COVID-19 as of today (03-19-20, summary is my own, not my employer’s):

[QUICK NOTE: As case counts continue to rise, I’m going to start focusing more on pertinent research and efforts to combat the outbreak. I will provide more in-depth looks at case counts each weekend, but I don’t see the effectiveness of displaying these numbers every day, especially since they don’t currently represent the magnitude of the outbreak in the US, and because there are plenty of other resources already doing the same thing. You can find definitions of some terms I use commonly in these posts, as well as the link to your state health department’s up-to-date COVID-19 case counts, here: https://docs.google.com/document/d/1CQZ9KGRJ8gLqSs89sEjpVSr5jBEkgvgBT-QoMOy-O0w]

Countries and Territories with New COVID-19 Cases: Countries Chad, El Salvador, Fiji, Nicaragua and territories Bermuda, Montserrat, and New Caledonia report their first COVID-19 cases. The number of confirmed cases worldwide has exceeded 200,000. It took over three months to reach the first 100,000 confirmed cases, and only 12 days to reach the next 100,000. [1, 2]

New Guidelines Released on How to Find out How Many People Have Already Been Infected with COVID-19: The World Health Organization has released guidance on ways to determine the extent of COVID-19 infection in the population, as new serology tests are being developed. This guidance explains how to investigate the extent of transmission in communities, households, and healthcare facilities; transmission from contaminated surfaces; estimates of the virus’s prevalence in the general population; and how to determine clinical characteristics of existing cases. [3]

The US is Facing a Severe Blood Shortage: The Red Cross and the FDA both ask the American public to donate blood, as we are facing a severe shortage due to blood drives being cancelled in areas with heightened social distancing measures in place. The Red Cross asks that you “postpone your donation for 28 days following travel to China and its special administrative regions, Hong Kong and Macau, as well as Iran, Italy and South Korea, or if you’ve been diagnosed with or have had contact with anyone with a suspected or confirmed case of COVID-19.” Of note, the Red Cross and other blood bank agencies are not allowed to accept blood donations from men who have sex with men (who make up 6 million people in the US population) due to the FDA’s current restrictions. These restrictions used to state that men who have sex with men could never donate blood; as of February 2018, they must wait a full year after their last sexual contact. In 2017 (the most recent year of data available), roughly 0.4% of men who identified as gay or bisexual were diagnosed with HIV. The Red Cross has had a highly effective HIV test in place since 1999, which it uses to screen all blood donations. [4-10]

Hospitals Should Delay Non-Essential Procedures to Free Up Resources for COVID-19 Patients: The Centers for Medicare & Medicaid Services announced yesterday that all elective surgeries and non-essential medical, surgical, and dental procedures should be delayed during the COVID-19 outbreak. This should help healthcare providers preserve personal protective equipment (PPE), blood supplies, beds, and ventilators. [11]

Chloroquine and Hydroxychloroquine Inhibit Growth of the Virus that Causes COVID-19 in Cell Cultures, and May Be Effective to Treat Humans, Though More Study is Needed [FOUR PARAGRAPHS]: Chloroquine is a drug that is currently approved for treating malaria, lupus and rheumatoid arthritis. In 2005, eight CDC researchers published an article on the effectiveness of chloroquine against SARS-CoV-1, the virus responsible for the SARS outbreak in 2002-2003. They found that the drug was effective at preventing the spread of the virus in a cell culture (also known as inhibiting growth of the virus), which suggests that it may be effective as a preventive measure and as a treatment for SARS-CoV-1. In fact, a study published this February in the journal Nature showed that both chloroquine and remdesivir (an HIV drug) were effective at inhibiting SARS-CoV-2 growth in a cell culture. Another study published in Cell Discovery in March found that hydroxychloroquine, a less toxic derivative of chloroquine, was also effective at inhibiting SARS-CoV-2 growth in a cell culture.

