Today the US COVID-19 death toll surpassed China's as it climbed to 3,727, and cases rose to 183,532—yet another day of more than 20,000 newly reported cases—according to the New York Times tracking map.

In addition, new US data add evidence to the impact of the pandemic on people with underlying conditions, including diabetes and heart disease, and reveal a 5% rate of COVID-19 in people with mild influenza-like illness (ILI), suggesting such people may be in the community contributing to disease spread.

New York count tops 75,000 cases

Later today, President Trump is expected to roll out new physical distancing guidelines for April and include data from models to explain his rationale for expanding the social distancing period in this country to 6 weeks.

In New York, the epicenter of the pandemic in the nation, case counts rose to 75,813, including 1,550 deaths—332 more deaths than reported yesterday. Today during his daily briefing, Governor Andrew Cuomo warned New Yorkers that the apex, or peak of cases, was still 14 to 21 days away, and he said he hoped the state would have enough ventilators in place within the coming weeks to deal with the influx of patients.

Today NYC Health, the city's public health department, reported the city's first COVID-19 death in a child.

In Louisiana, Governor John Bel Edwards warned that New Orleans is also at least 2 weeks away from its own apex. As of today the state has reported 5,237 cases and 239 deaths, for a case-fatality rate of 4.6%, one of the highest in the nation. Louisiana has the third-highest cases per capita, Bel Edwards said on Twitter, and he extended his state's stay-at-home orders through Apr 30.

Other hot spots in the country are New Jersey (18,696 cases), Michigan (7,630), California (7,566), Massachusetts (6,618), Florida (6,330), and Illinois (5,955), according to the New York Times tracker.

Medical workers, military members infected

On Twitter, a physician shared a spreadsheet showing 107 healthcare worker deaths in the United States thus far, and in Boston, four major hospitals said 345 of their employees have tested positive for the coronavirus.

And the military yesterday recorded the first death from COVID-19 in an active US service member, noting that a New Jersey Army National Guardsman died on Mar 28. The patient had been hospitalized since Mar 21.

In Massachusetts, 11 veterans died after contracting the virus in a soldier's home in Holyoke. And yesterday the captain of the USS Theodore Roosevelt said that more than 100 sailors were infected on his ship of 4,000 sailors, and he asked the Pentagon for more help in dealing with the outbreak.

In a 4-page letter leaked to the San Fransisco Chronicle, Captain Brett Crozier said only a few of the infected service members had been taken off ship, and it was impossible to execute effective isolation or quarantine measures on other infected or exposed sailors while still onboard.

"Due to a warship's inherent limitations of space, we are not doing this," Crozier wrote. "The spread of the disease is ongoing and accelerating."

Study underscores underlying conditions

In research news, a study today in Morbidity and Mortality Weekly Report shows that 37.6% of all US COVID-19 patients have an underlying health condition, and underlying health conditions were present in 78% of patients who required admission to an intensive care unit (ICU).

The data come from 122,653 COVID-19 patients reported to the Centers for Disease Control and Prevention patients confirmed to have the disease from Feb 12 to Mar 28 and show that, in total, 6.9% of 7,162 patients with known hospitalization status and complete information needed ICU care and 22.5% required hospitalization. Diabetes, chronic lung disease, and heart disease were the most common underlying conditions.

"These results are consistent with findings from China and Italy, which suggest that patients with underlying health conditions and risk factors, including, but not limited to, diabetes mellitus, hypertension, [chronic obstructive pulmonary disease], coronary artery disease, cerebrovascular disease, chronic renal disease, and smoking, might be at higher risk for severe disease or death from COVID-19," the authors concluded.

Of the 122,653 total patients, 2,112 died, for a case-fatality rate of 1.7%.

California data: 5% positive rate in mild ILI

Also today, a research letter published on the JAMA website from Brad Spellberg, MD, and colleagues at the University of Southern California showed that, in a rapid sentinel surveillance study of patients with mild ILI in Los Angeles, 5% tested positive for SARS-CoV-2, the virus that causes COVID-19.

The study was based on patients who presented to the emergency department or urgent care in Los Angeles County from Mar 2 to Mar 18. Patients were excluded from the study if they had known risk factors for COVID-19. Of the 131 COVID-19 tests performed, 7 were positive, with a median patient age of 38.

"The 5% rate of SARS-CoV-2 among patients with mild influenza-like illness without risk factors is concerning. These patients had sufficiently mild illness to be active in the community throughout their illness, increasing the possibility of transmission," the authors concluded.

"Such transmission is consistent with the unusual, third countywide influenza-like illness spike that occurred late in the season and with declining rates of influenza positivity."

See also:

Mar 27 CIDRAP News scan on increased ILI