs, vaccines or hyperimmune intravenous immunoglobulin for COVID-19. Potential therapies are probably 6 to 9 months away. In the United States our political leaders (the President and most Governors) and federal agencies (HHS, CDC) and many state public health officials have decided to open back up our country. Viruses (COVID-19, Influenza and perhaps measles) will have many more potential victims this year.
Please think globally and act locally.
We Cannot Return to Campus This Fall https://thebolditalic.com/we-cannot-return-to-campus-this-fall-1ad91b8a65e0
1918 Influenza: the Mother of All Pandemics (Emerging Infectious Diseases) https://wwwnc.cdc.gov/eid/article/12/1/05-0979_article
American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic by Nancy K. Bristow https://www.goodreads.com/book/show/13540533-american-pandemic
The Great Influenza: The Story of the Deadliest Pandemic in History by John M. Barry https://www.goodreads.com/book/show/29036.The_Great_Influenza?ac=1&from_search=true&qid=9DWUInOM10&rank=1
The Complex Question of Reopening Schools (The New Yorker) https://www.newyorker.com/magazine/2020/06/01/the-complex-question-of-reopening-schools
Public Health Experts Say Many States Are Opening Too Soon To Do So Safely (NPR) https://www.npr.org/2020/05/09/853052174/public-health-experts-say-many-states-are-opening-too-soon-to-do-so-safely
This Japanese Island Lifted Its Coronavirus Lockdown Too Soon and Became a Warning to the World (Time) https://time.com/5826918/hokkaido-coronavirus-lockdown/
Tired Of Wearing A Face Mask In Public? New Research Underscores Why You Still Need To (Forbes) https://www.forbes.com/sites/brucelee/2020/05/14/here-is-more-evidence-for-face-mask-use-with-covid-19-coronavirus/#30c0654b1060
The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission (PNAS) https://www.pnas.org/content/early/2020/05/12/2006874117
Hearts and masks: Czech-Vietnamese solidarity during coronavirus https://www.aljazeera.com/indepth/features/hearts-masks-czech-vietnamese-solidarity-coronavirus-200407101254028.html
California is publicly sharing incomplete data on coronavirus outbreaks at nursing homes (SF Chronicle) https://www.sfchronicle.com/bayarea/article/California-s-method-of-reporting-coronavirus-15258007.php
2019 Novel Coronavirus (2019-NCoV) – Local Data (Monterey County Public Health) https://www.co.monterey.ca.us/government/departments-a-h/health/diseases/2019-novel-coronavirus-covid-19/2019-novel-coronavirus-2019-ncov-local-data-10219
By our way of counting, this is Day 130 of the COVID-19 pandemic. Our first USA case was identified in Washington State on Day 21 of the pandemic. In those next 109 days (15.5 weeks) the United States, as of 5/08/20, had 1,292,623 known COVID-19 PCR positive infected patients and 76,928 deaths, giving us a still rising death rate of 5.95%. We have 1,035,768 more COVID-19 positive infected patients than any other country in the world. The total number of COVID-19 positive infected patients in Spain, Italy, France, Germany and the United Kingdom is 1,023,649 or 268,974 fewer infected patients than in the United States. Two new rapidly expanding “hot spot” countries are Russia with 177,160 infections and 11,231 new infections on 5/8/20 and Brazil with 135,693 infections and 9,082 new infections on 5/8/20.
As of 4/28/20:
57,812 deaths 215,461 deaths
1,004,908 infections 3,094,829 infections
Death rate: 5.75% Death Rate: 6.96%
As of 5/08/20:
76,928 deaths 270,426 deaths
1,292,623 infections 3,913,644 infections
Death Rate: 5.95% Death Rate: 6.91%
The University of Washington’s Institute of Health Metrics (IHME) said on 4/28/20 that we would have a total of 74,000 deaths in the USA by August 5, 2020. In contrast to this, we analyzed the case and death data using our two methods again on 5/08/20. We now estimate that we will reach 2,000,000 infected patients in 25 days (601 hours or 3.5 weeks) and have between 42,088 and 45,200 new daily deaths for a total number of deaths between 119,017 and 122,128.
Our predictions from 4/28/20, 5/03/20 and 5/08/20 for time to reach 2,000,000 infections and the estimate of the number of deaths are listed in the following chart:
Recently the University of Washington re-projected the number of deaths by August 4, 2020 to be 134,475.
We don’t usually project out 3 months for total infections and deaths, but if we did, using our methodology, we would predict that by August 4, 2020 in the United States we will have 3,807,104 COVID-19 infected patients and a total of between 207,895 and 231,101 deaths. If the death rate (now 5.95%) continues to increase, these estimates of the number of deaths will be too low.