Didier Raoult, a professor at IHU Méditerranée Infection in Marseille, France, recently stated that hydroxychloroquine could also be an effective treatment for SARS-CoV-2, the virus that causes COVID-19. France’s Ministry of Health stated that this claim was not valid. On March 16, Professor Raoult presented results of a study on 24 COVID-19 patients who received hydroxychloroquine. He stated that patients who received a combination of hydroxychloroquine and azithromycin (a common antibiotic) were more likely to test negative for COVID-19 by the sixth day of treatment than those who were treated with hydroxychloroquine alone, and that both groups who received hydroxychloroquine with or without azithromycin were more likely to test negative by the sixth day than those who did not receive the drug at all. Of note, this trial was not randomized (meaning that patients were not randomly selected as to who would get the drug and who would not), and patients knew whether they were receiving the drug in question or not. In most clinical trials, patients are randomized into treatment and non-treatment groups, so that researchers can control for other things that could affect a patient’s likelihood of recovery, such as age, gender, or pre-existing medical conditions. Prof. Raoult has submitted his findings to the International Journal of Antimicrobial Agents, where it will be peer-reviewed before being published.

When asked about hydroxychloroquine’s effectiveness for treating COVID-19 patients in a White House press briefing yesterday, Dr. Birx, the response coordinator for the Coronavirus Task Force, stated “there are things that look really good in cell culture against the virus, that may look good in small animals, and then don’t have an impact in humans. And so those are the pieces that we’re looking at very carefully. Of course, there are always anecdotal reports and we’re trying to figure out how many anecdotal reports equal real scientific breakthroughs.”

The FDA is currently working with several government agencies and academic institutions to study the effectiveness of hydroxychloroquine for treating COVID-19 patients. The FDA Commissioner states, “If clinical data suggests this product may be promising in treating COVID-19, we know there will be increased demand for it. We will take all steps to ensure chloroquine remains available for patients who take it to treat severe and life-threatening illnesses such as lupus.” There are at least four hydroxychloroquine clinical trials for COVID-19 currently preparing to recruit participants at the University of Oxford (United Kingdom), the Rajavithi Hospital (Thailand), the University of Queensland (Australia), and Hospital Universitari Germans Trias i Pujol (Spain). [12-21]

Virtually All Deaths in Italy Were in Patients with Underlying Health Conditions; Many US Adults Live with These Same Conditions: Italy’s national health authority released a study today that shows that of the country’s first 2,003 deaths, 99.2% had one or more health conditions, including coronary heart disease, atrial fibrillation, history of stroke, hypertension, diabetes, dementia, COPD, history of cancer (in the past 5 years), chronic liver disease, and chronic kidney disease. In the US, about 18.2 million adults suffer from coronary heart disease. Somewhere between 2.7-6.1 million have atrial fibrillation. More than 795,000 people in the US have a stroke annually. About 108 million US adults have hypertension (45% of all US adults). As of 2017, 30.3 million US adults had diabetes; 84.1 million had prediabetes, a condition that, if not treated, often leads to type 2 diabetes within 5 years. About 10% of those 65 and older have dementia. States with the highest rates of COPD are clustered along the Ohio and lower Mississippi Rivers (>9% of adults in Alabama, Tennessee, Kentucky, and West Virginia have the condition). In 2019 alone, about 1.8 million people in the US were diagnosed with some form of cancer. 4.5 million US adults have been diagnosed with chronic liver disease. About 37 million US adults are estimated to suffer from chronic kidney disease. [22-32]

California Issues Statewide Shelter-In-Place/Stay-At-Home Order: As of midnight tonight, 52.5% of California’s population were set to be under orders from their counties’ health officers to stay at home except for essential activities such as getting groceries or medicine, or taking walks while maintaining a six foot distance from others (this is an oversimplification); each county’s order varied slightly in what residents could and couldn’t do. 27% of the population had already been under such orders, primarily those in Bay Area counties. Tonight, however, Governor Newsom ordered that all Californians must stay home or at their place of residence, except as needed to maintain continuity of operation of federal critical infrastructure sectors, critical government services, schools, childcare, and construction (including housing construction). This order went into effect immediately and will stay in place until further notice. This order encompasses about 1/8 of the US population. [33-51]

