Category: COVID-19

COVID-19

COVID-19 Update (6/11/20)

davidcwrightmd

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). 

Click to enlarge images.

Monterey County

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.

Recommended Reading

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/ 

COVID-19

Helping Marginalized Communities During the Pandemic – Part 1

davidcwrightmd

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. 

LEARN

DONATE

ADVOCATE

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.  

Navajo Nation COVID-19 Data as of 6/2/2020.

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. 

LEARN

DONATE

ADVOCATE

COVID-19

COVID-19 Update (5/8/20)

davidcwrightmd

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:

      USA                                  WORLD

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:

USA                                     WORLD

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.

COVID-19

COVID-19 Update (5/3/20)

davidcwrightmd

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:

      USA                                  World

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:

USA                                  World

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.

Recommended Reading:

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-emergency-use-authorization-potential-covid-19-treatment

https://www.cnbc.com/2020/05/03/gilead-ceo-says-remdesivir-available-to-coronavirus-patients-this-week-weve-donated-the-entire-supply.html

COVID-19

COVID-19 Update (4/28/20)

davidcwrightmd

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:

      USA                                  World

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.

COVID-19

This Week’s COVID-19 Update (4/25/20)

davidcwrightmd

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.