to read POSTS 1-25 in chronological order, highlight and click on

“In the latest sign of worry that the coronavirus could be spreading through the senior ranks of the Trump administration, three top public health officials have begun partial or full self-quarantine for two weeks after coming into contact with someone who has tested positive for the coronavirus.

Representatives for Dr. Robert Redfield, the director of the Centers for Disease Control and Prevention, and Dr. Stephen Hahn, the commissioner of the Food and Drug Administration, confirmed the precautions on Saturday. Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, confirmed a CNN report that he had begun a “modified quarantine” given what he called a “low risk” contact.

The actions come after the disclosure on Friday that Vice President Mike Pence’s press secretary, Katie Miller, tested positive for the virus. Ms. Miller has attended numerous meetings of the White House’s coronavirus task force, which also includes Dr. Redfield, Dr. Hahn and Dr. Fauci.

Dr. Fauci will telework from home and wear a mask for 14 days, he told CNN, possibly visiting his office at the National Institutes of Health when he will be the only person present. He tested negative for the virus on Friday and plans to be tested daily from now on.

Dr. Redfield also had a “low-risk exposure” with a person at the White House, on May 6, and will be teleworking for the next two weeks, Benjamin Haynes, a C.D.C. spokesman, said in a statement. Dr. Redfield “is feeling fine, and has no symptoms,” he said, adding that if Dr. Redfield needed to visit the White House for official business he would follow C.D.C. safety guidelines for essential workers who may have been exposed to the virus. Those guidelines call for temperature checks, screening for symptoms, masks as well as social distancing.” (A)

“The Trump administration is racing to contain an outbreak of Covid-19 inside the White House, as some senior officials believe that the disease is already spreading rapidly through the warren of cramped offices that make up the three floors of the West Wing….

Others who came into contact with Ms. Miller and the valet are continuing to report for duty at the White House.

“It is scary to go to work,” Kevin Hassett, a top economic adviser to the president, said on the CBS program “Face the Nation” on Sunday.

Mr. Hassett said he sometimes wears a mask in the White House, but he conceded that “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”

He added: “It’s a small, crowded place. It’s, you know, it’s a little bit risky. But you have to do it, because you have to serve your country.”

Dr. Fauci was scheduled to testify at a Senate committee hearing on Tuesday; he and other witnesses will now appear by videoconference instead of in person, according to the office of the committee chairman, Sen. Lamar Alexander of Tennessee.

The discovery of the two infected staff members has prompted the White House to step up its procedures to combat the coronavirus, including daily tests for some senior staff, increased use of masks and more rigorous screening of people entering the complex.

The concern about an outbreak at the White House — and the swift testing and contact tracing being done to contain it — underscores the broader challenge facing Americans as Mr. Trump urges them to begin returning to their own workplaces. Public health officials continue to warn that the virus is still ravaging communities across the country and that precautions are still needed.

Mr. Trump himself continues to reject guidance from the Centers for Disease Control and Prevention to wear a mask when meeting with groups of people. But a senior administration official said the president was spooked that his valet, who is among those who serve him food, had not been wearing a mask. Mr. Trump was annoyed to learn that Ms. Miller had tested positive, and has been growing irritated with people who get too close to him, the official said.” (B)

“Experts have repeatedly remarked on how highly transmissible the coronavirus is, a particularly dangerous fact given the close quarters of the West Wing. Trump and Pence were in meetings together with the governors of Iowa and Texas each of the last two days, and Pence has led task force meetings this week with the administration’s top health officials.

But if Trump was nervous about the virus spreading within the White House, he did not make it known publicly.

“I’m not worried. But you know, look, I get things done. I don’t worry about things. I do what I have to do,” he said. “We’ve taken very strong precautions at the White House. But again, we’re dealing with an invisible situation. Nobody knows.”

“All you can do is take precaution and do it the best you can,” he added.

The White House is said to be implementing more stringent policies and procedures meant to protect the president and vice president. Trump and Pence and their closest aides will now be tested daily, rather than weekly, for the virus.

Visitors who meet with Trump or Pence are given rapid virus tests upon arriving at the White House, and events have been set up in recent weeks to accommodate a greater level of social distancing…

Masks have appeared to be a particular sticking point for a president who is known to be extremely image-conscious and is trying to convince the country that it’s safe to go back to work.

