So when did this epidemic start? A new paper examines that question. (Lancet Article) Due to China’s deviousness and lack of transparency, we really don’t know when the current coronavirus strain may have jumped to humans and what the early progress of the epidemic looked like. People have tried to ascertain whether there were unusual levels of flu-like illness last year and even looked at sputum or blood samples taken from that time period. This paper starts by noting that confirmed cases by testing seem far too low for the length of time a highly transmissible virus was circulating. The authors used the ratio of coronavirus to influenza cases in some early retrospective sample testing studies to estimate how widespread the epidemic actually was early on in Wuhan and in Seattle. For Wuhan they find a ratio of CV cases to influenza ones of .61 so that there were about 1400 symptomatic CV cases in Wuhan between December 30 and January 12 in adults over the age of 30, which rose to a central estimate of about 18,500 cases by January 23rd, when lockdown began. Only 422 documented cases existed at that point. And remember this is just symptomatic cases. They further estimate that the epidemic began in China by late November or early December. Using a 50% ratio for detected cases to all cases, suggests as many as 37,000 cases in Wuhan by January 23rd just in adults over age 30.
For Seattle, a lower ratio of coronavirus to influenza cases was estimated, and by March 9 they estimated a cumulative 6750 cases across all ages in Seattle, which again could be doubled to account for undetected cases to 13,500. They also estimate that the epidemic began in Seattle around January 6. My personal belief is that the epidemic likely started earlier in both places, had large numbers of undetected cases initially, as younger people with higher contact patterns had largely mild infections and it wasn’t until a few weeks later, when the epidemic reached more older and vulnerable people and caused serious illness, that providers realized they had a new infectious agent on their hands.
I work with a business involved in organ and cell transplants so I have some first-hand knowledge of the impacts of the lockdowns on transplant activity. A study from Lancet finds that there was a dramatic slowdown in both organ availability and transplants during the early phases of the epidemic. (Lancet Study) Transplants from deceased donors declined by over 65% in the UK in this time period. Not shown was the impact on the health of the people awaiting a transplant. Undoubtedly a number died.
A number of factors have been hypothesized to be associated with milder or more severe illness. Blood type is one. This paper pretty much debunks the likelihood of that in a review of over 400 cases. (Medrxiv Paper)
I have talked about the usefulness of knowing place of death and of comparing it this year to other years. The paper looked at place and cause of death in the United Kingdom. (Medrxiv Paper) These numbers will be revised down, because the UK has recently acknowledged that assigning a number of deaths to CV made no sense. But for this paper, there were 57860 deaths above the expected number, 50,603 of which supposedly related to CV. One-half of these excess deaths occurred in care homes, a 55% increase, but only 61% of the excess deaths involved CV. 20% of the excess deaths occurred in hospitals, up 21% from the expected number, but this was a mix of many more CV deaths and fewer deaths from cardiac disease and cancer. 20% of the excess deaths occurred at home, an increase of 39% in the expected number and only 14% of these involved CV. There were 6000 excess cancer deaths at home and 2500 excess heart disease ones. Place of death for those diseases clearly shifted from the hospital to home and is likely a reflection of fear of seeking care.
Lockdowns do not work, do not work, do not work. South America is busy proving that. Two countries with very long running and strict lockdowns, Argentina and Peru, are having horrific epidemics. (Bloomberg Story) They don’t work because we may not know how or why, but the virus has some very unique ability to transmit. Now what is interesting, since Brazil has taken a lot of heat for not locking down more aggressively, is that Peru and Chile had per capita death rates similar to Brazil. But interestingly, Chile, while it has a much higher death rate to date, is seeing rapidly declining cases, while Argentina, which has to be considered a sort of sister country, hasn’t seen that drop.
Every now and then people get excited about a new CV test or a new therapeutic. Progress is important but there will be no magic pill that makes this go away. These respiratory viruses are going to be with us and causing disease even with a vaccine and better treatment plans. Here is a paper on a new diagnostic test that got buzz, for being just saliva you can self-collect and that can be tested fast, supposedly. (Medrxiv Paper) The test was approved by the FDA. It was validated with only about 40 samples. Realistically, it needs to be tested for false negatives and false positives in a much more rigorous manner, or in a low CV prevalence world, which is pretty much where we are, it may not be that accurate. And the idea that everyone will take a test every day and then will isolate if they are positive, is kind of extreme and if it worked, would exacerbate that accuracy problem I mentioned. On the treatment side, the Wall Street Journal had an article about a cell therapy which supposedly offers dramatic improvements for very ill patients. Maybe, maybe not. Trust me, the most important thing to really believe something is repeated, well-designed experiments.
As you might expect, but this paper gives evidence to, for people with Alzheimer’s and dementias the quarantines and lockdowns and isolation make their disease far worse. Many of these people are in nursing homes and I believe that many deaths are being wrongly attributed to coronavirus among this group that actually are due to the underlying dementia worsening during quarantine. (Lancet Paper) In this paper Italian researchers observed the condition of 4900 dementia patients who were locked down and isolated and found that at least half had a dramatic worsening of symptoms and condition. Caregivers also were under more stress.