[1] Johns Hopkins COVID-19 Map

https://coronavirus.jhu.edu/map.html

[2] WHO COVID-19 Situation Report, 03-19-20

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200319-sitrep-59-covid-19.pdf?sfvrsn=c3dcdef9_2

[3] Coronavirus disease (COVID-19) technical guidance: Early investigations protocols

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/early-investigations

[4] Coronavirus (COVID-19) Update: Blood Donations

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-blood-donations

[5] Severe Blood Shortage Due to Coronavirus Outbreak

https://www.redcross.org/

[6] Revised Recommendations for Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products - Questions and Answers

https://www.fda.gov/vaccines-blood-biologics/blood-blood-products/revised-recommendations-reducing-risk-human-immunodeficiency-virus-transmission-blood-and-blood

[7] HIV and Gay and Bisexual Men

https://www.cdc.gov/hiv/group/msm/index.html

[8] In U.S., Estimate of LGBT Population Rises to 4.5%

https://news.gallup.com/poll/234863/estimate-lgbt-population-rises.aspx

[9] Total population in the United States by gender from 2010 to 2024

https://www.statista.com/statistics/737923/us-population-by-gender/

[10] With better HIV tests, should FDA end its ban on gay men donating blood?

https://www.washingtonpost.com/national/health-science/with-better-hiv-tests-should-fda-end-its-ban-on-gay-men-donating-blood/2012/04/16/gIQAT2a6LT_story.html

[11] CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response

https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental

[12] Chloroquine Is a Potent Inhibitor of SARS Coronavirus Infection and Spread

https://pubmed.ncbi.nlm.nih.gov/16115318

[13] Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro

https://www.nature.com/articles/s41422-020-0282-0

[14] Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro

https://www.nature.com/articles/s41421-020-0156-0

[15] COVID-19: Could Hydroxychloroquine Really Be the Answer?

https://www.medscape.com/viewarticle/927033

[16] Remarks by President Trump, Vice President Pence, and Members of the Coronavirus Task Force in Press Briefing

https://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-5/

[17] Coronavirus (COVID-19) Update: FDA Continues to Facilitate Development of Treatments

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-continues-facilitate-development-treatments

[18] Chloroquine Prevention of Coronavirus Disease (COVID-19) in the Healthcare Setting (COPCOV)

https://clinicaltrials.gov/ct2/show/NCT04303507?term=covid-19&cond=chloroquine&draw=2&rank=1

[19] Various Combination of Protease Inhibitors, Oseltamivir, Favipiravir, and Chloroquine for Treatment of COVID19 : A Randomized Control Trial (THDMS-COVID19)

https://clinicaltrials.gov/ct2/show/NCT04303299?term=covid-19&cond=chloroquine&draw=2&rank=2

[20] Researchers set to begin clinical trials on coronavirus cure

https://www.uq.edu.au/news/article/2020/03/researchers-set-begin-clinical-trials-coronavirus-cure

[21] Treatment of Mild Cases and Chemoprophylaxis of Contacts as Prevention of the COVID-19 Epidemic (HCQ4COV19)

https://clinicaltrials.gov/ct2/show/NCT04304053?term=covid-19&cond=chloroquine&draw=2&rank=3