All 14 reporters seated in the briefing room for Friday’s press briefing wore masks, as did the White House stenographer. Press secretary Kayleigh McEnany and the three aides who joined her did not.

Trump, an admitted germaphobe, did not wear a mask to visit the World War II Memorial to mark the 75th anniversary of V-E Day. He said he did not consider wearing one to greet the veterans in attendance, noting that he kept several feet away when greeting them.

Zero of the roughly three dozen Republicans and administration officials seated in the State Dining Room for the meeting with Trump had a mask on. The officials were seated only a couple feet apart from one another. Lawmakers could be spotted touching their faces and picking up microphones to move them closer throughout the nearly two hours reporters were allowed to observe…

Meadows, apparently unaware the president’s event with Republican lawmakers was being broadcast live, said “off the record” that reporters in the building could get tested for peace of mind, and many did on Friday afternoon.” (C)

“Despite a second White House staffer testing positive for COVID-19 this week, President Donald Trump has continued to undermine social distancing efforts. As the Washington Post reports, new protocols were put into place to secure the White House complex over the past two days, during which a military valet to the president and Katie Miller, the press secretary for Vice President Mike Pence, tested positive…

Trump attended the meeting less than an hour after Pence’s plane took off for Des Moines, a trip that was delayed for more than an hour as two aides who had been in close contact with Miller were removed from Air Force Two out of precaution. While the White House said Pence and the aides tested negative for the virus, the Post notes that Miller has attended almost all of the White House coronavirus task force meetings—during which almost no aides wore masks—in the Situation Room, prompting concern for who else Miller interacted with. During an event with GOP members, the president sent conflicting messages, suggesting that “the whole concept of tests isn’t great” while also claiming “I don’t worry about things” and that “we’re dealing with an invisible situation. Nobody knows.” According to several security officials, not wearing a mask—which Pence and White House Chief of Staff Mark Meadows have followed suit— and gathering with guests for photo-ops at the White House speaks to Trump’s repeated efforts to minimize the public health crisis.

“This is a show of bravado,” a former security official told the Post. “If he backtracks now, and starts wearing a mask, it will contradict the red meat he’s feeding to his base constantly. This is the first health crisis that has been politicized.”

…While Secret Service spokesperson Justine Whelan said that the agency “continues to follow guidelines issued by the CDC to ensure the health and welfare of our employees and those they come in contact with,” Yahoo notes that measures taken at the White House have not necessarily followed such guidelines, with many Secret Service employees on the White House complex among those not wearing a mask. And while temperature checks have been occurring for everyone entering the White House, testing has been partial, with reporters entering the Oval Office without being required to wear masks or being given tests. This remains true even as the virus seems to spread within the White House: Yahoo reports that the press covering the event where Trump discussed Miller’s diagnosis were not given tests before being brought into the State Dining Room.” (D)

“Vice President Pence and President Trump are now both being tested daily for the coronavirus and continued to test negative as of Friday…

But the White House’s own coronavirus guidance urges people who’ve been exposed to COVID-19 to stay home, and away from others who haven’t been exposed to the virus for 14 days, even if they’re not sick. ..

The coronavirus is highly contagious and may spread easily between people who aren’t showing symptoms, which is why it’s critical for people to stay home when they’ve been exposed to a sick person, even if they aren’t feeling ill. People over 60 (which Trump and Pence both are) are also at a much higher risk of developing some of the virus’s most severe complications, making social distancing even more critical for the pair right now.

Since not everyone can stay home, even when they’re sick, the US Centers for Disease Control and Prevention has issued special guidance for essential workers who’ve had close contact with an infected person. The guidance says they can still go to work, if they must, but only so long as they wear a mask for 14 days after their exposure, maintain a 6-foot distance from others, monitor themselves for symptoms, and disinfect workspaces regularly. 

