COVID-19 Update: Friday, July 24

Numbers, CDC guidance & a tool for parents, Face Shields, Autoimmune disorders, Amputations, and Fake News. This is a long one as I tried to put in everything I hadn’t been able to fit earlier in the week – so grab a snack and your favorite beverage before venturing in.

1. US Numbers increased by 474k new cases this week and 6,217 additional deaths. This represents a flat change from last week amid increased restrictions and mask mandates (last week was 475k new cases, 5,297 deaths). Our case fatality rate decreased from 3.82 to 3.53. This improvement in fatalities is due to improvements in our ability to treat serious cases as well as an influx in cases (statistically the more of the mild/moderate/asymptomatic cases we capture in the numbers, the lower the CFR looks). Florida and Texas also saw lower case counts this week compared to last week, but fatalities increased in both. Texas saw 992 more deaths than the week before, Florida 843. However, as cases increase, labs have become overwhelmed and test results are now lagging up to 2 weeks in some locations – so this weeks case numbers may be artificially low.

2. Globally we added 1.7million new cases this week and 43k new deaths. The global CFR also dropped from 4.25 to 4.06.

3. The new CDC guidelines for schools have been released. As part of that guidance they have also updated the % of total cases attributed to children from 4% to 6.6% while only 0.1% of all deaths are in children. While the guidance itself is relatively the same, they did include quite a bit of background information, data from what and how other countries approached school reopenings (based on the countries that were successful) and some of the threats our children face when schools are closed (you may recall we discussed these previously, they include things like increased abuse, lack of access to social services/counseling, hunger, increased disparities etc.). Here is the link where you can find the guidelines as well as a decision-making tool for parents: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/index.html

4. Face shields are considered more protective to the wearer than face masks and are a good option for teachers and students (when distanced). In simulations, face shields provide effective protection from coughs and droplets and are more comfortable to wear with the added benefit of people being able to see your face and read your lips. The face shield needs to extend to the chin and wrap around the sides of your face to be effective. Chose one with a comfortable but snug fit around the forehead. Face-shields should not replace masks for everyday use and have not been proven to provide the same level of protection to others that masks provide but can be an effective option in classrooms where social distancing is possible (particularly for teachers). So when you are in front of the class, a face shield is a good option. When you are mingling around helping the students with things - the mask is best. Check out the sketch of face shields from 1918 - that thing is more of a helmet!

5. A case study has linked COVID with the onset of autoimmune disorders. It was a single case, so nothing to be concerned about yet, just something to watch.

6. EDITED FOR CLARITY: A small cohort study out of China (published in PubMed) found that 10.99% of patients in the study re-tested positive after having seemingly recovered, despite having antibodies present in their blood. Most of those who were re-tested positive were 18 and under and experienced mild cases the first time. This was the third such study released this week (regarding possible 2nd cases among those who have recovered). There is evidence that re-infection is possible in those with mild-moderate cases or at least re-testing positive after recovery. It also seems safe at this point to say that despite having antibodies present in our blood, it may not be a strong enough response to provide immunity.

7. Blood clots are a significant issue for COVID patients and are leading to amputations in some.

8. Two fake news stories to be aware of, 1) there are stories claiming that now that the DHHS has the data, the CDC has had to admit they were padding the numbers of cases with influenza and pneumonia cases. This is not true. My best guess where this came from is that people are misunderstanding how it all works. Case counts are just that – straight numbers of reported cases of COVID. Nothing else. However, when you pull the official death certificates to get the COD data (cause of death) as reported in the national health statistics information the first level of data consists of PIC (pneumonia, influenza, covid) – you may recall we discussed this several times in the past – most recently a week or so ago. This is the data that told us that only 6% (this is an estimate because I am working off memory and limited coffee here) of total deaths in the United States were covid related. You may also recall we specifically discussed two import things related to that number, a) it was preliminary data from partial reporting of official state death certificates and would change as more death certificates were received and reviewed, and b) that it was grouped together as PIC for reporting purposes but could be teased out once all the certificates for the month were received. To be clear – these counts are not what is being reported as part of the outbreak. They are official death certificate data that must be searched for and are grouped to make it easier on researchers who use this data. This is common practice and doesn’t impact the outbreak numbers.

The second fake news story making its way around is that there is a cure some doctor out of Texas found but that the wait for publishing is months and months so he can’t get the information out there. This is not true. There is no cure. Currently, research is being fast-tracked to get information out as quickly as possible. Secondly, anything we think is going to be a great treatment has to be tested to be sure it really works and doesn’t cause harm. We have seen already what happens when we rush to assume something is a miracle cure. The story about the doctor says 100% of his patients were cured – but it doesn’t tell us how many patients there were, the condition of the patients, their ages, if they had any co-morbidities etc. This story is just hype.

FINAL THOUGHTS: Friday is here, we have made it yet another week of this crazy crazy year. Be intentional about stepping out of the fray, taking time to relax and refresh, and doing something fun. This may be a great weekend to watch your favorite comedy with a big bowl of popcorn and a small dish of your favorite candy. It may be just the right reward for your tongue for all the things it didn’t say this week. You did great.