[22] Report sulle caratteristiche dei pazienti deceduti positivi a COVID-19 in Italia Il presente report è basato sui dati aggiornati al 17 Marzo 2020

https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_17_marzo-v2.pdf

[23] Heart Disease Facts

https://www.cdc.gov/heartdisease/facts.htm

[24] Atrial Fibrillation

https://www.cdc.gov/heartdisease/atrial_fibrillation.htm

[25] Stroke Facts

https://www.cdc.gov/stroke/facts.htm

[26] Facts About Hypertension

https://www.cdc.gov/bloodpressure/facts.htm

[27] New CDC report: More than 100 million Americans have diabetes or prediabetes

https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

[28] Research shows that the prevalence of dementia has fallen in the United States

https://www.washingtonpost.com/national/health-science/research-shows-that-the-prevalence-of-dementia-has-fallen-in-the-united-states/2018/06/15/636d61ac-6fd1-11e8-bf86-a2351b5ece99_story.html

[29] Chronic Obstructive Pulmonary Disease (COPD) Data and Statistics

https://www.cdc.gov/copd/data.html

[30] Cancer Stat Facts: Common Cancer Sites

https://seer.cancer.gov/statfacts/html/common.html

[31] Chronic Liver Disease and Cirrhosis

https://www.cdc.gov/nchs/fastats/liver-disease.htm

[32] Chronic Kidney Disease in the United States, 2019

https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html?utm_source=miragenews&utm_medium=miragenews&utm_campaign=news

[33] New Order Directing Alameda County to Shelter at Home

http://www.acphd.org/2019-ncov/shelter-in-place.aspx

[34] Stay Home Except For Essential Needs

https://cchealth.org/coronavirus/pdf/Stay-Home-Order-FAQs.pdf

[35] Shelter in Place – Order of the Health Officer FAQ

https://humboldtgov.org/DocumentCenter/View/84621/20200319---FAQ---Shelter-in-Place

[36] County and City Officials Announce Additional Public Health Orders Regarding COVID-19

https://www.facebook.com/1438722236161076/videos/620509455179535/

[37] Stay at Home Order in effect for Marin County

https://coronavirus.marinhhs.org/stay-home-order-effect-marin-county

[38] Order of the Health Officer of the County of Mendocino

https://www.mendocinocounty.org/home/showdocument?id=33103

[39] Order of the Napa County Health Officer

https://www.countyofnapa.org/DocumentCenter/View/16687/3-18-2020-Shelter-at-Home-Order

[40] Order of the Health Officer of the County of Sacramento

https://www.saccounty.net/COVID-19/Documents/20200319_HO_Signed_Stay_at_Home_Order.pdf

[41] Stay at Home Except for Essential Needs

https://hhsa.cosb.us/wp-content/uploads/2020/03/San-Benito-County-Stay-At-Home-Frequently-Asked-Questions-031720VF.pdf

[42] Stay Home Except for Essential Needs

https://sf.gov/stay-home-except-essential-needs

[43] Shelter at Home Order

https://www.emergencyslo.org/en/shelter-at-home-order.aspx

[44] San Mateo Health Officer Statements

https://www.smchealth.org/post/health-officer-statements

[45] Order of the Health Officer of Santa Clara

https://www.sccgov.org/sites/phd/DiseaseInformation/novel-coronavirus/Pages/order-health-officer-031620.aspx

[46] Shelter in Place Order from County Health Officer

https://www.santacruzhealth.org/HSAHome/HSADivisions/PublicHealth/CommunicableDiseaseControl/Coronavirus/ShelterInPlace.aspx

[47] Shelter at Home for Solano County

http://www.solanocounty.com/documents/ShelteratHomeOrderforSolanoCounty(002).pdf

[48] Eve of "Stay at Home" Directive from the Yuba-Sutter Health Officer

https://www.youtube.com/watch?v=n6bDBm03f04

[49] Health Officer Order for the Control of COVID-19

http://www.vchca.org/images/public_health/PH_Order_Final_2020-03-17.pdf

[50] Order of the Yolo County Public Health Officer

https://www.yolocounty.org/Home/ShowDocument?id=62366

[51] Governor Newsom: Stay home except for essential needs

https://covid19.ca.gov/stay-home-except-for-essential-needs/