The FDA finally approved Gilead’s Remdesivir for intravenous treatment of COVID-19 infected patients (5/01/20). Since we initially recommended approval of this drug, another 66,500 Americans have died. Gilead is donating a large amount of drug for free. Unfortunately, it now appears that the government will be involved in the distribution of the drug, which means that rural counties and clinics like ours will probably not have the opportunity to treat our patients with Remdesivir. If it were up to us, this drug would be sold through normal drug distribution channels. Hopefully use of Remdesivir and/or plasma therapy will alter reported deaths in the next four months. I’m not optimistic based on the United States government’s performance during the first 130 days of the COVID-19 pandemic.
Please think globally and act locally.
By our way of counting, this is Day 125 of the COVID-19 pandemic. Our first USA case was identified in Washington State on Day 21 of the pandemic. In those next 104 days (15 weeks) the United States as of 9:32 A.M. on 5/03/20 had 1,138,690 known COVID-19 PCR positive infected patients and 66,570 deaths giving us a still rising death rate of 5.84%. We have 922,108 more COVID-19 positive infected patients than any other country in the world. The total number of COVID-19 positive infected patients in Spain, Italy, France, Germany and the United Kingdom is 944,501 or 194,184 fewer infected patients then the United States. By our modeling method, in the United States we should now reach 2,000,000 COVID-19 positive infected patients in 29.7 days (714 hours or approximately 4.25 weeks).
As of 4/28/20:
57,812 deaths 215,461 deaths
1,004,908 infections 3,094,829 infections
Death rate: 5.75% Death Rate: 6.96%
As of 5/03/20:
66,570 deaths 244,911 deaths
1,138,690 infections 3,462,682 infections
Death rate: 5.84% Death Rate: 6.43%
The University of Washington’s Institute of Health Metrics said on 4/28/20 that we would a total of 74,000 deaths in the USA by August 5, 2020.
For our prediction on 4/28/20, we used two simple methods to predict the number of deaths and came up with two numbers: in 34.5 days (828 hours or 5 weeks) we should have either 56,166 additional deaths or 57,004 additional deaths from COVID-19. Therefore we predicted that 5 weeks from (April 28, 2020), the total number of deaths in the United States would be either 112,641 deaths or 113,479 deaths and we would have 2,000,000 PCR positive COVID-19 infected patients.
We’ve looked at our two methods again 5 days later (5/03/20). We would now estimate we will now reach 2,000,000 infected patients in 29.7 days (714 hours) and have either 48,400 or 50,587 new deaths, for a total number of deaths between 114,970 and 117,157.
Other news of interest is that the FDA has finally approved Gilead’s Remdesivir for intravenous treatment of COVID-19 infected patients (5/01/20). Gilead is also donating a large amount of drug for free. Hopefully use of Remdesivir and/or plasma therapy may alter reported deaths in the next month. We recommended that the FDA approve Remdesivir back on March 14.
Please think globally and act locally.
By our way of counting, this is Day 120 of the COVID-19 pandemic. Our first USA case was identified in Washington State on Day 21 of the pandemic. In those next 99 days (14 weeks) the United States as of 2:05 P.M. on 4/28/20 had 1,004,908 known COVID-19 PCR positive infected patients and 57,812 deaths giving us a still rising death rate of 5.75%. We have 772,780 more COVID-19 positive infected patients than any other country in the world. The total number of COVID-19 positive infected patients in Spain, Italy, France, Germany and the United Kingdom is 921,450 or 83,458 fewer infected patients then the United States. By our modeling, we should reach 2,000,000 COVID-19 positive infected patients in 34.5 days (828 hours or 5 weeks).
As of 4/28/20:
57,812 deaths 215,461 deaths
1,004,908 infections 3,094,829 infections
Death rate: 5.75% Death Rate: 6.96%
One thing that concerns us is that the University of Washington’s Institute of Health Metrics said last week that we would have 67,641 deaths from COVID-19. This was updated today to a nice round number of 74,000 deaths by August. Their prediction is that we will have this number of total deaths in 93 days.
We think we have a more accurate prediction. We used two simple methods to predict the number of deaths and came up with two numbers: in 34.5 days (828 hours or 5 weeks) we should have either 56,166 additional deaths or 57,004 additional deaths from COVID-19. Therefore, I would predict that 5 weeks from today (April 28, 2020), the total number of deaths in the United States will be either 112,641 deaths or 113,479 deaths. Let’s review this in 5 weeks.
Again I’m going to leave it up to each of you to decide whether we’ve done a good job in this pandemic. Please think globally and act locally.
