This column was updated on the evening of April 26. This is a swiftly changing situation. The information here was compiled from a variety of official reliable sources including World Health Organization (who.int), the Centers for Disease Control (cdc.gov), Our World in Data (which relies on European CDC data), and SoCo Emergency.
COVID-19 viral pandemic – by the facts and numbersAt the time of writing this there are 2,971,477 reported cases globally, with 206,544 deaths. That puts the average global death rate, as of today, at 6.95%. Case Fatality Rates (CFR) are calculated by dividing the number of reported deaths by the number of total cases. This number will almost certainly change, because we are still at the beginning edge of a pandemic, and the CFR will eventually go down, because the denominator (number of total cases) will certainly go up as there is increased testing. In terms of numbers of cases, the United States leads the world right now and is reporting 965,785 cases and 54,881 deaths (5.7% CFR). Spain is second with 226,629 cases and 23,190 deaths (10% CFR).
Case positives are confounded by testing rates and total numbers are less instructive unless scaled by population size. The highest death rates scaled to population size are currently found in Belgium with 598 deaths per million (dpm), followed by Spain (494 dpm), Italy (436 dpm), France (346 dpm), United Kingdom (299 dpm), Netherlands (257 dpm), and Sweden (217 dpm). The United States is currently at 160 deaths per million. It is also important to remember that each country, and within the country each locale, is at a different stage on their own epidemic trajectory, their own curve.
Flattening the curveThe purpose of slowing the rate of new cases is to keep the local healthcare system from being locally overwhelmed. If done properly, conditions to flatten the curve will likely be interpreted as an over-reaction because the healthcare system will not have been severely overwhelmed. Overall, and as of today, data suggest that the United States’ curve is flattening; however, various regions of the country are on their own curve trajectories. Some locations may not have even begun the uphill climb at this point.
Other benefits of flattening the curve include buying time for the medical professionals to develop more useful tests for both viral infection and antibodies, to learn more about symptom presentation and effectiveness of treatments, and for the creation and testing of vaccines.
Symptoms and treatmentsCOVID-19 patients who are hospitalized today will receive the benefit of several months of new medical understanding, something that patients back in February did not have. Each day that goes by reveals new thoughts on how to identify and treat this disease. In just this past week the symptom list for the disease has been revised to add body chills, repeated shaking with chills, muscle pain, headache, and new loss of taste and smell; these are added to the original complement of symptoms: cough, fever, and shortness of breath or difficulty breathing. It is still the case that older adults and people with heart or lung conditions and diabetes are considered at higher risk for death due to COVID-19.
California and SonomaIn the United States, California currently ranks 31 out of 55 states/territories in total deaths by population. The top five states for death by population are New York, New Jersey, Connecticut, Massachusetts, and Louisiana. In California, the top five counties for death by population are Los Angeles, Mono, Tulare, Yolo, and Inyo. Sonoma County ranks 37 out of 54 counties. Sonoma County has registered 220 COVID-19 cases. Ten percent of those cases have resulted in hospitalizations and the county’s current deaths stand at two, which is a 1% CFR according to current data.
Currently in the United States, the top five states with highest numbers of daily new cases per population are New Jersey, New York, Rhode Island, Massachusetts, and Connecticut. California is ranked at 33. Within California the top five counties for that same statistic are Los Angeles, Imperial, Riverside, Tulare, and San Francisco. Sonoma County ranks 30th. While high daily new cases per population size may suggest that these locations are emerging or current “hotspots,” these data are greatly confounded by variations in testing rates. High rates of testing can move a locale up the list and may represent asymptomatic individuals. Identifying positives is very important for the process of proper tracking and contact tracing, but a lack of testing can be misinterpreted as lack of cases. If you don’t look for cases you won’t find cases until, or if, those cases end up in illnesses that require hospitalization.
TestingThe two broad categories of testing are looking for the virus (RNA or antigen) and looking for antibodies (serology). Virus testing is only effective if the viral load is high enough (due to active infection) to be detected. Serological testing looks for the indication of a previous infection with the virus. Once infected, the adaptive response of the human immune system builds antibodies specific to the antigen (viral signature). Those antibodies and memory B cells stay in the body for a period of time and can be picked up through testing. One topic of current concern is the longevity of immunity to this SARS-CoV2 (the name for the virus that causes the disease of COVID-19) that is gained by initial infection. This natural immunity concern will also be of concern for immunity gained via vaccination. It might be that an eventual vaccine will not provide life-long immunity but may require cyclical or booster vaccinations.
Social distancing, shelter-in-place, and “re-opening”The process of lifting restrictions on social behavior will, by necessity, involve considerations of local pandemic conditions, feeding available data into predictive modeling, and coordination with adjacent populations. The new normal will be phased in over several stages and there are several bipartisan groups suggesting methods of phasing based on solid expertise. Governor Gavin Newsom has begun to outline benchmarks for “re-opening” and there is movement state-wide regarding open spaces, including beaches. Social-distancing, sanitary procedures, and personal protective equipment (PPE) such as masks are likely to continue to be a way of life, probably at least through the end of this year.
Shannon Lee, Ph.D., is a Glen Ellen resident and an instructor in the Biology Department at Sonoma State University. She has been a science educator for 20 years, having taught previously at UCLA and California State University Northridge.
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