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Coronavirus COVID-19 Update for 3/19/2020

The coronavirus COVID-19 is affecting 179 countries and territories around the world and 1 international conveyance (the Diamond Princess cruise ship harbored in Yokohama, Japan).


As of March 20, 2020 at 01:45 GMT, there have been 14267 confirmed cases (up 4,998 cases or 53% over yesterday) and 218 deaths due to coronavirus COVID-19 in the United States.


Personal Note:
My daughter returned home from U.C. Davis in Northern California last Sunday.  My wife and her are planning to drive 400 miles to the Davis hot zone tomorrow to retrieve her personal belongings which remain in her dorm room.  They will spend the night at a friends house in the area then drive home Saturday.  Currently, Davis residents are being asked to shelter-in-place.




Trump Suggests Anti-Malarial Drug Chloroquine Is an Effective Treatment Against COVID-19


President Donald Trump at a White House press conference today said that using the anti-malarial drug chloroquine to treat COVID-19 infections caused by the novel coronavirus has "been approved" by Food and Drug Administration (FDA) and would be available "almost immediately."

However, at the same press conference, FDA Commissioner Stephen Hahn cautioned, "That's a drug that the president has directed us to take a closer look at as to whether an expanded use approach to that could be done and to actually see if that benefits patients. And again, we want to do that in the setting of a clinical trial, a large, pragmatic clinical trial to actually gather that information." Hahn added, "What's also important is not to provide false hope. We may have the right drug, but it might not be in the appropriate dosage form right now, and it might do more harm than good."

The following research papers indicate that there is potential hope that the drug may be effective against COVID-19:

Physicians work out treatment guidelines for coronavirus

Of chloroquine and COVID-19


Breakthrough:  Chloroquine  phosphate  has  shown  apparent  efficacy  in  treatment  of  COVID-19  associated  pneumonia  in  clinical studies


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


Coronavirus will radically alter the U.S. 




When Jason Christie, chief of pulmonary medicine at Penn Medicine, got projections on how many coronavirus patients might soon be flocking to his Philadelphia hospital, he said he felt physically ill.
“My front-line providers — we were speaking about it in the situation report that night, and their voices cracked,” Christie said on Wednesday. They saw how quickly the surge would overwhelm the system, forcing doctors to make impossible choices — which patients would get ventilators and beds, and which would die.

“They were terrified. And that was the best-case scenario.”
Experts around the country have been churning out model after model — marshaling every tool from math, medicine, science and history — to try to predict the coming chaos unleashed by the new coronavirus and to make preparations.
 ...
In the worst-case scenario, America is on a trajectory toward 1.1 million deaths. That model envisions the sick pouring into hospitals, overwhelming even makeshift beds in parking lot tents. Doctors would have to make agonizing decisions about who gets scarce resources. Shortages of front-line clinicians would worsen as they get infected, some dying alongside their patients. Trust in government, already tenuous, would erode further.


 More than half of Californians will be infected by coronavirus in 2 months, Newsom projects

Gov. Gavin Newsom’s office projects that more than half of all Californians will be infected with coronavirus in two months, according to a letter Newsom sent President Donald Trump on Wednesday.

“We project that roughly 56 percent of our population - 25.5 million people - will be infected with the virus over an eight-week period,” Newsom wrote.

The letter requests that the federal government immediately deploy the Navy Mercy Hospital Ship to the port of Los Angeles to help the state deal with a surge of COVID-19 patients that could overwhelm the state’s hospitals.


Younger adults are large percentage of coronavirus hospitalizations in United States, according to new CDC data

As of March 16, a total of 4,226 COVID-19 cases had been reported in the United States, with reports increasing to 500 or more cases per day beginning March 14 (Figure 1). Among 2,449 patients with known age, 6% were aged ≥85, 25% were aged 65–84 years, 18% each were aged 55–64 years and 45–54 years, and 29% were aged 20–44 years (Figure 2). Only 5% of cases occurred in persons aged 0–19 years.

Among 508 (12%) patients known to have been hospitalized, 9% were aged ≥85 years, 26% were aged 65–84 years, 17% were aged 55–64 years, 18% were 45–54 years, and 20% were aged 20–44 years. Less than 1% of hospitalizations were among persons aged ≤19 years (Figure 2). The percentage of persons hospitalized increased with age, from 2%–3% among persons aged ≤9 years, to ≥31% among adults aged ≥85 years. (Table).

Among 121 patients known to have been admitted to an ICU, 7% of cases were reported among adults ≥85 years, 46% among adults aged 65–84 years, 36% among adults aged 45–64 years, and 12% among adults aged 20–44 years (Figure 2). No ICU admissions were reported among persons aged ≤19 years. Percentages of ICU admissions were lowest among adults aged 20–44 years (2%–4%) and highest among adults aged 75–84 years (11%–31%) (Table).

Among 44 cases with known outcome, 15 (34%) deaths were reported among adults aged ≥85 years, 20 (46%) among adults aged 65–84 years, and nine (20%) among adults aged 20–64 years. Case-fatality percentages increased with increasing age, from no deaths reported among persons aged ≤19 years to highest percentages (10%–27%) among adults aged ≥85 years (Table) (Figure 2).

SOURCE:
https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm6912e2_w



Hospitals could face severe shortages of nurses, beds and blood. How California is responding 
 
California is facing the frightening prospect of local hospitals overwhelmed by thousands of patients with COVID-19 in the coming weeks, as they confront potentially severe shortages of ventilators, bed space, donated blood, respirators and nurses.

On Wednesday, the federal government said it would move 1,000-bed hospital ships into New York to deal with the new coronavirus pandemic. That followed an offer by the U.S. Department of Defense to open up its strategic supply of ventilators, single-use masks and other supplies, potentially easing a shortage of life-saving equipment.


A New York Doctor’s Coronavirus Warning: The Sky Is Falling

...Today, at the hospital where I work, one of the largest in New York City, Covid-19 cases continue to climb, and there’s movement to redeploy as many health care workers as possible to the E.R.s, new “fever clinics” and I.C.U.s. It’s becoming an all-healthy-hands-on-deck scenario.

The sky is falling. I’m not afraid to say it. A few weeks from now you may call me an alarmist; and I can live with that. Actually, I will keel over with happiness if I’m proven wrong...


‘At War With No Ammo’: Doctors Say Shortage of Protective Gear Is Dire

The Open Cities Community Health Center in St. Paul, Minn., is considering shutting its doors, because of a dwindling supply of face masks. Doctors at Barnes Jewish Hospital in St. Louis have been forced to perform invasive procedures with loose fitting surgical masks rather than the tight respirator masks recommended by health agencies. At one Los Angeles emergency room, doctors examining a suspected coronavirus patient were given a box of expired masks. When they tried to secure them to their faces, the elastic bands snapped.

With coronavirus cases soaring, doctors, nurses and other front-line medical workers across the United States are confronting a dire shortage of masks, surgical gowns and eye gear to protect them from the virus.

In interviews, doctors expressed soaring anxiety, fearing they could expose not only themselves to the virus, but their families and others.

“There’s absolutely no way to protect myself,” said Dr. Faezah A. Bux, an anesthesiologist in central Kentucky who in recent days had to intubate several elderly patients in respiratory distress without the N95 masks and protective eye gear recommended by the Centers for Disease Control and Prevention. “Not only can I not protect myself, I can’t protect my patients.”



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