Neither Pence nor Trump has been wearing a mask, though…

Recent studies have suggested that the coronavirus thrives especially well in enclosed, indoor workplaces where people sit next to each other, chat, and exchange air all day long…

“More distance is better,” University of Maryland virologist Don Milton recently told Business Insider.” (E)

“The decision to shelve detailed advice from the nation’s top disease control experts for reopening communities during the coronavirus pandemic came from the highest levels of the White House, according to internal government emails obtained by The Associated Press…

The trove of emails obtained by The Associated Press show the nation’s top public health experts at the CDC spending weeks working on guidance only to see their work quashed by political appointees with little explanation…

The document, titled “Guidance for Implementing the Opening Up America Again Framework,” was researched and written to help faith leaders, business owners, educators and state and local officials as they begin to reopen. It included detailed “decision trees,” or flow charts aimed at helping local leaders navigate the difficult decision of whether to reopen or remain closed.

White House spokeswoman Kayleigh McEnany said Friday that the documents had not been approved by CDC Director Robert Redfield. The new emails, however, show that Redfield cleared the guidance.

“The re-opening guidance shared prematurely was in draft form and had not been vetted through the interagency review process,” Redfield said in a statement released by the White House on Saturday.

“This is an iterative effort to ensure effective, clear guidance is presented to the American people. I had not seen a version of the guidance incorporating interagency and task force input and therefore was not yet comfortable releasing a final work product,” the statement said.

This new CDC guidance — a mix of advice already released along with newer information — had been approved and promoted by the highest levels of its leadership, including Redfield. Despite this, the administration shelved it on April 30.

As early as April 10, Redfield, who is also a member of the White House coronavirus task force, shared via email the guidance and decision trees with President Donald Trump’s inner circle, including his son-in-law Jared Kushner, top adviser Kellyanne Conway and Joseph Grogan, assistant to the president for domestic policy. Also included were Dr. Deborah Birx, Dr. Anthony Fauci and other task force members.

Three days later, CDC’s upper management sent the more than 60-page report with attached flow charts to the White House Office of Management and Budget, a step usually taken only when agencies are seeking final White House approval for documents they have already cleared…

The CDC’s guidance was shelved. Until May 7.

That morning The Associated Press reported that the Trump administration had buried the guidance, even as many states had started allowing businesses to reopen.

After the story ran, the White House called the CDC and ordered them to refile all of the decision trees, except one that targeted churches. An email obtained by the AP confirmed the agency resent the documents late Thursday, hours after news broke.

“Attached per the request from earlier today are the decision trees previously submitted to both OIRA and the WH Task Force, minus the communities of faith tree,” read the email. “Please let us know if/when/how we are able to proceed from here.”” (F)

“One day after President Trump complained that the amount of coronavirus testing happening nationwide makes the United States “look bad,” Deborah Birx, the White House coronavirus response coordinator, said such efforts are essential and should be stepped up.

Birx’s comments came Thursday evening in an answer to a pointed question from CNN anchor Anderson Cooper, who wanted to know whether she agreed with Trump’s take on testing.

Though the president continues to brag about and take credit for U.S. testing, in recent days, he has expressed skepticism about the need for so much of it. On Tuesday, he did both in the same breath.

Trump said that while the U.S. has “the greatest testing in the world” and “the most testing in the world,” he didn’t think “you need that kind of testing or that much testing.” The next day, Trump took his remarks a step further, telling reporters at the White House, “In a way, by doing all of this testing, we make ourselves look bad.”…

Cooper, who was joined by CNN’s chief medical correspondent Sanjay Gupta, opened Thursday’s interview with Birx by asking her about why guidelines on reopening the country from the Centers for Disease Control and Prevention have not yet been released, despite being in the works for weeks.

Earlier in the day, the Associated Press and CNN reported that the White House had shelved the recommendations — a move that would further limit the CDC’s public role during a pivotal moment in the country’s coronavirus response as more than half the states are now reopening or in the process of lifting restrictions.

In response to Cooper, Birx stressed that administration officials are “in deep partnership” with the CDC on a number of different guidelines, including those related to reopening the country.

“No one has stopped those guidelines. We’re still in editing,” Birx said with a smile. “I just got my edits back from the CDC late yesterday. I’m working on them as soon as I get off of this discussion. We are in constant work with the CDC and really value their partnership.”…

Then, the conversation turned to another delicate subject: the practice of wearing masks at the White House, in light of news that a valet, whose job potentially puts him in close daily contact with Trump, had tested positive for the novel virus…

“All of us are very nervous every day. None of us want to be the one to ever bring coronavirus into the White House,” Birx said. “Most of us don’t do anything but go to work and come home. If we go out at all, even to take a walk, I can assure you we do wear masks in public.”

