COVID-19 Update (5/8/20)

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.

PubMed, Support Group

[November] Articles of Interest

Dr. Wright discussed the following articles with the members of the Borrelia (Tick-borne Relapsing Fever and Lyme disease) patient support group in their November meeting:

1. Autoimmunoreactive IgGs from patients with postural orthostatic tachycardia syndrome. (link to abstract)
Cardiologists at the Mayo Clinic in the Department of Internal Medicine looked at people with postural orthostatic tachycardia syndrome (POTS) to see whether they had autoimmune antibodies. The study revealed 40 unique proteins, many of which are associated with cardiac problems. The study concluded that patients with POTS do have autoantibodies, and these autoantibodies cross-react with cardiac proteins, possibly causing changes in cardiac function.

Dr. Wright commented that many patients with tick-borne illnesses have postural tachycardia, so in the case of damage to the cardiac muscle, it is unclear whether damage is caused by the infection or by the autoimmune issues associated with POTS.

2. Investigation of Borrelia burgdorferi genotypes in Australia obtained from erythema migrans tissue (link to full text)
A dermatologist in Australia conducted a study on four patients with erythema chronicum migrans (EM) (the bull’s-eye rash) to see which species of Borrelia patients were infected. PCR of central tissue biopsy revealed two strains similar to Borrelia burgdorferi (strain 64b), one isolate similar to Borrelia bissettii, and one similar to Borrelia valaisiana. Dr. Wright commented that it would be a good idea to do both a central lesion biopsy and a leading edge biopsy. This study suggests the presence of both Borrelia burgdorferi and Relapsing Fever Borrelia isolates in Australia.

3. A hard tick relapsing fever group spirochete in a Brazilian Rhipicephalus (Boophilus) microplus. (link to abstract)
One of Dr. Wright’s patients was planning a trip to Brazil, and he was reminded of this article from 2007, the first documented isolation of Borrelia from ticks in Brazil. The researchers found a species similar to the Relapsing Fever isolate Borrelia lonestari and labeled it Borrelia sp-BR. This species of Borrelia was found in the Rhipicephalus (Boophilus) microplus tick, a hard-bodied tick that feeds on cattle (it is also known as the southern cattle tick). This tick can be found in South and Central America, as well as in Africa, Asia, and Australia.

4. A novel relapsing fever Borrelia sp. infects the salivary glands of the molted hard tick, Amblyomma geoemydae. (link to abstract)
Japanese researchers have found a new, yet unnamed, species of Borrelia. It is phylogenetically related to B. miyamotoi and B. lonestari (both of which cause tick-borne relapsing fever). The new species was found in Amblyomma geoemydae ticks, which feed on cows and other large animals. Also found in 5% of the ticks studied was Borrelia sp. tAG, a species associated with reptiles.

5. Associations of passerine birds, rabbits, and ticks with Borrelia miyamotoi and Borrelia andersonii in Michigan, U.S.A. (link to full text)
A four-year study from Michigan, published in October 2012, examined ticks found on wild birds and rabbits to see what isolates of Borrelia they were carrying. Two strains of B. miyamotoi were found, and this was the first time B. miyamotoi was documented in ticks removed from wild birds. Most of the birds carrying ticks positive for B. miyamotoi were Northern Cardinals. Ticks found on birds and rabbits also tested positive for B. andersonii. The authors of the study conclude, “Given the current invasion of I. scapularis, a human biting species that serves as a bridge vector for Borrelia spirochetes, human exposure to B. miyamotoi and B. andersonii in this region may increase.”

Dr. Wright reminded patients that there are currently no commercially-available tests (in the U.S.) for B. miyamotoi and B. andersonii. He also recommended that people limit exposure to wild birds and bird feeders.