Coronavirus Update, Sunday, March 15.
The latest numbers for Washington state are 645 cases and 40 deaths. This increase was expected, and so far is manageable. That doesn’t mean the infection is waning; only that we are not seeing the explosion that was seen in Northern Italy.
At the same time, China, South Korea and Singapore all report declining cases. The South Korean response to the pandemic was a lesson for all nations; rapid testing, triage, treatment, curfews and travel restrictions. As a result, deaths in that nation are staying at about 1% of cases, and on Friday, people released from hospital outnumbered new cases, 510 to 110.Spain is the new hotspot in Europe, with cases rising rapidly to more than 7,000. Again, the numbers to watch are hospitalizations and deaths. Since 80% of affected people recover after 7 to 14 days, triage (the ability to evaluate risk and apply appropriate medical resources) is job one.
In the US, Washington is the bellwether state.Genomic data suggests that Covid-19 arrived in the Seattle area in late December, with the first confirmed case on January 21. That means we Washingtonians are in what is known as the acceleration phase of the pandemic, while the rest of the country is in the initiation phase. So while WA looks to South Korea for guidance, New York and California (with rapidly increasing cases) will watch and learn from the WA response.
1. To date, there are 33 deaths in King County, WA. But 25 of those were linked to the Life Care Center nursing facility in Kirkland. This highlights a tremendous risk factor, in that we have just learned that 1/3 of the nursing staff of that facility are not coming to work because they themselves are showing signs of possible infection. What’s more, a quarter of the city’s fire department has been quarantined after exposure to infected patients at the same nursing home.
Lesson and Action steps. We have to do a better job protecting first responders. That means a lot more safety gear. Keeping health care workers healthy is crucial to preventing the disease from spreading. A shortage of doctors and nurses could lead to understaffed hospitals and other care centers being overwhelmed. If this virus is challenging for King County Washington, with some of the best hospitals in the nation, it will be even more important to send safety gear to states with fewer health care workers, fewer hospital beds and ICU’s.
2. The issue of testing. The University of Washington’s Virology Department has capacity for 2,200 tests each day, with results available in 24 hours. By mid-week, I am told the UW lab could reach 3,000 daily tests. Two private companies based in California are also testing patients. Quest Diagnostics is expanding its number of labs across the country, and can now test more than 1,000 patients a day. LabCorp is hoping to have capacity for thousands of daily tests in a few weeks.But this is only a fraction of what is needed to emulate the South Korea model. Early in the acceleration phase, South Korea was testing 15,000 people per day. It has conducted 3,600 tests per million people compared to five per million in the U.S. That means we have to be smart about who gets tested and when.
Lesson and Action Steps
1. There are not enough tests for the general public, and there won’t be for months. Testing is most important for people who are symptomatic. That is what makes triage possible.
2. Even with a positive test, most people can manage their symptoms at home.
3. Some employers are requiring proof of a negative test before allowing an employee to return to work. Sorry; there are not enough tests. The Gates Foundation is working on a home testing kit, but that awaits FDA approval, and even with approval, scaling up production will take 90 to 120 days.
I am encouraged by steps taken to reduce exposure. Travel restrictions, event cancellations and curfews might be disruptive for our daily lives, but we know from the South Korean success that this pandemic can only be managed with such a comprehensive approach. I’m also encouraged by a marked reduction in posts in my news feed from people claiming that the whole thing is a media hoax.
About the author: Stephen Cherniske is a biochemist with 50 years of academic, research and clinical experience. He taught university clinical nutrition, and directed the nation’s first FDA-licensed clinical laboratory specializing in nutrition and immunology.
References and Resources https://ncov2019.live/data  https://komonews.com/…/washington-death-toll-from-coronavir…  https://www.cdc.gov/coronavirus/…/cases-updates/summary.html  https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html