“I think all of us are very nervous every day. None of us want to be the one to ever bring coronavirus into the White House,” says coronavirus response coordinator Dr. Deborah Birx.

When Gupta asked Birx if she would tell people to start wearing masks around Trump given how easily transmittable the virus is, the doctor artfully dodged the question.

“Certainly there are people who wear masks on the White House complex,” she said, before shifting to discuss the effort being made by officials to maintain social distancing in their daily interactions.

“I’m very scrupulous and I know all of the meetings we have are very much focused on social distancing,” she continued. “We all are very concerned about protecting others as well as ensuring that we don’t become positive ourselves.”” (G)

“President Donald Trump hoped this would be the week he emerged into a nation recovering from pandemic. Instead the pandemic came to him…

The arrival of coronavirus to the West Wing only served to illustrate the continued spread of the disease months into a pandemic that’s taken more than 77,000 American lives and turned a once hot economy to ice. Even the nightly deep cleanings, regular testing and a lot of wishful thinking couldn’t prevent the virus from arriving on Trump’s doorstep…

As Trump agitates for states to loosen their restrictions and allow Americans back into workplaces and businesses, the sight of his aides contracting the disease did little to boost confidence the nation is ready to return to normal, even as jobless claims skyrocket to never-seen-before levels and options for reviving the economy fall short….

The new testing rules have only underscored to aides the new reality in which they find themselves: forced to confront a virus that hasn’t yielded, even though Trump says the country must reopen and Americans must return to work.” (H)

• A.Top Health Officials to Quarantine After Being Exposed, https://www.nytimes.com/2020/05/09/us/coronavirus-news-updates.html?referringSource=articleShare
• B.Coronavirus Live Updates: White House Races to Contain an Outbreak Among Staff, https://www.nytimes.com/2020/05/10/us/coronavirus-deaths-cases.html
• C.Positive coronavirus cases shake White House, BY BRETT SAMUELS, https://thehill.com/homenews/administration/496876-positive-coronavirus-cases-shake-white-house
• D.Coronavirus Cluster Blossoms At White House As Trump Continues To Minimize Threat, BY CHARLOTTE KLEIN, https://www.vanityfair.com/news/2020/05/coronavirus-cluster-blossoms-white-house-trump-continues-minimize-threat
• E.Trump and Pence should go into self-quarantine for the next 2 weeks — according to the government’s own coronavirus guidelines, Hilary Brueck, https://www.businessinsider.com/trump-pence-exposed-to-coronavirus-at-white-house-wont-quarantine-2020-5
• F.Top White House officials buried CDC report, https://www.nbcnews.com/politics/white-house/top-white-house-officials-buried-cdc-report-n1203521
• G.Trump is now downplaying coronavirus testing. Deborah Birx just did the opposite., by Allyson Chiu,  https://www.washingtonpost.com/nation/2020/05/08/trump-birx-coronavirus-test/
• H.Trump sought a reopening but found the virus in the White House instead, by Kevin Liptak, https://www.cnn.com/2020/05/08/politics/donald-trump-staffers-coronavirus/index.html

CORONOVIRUS TRACKING

Links to Parts 1-25

Doctor, Did You Wash Your Hands?®

Curated Contemporaneous Case Study Methodology

Jonathan M. Metsch, Dr.P.H.

PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)

PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….

PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”

POST 6. February 18, 2020.  Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””

PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”

PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.

PART 11. March 5, 2020.  CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”

Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”

Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”

PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”

PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.

PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT

PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.”  “New York’s private and public hospitals unite to manage patient load and share resources.

PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.

PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”

PART 20. April 20, 2020. CORONAVIRUS. “…nothing is mentioned in the “Opening Up America Again” plan about how states should handle a resurgence.”

PART 21. April 23, 2020. CORONAVIRUS. “We need to ask, are we using ventilators in a way that makes sense for other diseases but not this one?”

POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”

POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)

POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.

POST 25. May 10, 2020, CORONAVIRUS.

