Monday, April 20, 2020

April 19/20: A Flurry of Real News about COVID - NYT, WSJ, Testing, Symptom-Free Rates, More

Yes, every day 80% of the news is COVID news,  But for me, Sunday/Monday April 19/20, 2020, was a flurry of actual new-news about COVID.

I highlight items below.

88% Symptom-Free Rates at Columbia University Medical Center

  • In the most interesting story, 15% of women coming to labor and delivery at Columbia IrvingMedical Center tested positive for COVID virus (PCR), but 88% had no symptoms.  (The math is, 13% of all of these individuals were virus positive and asymptomatic.) 
    • This hospital serves Upper Manhattan and Bronx.  S
  • See article in WaPo by Goffman and Sutton here.
  • The original medical article appeared NEJM, April 13, 2020, here.
  • The authors tested 215 women March 22-April 4, and published in NEJM on April 13.
Beyond that one, some more "new-news" stories came one after another.

NYT and WSJ Pile On Testing Crisis and Reopening
  • New York Times and Wall Street Journal concurrently ran articles about the testing crisis.
    • NYT April 19 (Eder et al.) focuses on poor antibody tests Here.
    • See similarly April 21 at LATimes (Chabria et al.) - "wild west" of antibody testing, here.
    • -- While WSJ has April 20 article that New York is gearing up for large-scale antibody testing - Dvorak et al., here.
    • WSJ April 19 (Weaver & Ballhaus) focuses on chaos and shortage in the supply chain of parts and necessities for testing. Here.
    • -- To my eye, the WSJ builds up a substantial set of unflattering quotations from Brett Giroir, the HHS official newly in charge of national testing.
    • A third newspaper, Washington Post, jumps on Giroir, asserting he was fired from a job in vaccine development not long before joining HHS. Here.
    • WSJ also features an April 20 article (Kraus) on the dynamic push at Amazon, General Motors, and other employers to ramp up employee COVID testing - here.
    • Also on the theme of workplace, Gottlieb and Ostroff in WSJ April 19 have opinion on the return to work, discussing both distancing and testing - here.
    • NYT says that the next COVID business relief bill is held up over debates regarding national vs state control of the testing fiasco, here In WaPo, Senators Alexander and Blunt propose a "shark tank" test to reboot US COVID testing, here.
    • On the theme of reopening, the Brit newspaper The Guardian April 20 has a detailed article on reopening plans in Europe, with excellent graphics and tables across the E.U. - here.

Paradoxical Bankruptcies of Physicians and Hospitals?

In the past week, I saw an article about a Colorado hospital that had had 8 COVID patients in four weeks, but had many empty beds, no elective surgeries, and an empty ER, facing financial disaster and laying off staff.  MedCity News April 17 here.  More on this theme this weekend.

  • WSJ April 19 (Editorial Board) on the economic crisis facing many healthcare institutions and individual providers - here.
  • Similarly April 20 as Axios - here.
  • HHS - Reopen Hospitals in Low-Incidence Areas
    • On Sunday, April 19: the administration issued policies for reopening hospitals in low-incidence areas.  Press release here PDF here This updates the March 18 notice against non-emergent care.
    • (I believe this is couched as HHS recommendations, since hospitals are also under state law.)

Cities - California

San Francisco County (1M people) has had 20 deaths from COVID, Los Angeles County has 600 deaths (10M people).  (Accounting for the 10X population, the death rate in LA is 3X higher, which is a lot higher, but not as graphic as the absolute numbers suggest.)
  • LA Times April 20 profiles SF mayor London Breed - here.
  • LA Times April 20 profiles speech by major Eric Garcetti forecasting grim times and many layoffs in LA government - here  Obviously, these layoffs also contribute to the financial catastrophe with more payments for unemployment, more people without health insurance, with hurdles maintaining food and shelter.

Human Interest

WaPo article April 19 by a nurse (Sakal) who left her job in an overwhelmed ER - here.   An ER doctor at Bellevue in NYC argues that we need home pulse oximeter monitoring of COVID patients to save lives, here.

From April 17 - Leavitt Partners COVID Dashboard & Projections

See the Leavitt Partners national, state, county dashboard for COVID here.

For example, they predict the national ICU cases is circa 6,000 on April 20, relatively flat (5000-6000) from April 10-20, but still, and using the best data through today, predicted to double to 12,000 ICU beds for COVID by May 3.


New Cases?
One key fact I have not seen - in places with 3-4 weeks of lockdown, Los Angeles, New York - where do we think the most new cases are coming from?  Obviously nursing home patients, and likely healthcare workers at 10-20%.  But after that?   From front line workers (fire, police, ambulance)?  Centralized workers (Amazon?)   Retail public workers (CVS?)  Seemingly random (person at home, goes to grocery store twice a week?)   We should know something about this, and feed it into reopening plans, but I don't see it written about.    

Prevalence vs Deaths
If the prevalence of COVID positivity is higher - 2%, 4%, 8% - the death rate is lower.  But the absolute death rate is the same.  I read a week or two ago, that over 50 NYC transit workers had died - not sick, not hospitalized, but dead.  That's really scary regardless of whether we think 1% or 3% of bus riders were occult positives.  And surely those dead transit workers didn't have someone walk up to their face and cough on them repeatedly.



While putting this together, I found some interesting articles at Chem & Engineering News.

  • Scaling up remdesivir production, here.
  • Best material for homemade mask, here.
  • Disinfectants and COVID, here.
  • COVID virus in sewage, here.
  • Biology of non-respiratory symptoms in COVID, here.