By our way of counting, this is Day 116 of the COVID-19 pandemic. Our first USA case was identified in Washington State on Day 21 of the pandemic. In those next 95 days (13 weeks), the United States as of 10:30 A.M. on 4/24/20 had 883,826 known COVID-19 PCR positive infected patients and 50,373 deaths giving us a still rising death rate of 5.69%. We have 664,062 more COVID-19 positive infected patients than any other country in the world. The total number of COVID-19 positive infected patients in Spain, Italy, France, Germany and the United Kingdom is 870,996 or 12,830 fewer infected patients than the United States. At our current rate of testing and rate of positive PCR tests, I would predict in the United States that we will have 1,000,000 infected patients in 103 hours (4.3 days). We could reach 2,000,000 COVID-19 positive infected patients in 41.3 days (6 weeks). Again, I’m going to leave it up to each of you to decide whether we’ve done a good job in this pandemic.
As of 4/24/20:
New York City New York State USA World
11,544 deaths 16,388 deaths 50,373 deaths 194,456 deaths
150,473 infections 271,590 infections 883,826 infections 2,766,611 infections
Death rate:7.67% Death rate: 6.03% Death rate: 5.69% Death Rate: 7.02%
In New York State, 695,920 PCR assays have been performed, and 271,590 tests were positive (39.02%). Only 4 countries have more infections than New York City. No other country has more infections than New York State.
As previously stated, every state, to include New York and Georgia, needs to perform more tests. Homeless shelters need to be screened and positive folks quarantined. Nursing homes and extended care facilities need to have all staff and patients screened. All hospitals should test every one of their employees. Additionally, it would be nice to give everyone an antibody test for COVID-19.
In our county we should screen and sample at least our nursing homes, extended care facilities, hospital employees, first responders (police, fire and ambulance staff), jails and prisons to identify problems before it’s too late. We should also screen our agricultural employees to include folks in our agricultural processing plants.
COVID-19 is a disease of hot spots with lots of asymptomatic transmission. A study of infections in Italy in April 2020 showed that 41% of their infections occurred in nursing homes (staff and patients), 24.7% from spread within families, 10.8% from hospitals, and 4.2% at work.
Speaking of hot spots and asymptomatic transmission of COVID-19, California Public Health officials released the following data on California skilled nursing facilities for the last two weeks:
The first week of reporting, 258 of 1224 skilled nursing facilities had one or more staff and patients with COVID-19 infections, 1290 staff were infected, and 1740 patients were infected. A little simple math shows that 33 of the 258 sites had 716 of the infected workers (average 21 workers per facility). The other 225 facilities only had 574 infected workers (average of 2 per facility). Data a week later revealed 2,099 infected staff (62% increase in one week) and 3141 infected patients (80% increase in one week). 486 infected patients have died (15.4%). No data on deaths of staff has been provided. Either incomplete data was provided by facilities the first week, or in the second week of reporting there has been a remarkable increase of infected staff and patients in skilled nursing facilities in California. The state has agreed to attempt to update the report weekly.
The scope of our problem locally is that skilled nursing facilities in our region include 52 in Santa Clara County, 16 in Monterey County, 8 in Santa Cruz County and 1 in San Benito County. Only one skilled nursing facility in Monterey County reported any infections in the first weekly report. Data is incomplete or not entered in the state report from this week.
A new hot spot of interest is one of the nuclear power plants in Georgia. The Vogtle and Hatch Nuclear Power plants in southeastern Georgia provide approximately 20% of the electrical power in Georgia. The Vogtle power plant has two functioning reactors and two new reactors under construction. 9,000 workers were on the site until April 17th when 2,000 workers were laid off due a COVID-19 outbreak. The Vogtle plant is in Burke County, Georgia on the banks of the Savannah River. Adjacent counties on the Georgia side of the river are Richmond and Columbia Counties. Across the river in South Carolina are Aiken and Edgefield Counties. Georgia has 22,147 COVID-19 positive patients and 892 deaths. South Carolina has 4,917 COVID-19 infected patients with 150 deaths. The five counties listed above have a total of 642 COVID-19 infected patients and 24 deaths. Burke County has only reported 64 COVID-19 infections and three deaths. There are at least 130 infections listed just at the Vogtle plant in Burke County below:
At the Vogtle plant, 28.0% of the tested workers are COVID-19 PCR positive. To date only 5.1% of the work force has been tested. The Vogtle nuclear power plant in Burke County appears to be an epicenter of an outbreak in five counties in two states.
Georgia already opened up their economy on 4/24/20 in an uncoordinated regional manner and has multiple other hot spots including this potentially dangerous outbreak.
Power plants and our power grid are key components of our infrastructure, and protecting their workers should also be a priority in each state, county and city. Has anyone offered testing to the workers at the power plant in Moss Landing, California?
Locally, are we squandering an opportunity to get ahead of an approaching storm?
Please think globally and act locally. As usual, please feel free to share this post.
KSBW’s Brittany Nielsen sat down with Dr. Wright to discuss the COVID-19 pandemic and why he believes the 14-day quarantine period is not long enough. Click here to watch the interview and read the transcript.
You can also view their previous interview that aired March 16.