COVID-19 Blog - 05/29/20

As of May 29, 2020, there are over 5.6 million people diagnosed with COVID-19 and nearly 346,000 deaths worldwide. In the US, there are over 1.7 million infections and more than 101,000 deaths. To put this in perspective, in 3 months, COVID-19 has killed more Americans than in any wars except World War I, World War II, and the Civil War. The CDC is reporting a forecast that we will have 115,000 deaths by June 20, 2020, which is approximately the number of Americans who died in World War I.

The 1.7 million documented infections in the US may just be the tip of iceberg. In a  study from of one cruise ship with complete testing of 217 passengers and crew, out of the 128 who tested positive, 81% having no symptoms. In another study at a skilled nursing facility, 56% of those who tested positive had no symptoms at the time of the test. In another study done by my colleagues at UCSF in the Mission District of San Francisco, 53% of the people who tested positive did not have symptoms. Since most testing at this time are being done on people who present to the healthcare system presumably with symptoms, it is not unreasonable to conclude that there are hundreds of thousands of infections that have not been documented.

In the UCSF study, although Latinx comprised 44% of the sample tested, they made up 95% of those infected. Among those who tested positive, 90% could not work from home, were mostly low-income, and lived in household with 3 or more people. These findings support the concern that low-wage essential workers are at high risk.

There are no new major developments on the treatment or vaccine front. There is a report that after Gilead Sciences, Inc. donated 607,000 doses of remdesivir to the US government to distribute, the federal government mishandled its distribution and may have delayed getting the drug to patients who needed it.

I want to close with some concerns about re-opening based on the data. For the week ending 5/24, 20 states had an increase in the number of new cases, up from 13 states the week before. One of the first states to re-open, Georgia, reported a 21% increase in number of cases in the week that ended on 5/24. 2 weeks after the Wisconsin Supreme Court struck down a stay-at-home order, on 5/28, the state recorded its highest daily number of infections and deaths.

This morning, the report out of South Korea, which has done a great job of limiting the pandemic and which had re-opened schools with attendance limits, just shut down 500 schools because of a spike in the number of infections. The situation in South Korea should worry us because they are much better at testing and contact tracing than we are, and generally speaking, Koreans are better at adhering to social policies like social distancing and mask wearing than we are. They are also making data-based decisions.

As I stated last time, our federal and some state governments are making decisions not always using data, but instead are changing the data to make them fit their decisions. Already, one-third of the states are not reporting COVID hospitalization data, a significant marker of an increasing pandemic. The Governor of Iowa has stated they will not report pandemic data from meat packing plants on their data website. The District of Columbia does not meet its own criteria of having 2 weeks of decreasing number of infections before re-opening. So instead of not re-opening, it is now excluding infections in nursing homes, homeless shelters, and jails, which appears to be an effort in changing the data to fit the re-opening decision.

A wrong decision at the wrong time--going to sheltering in place 1 week later--led to the death of 36,000 Americans by one modeling analysis. The way things are going, I am sure there will be a second wave and almost sure that it will be significant. We will look back and mourn the terrible decisions that will kill thousands needlessly once again.