May 10, 2020

 [JM1]

to read Posts 1-24 in chronological order, highlight and click on https://doctordidyouwashyourhands.com/2020/05/coronovirus-tracking-links-to-parts-1-24/

“In a podcast interview with CNN’s Dana Bash, former New Jersey Gov. Chris Christie conceded that there would be deaths if states begin to ease their lockdown restrictions, but that people need to accept these deaths because the economic impact would be more dangerous.

Bash began by asking Christie about New York Times reporting that showed White House modeling projected 3,000 deaths a day from the coronavirus by June 1.

Christie acknowledged that “it’s absolutely true,” but believed the country could not sustain its current economic course.

“If we leave this purely up to the physicians’ and the epidemiologists’ data we will be locked in our houses for another year because they don’t want us to be doing anything other than staying in our homes until there’s a vaccine,” Christie said.

“Of course, everybody wants to save every life they can — but the question is, towards what end, ultimately?” Christie later said. “Are there ways that we can thread the middle here to allow that there are going to be deaths, and there are going to be deaths no matter what?”

Christie said it was important to “let some of these folks get back to work, because if we don’t, we’re going to destroy the American way of life in these families — and it will be years and years before we can recover.” (A)

What is herd immunity?

Exposure to a disease-causing organism triggers the body to produce antibodies, disease-specific proteins that fight off the infection. On first exposure, it can take the body a while to develop the right antibody. However, in many cases, the human immune system retains knowledge of that infectious agent, and if it comes across it again, is able to rapidly deploy these antibodies to fight it off.

When a person develops this sort of antibody-based immunity to a given infectious agent, the likelihood that they will pass it on falls significantly says D’Souza. When 70-80% of a given population develops this antibody protection, herd immunity is achieved, indirectly providing protection to those who are not yet immune.

“It’s enough people being immune that over time the number of infections goes down rather than up,” says David Dowdy, associate professor of epidemiology also at Johns Hopkins University. “There are really only two ways to achieve this level of immunity. One is through development and mass distribution of a vaccine, and the other is through a massive increase in the number of people who get sick.” (B)

“How have we achieved herd immunity for other infectious diseases?

Measles, mumps, polio, and chickenpox are examples of infectious diseases that were once very common but are now rare in the U.S. because vaccines helped to establish herd immunity. We sometimes see outbreaks of vaccine-preventable diseases in communities with lower vaccine coverage because they don’t have herd protection. (The 2019 measles outbreak at Disneyland is an example.)

For infections without a vaccine, even if many adults have developed immunity because of prior infection, the disease can still circulate among children and can still infect those with weakened immune systems. This was seen for many of the aforementioned diseases before vaccines were developed.

Other viruses (like the flu) mutate over time, so antibodies from a previous infection provide protection for only a short period of time. For the flu, this is less than a year. If SARS-CoV-2, the virus that causes COVID-19, is like other coronaviruses that currently infect humans, we can expect that people who get infected will be immune for months to years, but probably not their entire lives.

What will it take to achieve herd immunity with SARS-CoV-2?

As with any other infection, there are two ways to achieve herd immunity: A large proportion of the population either gets infected or gets a protective vaccine. Based on early estimates of this virus’s infectiousness, we will likely need at least 70% of the population to be immune to have herd protection.

In the worst case (for example, if we do not perform physical distancing or enact other measures to slow the spread of SARS-CoV-2), the virus can infect this many people in a matter of a few months. This would overwhelm our hospitals and lead to high death rates.

In the best case, we maintain current levels of infection—or even reduce these levels—until a vaccine becomes available. This will take concerted effort on the part of the entire population, with some level of continued physical distancing for an extended period, likely a year or longer, before a highly effective vaccine can be developed, tested, and mass produced.

The most likely case is somewhere in the middle, where infection rates rise and fall over time; we may relax social distancing measures when numbers of infections fall, and then may need to re-implement these measures as numbers increase again. Prolonged effort will be required to prevent major outbreaks until a vaccine is developed. Even then, SARS-CoV-2 could still infect children before they can be vaccinated or adults after their immunity wanes. But it is unlikely in the long term to have the explosive spread that we are seeing right now because much of the population will be immune in the future.” (C)

“There’s a consensus that the key to ending the coronavirus pandemic is establishing herd immunity. But there are many unknowns. One is whether researchers can develop a safe and effective vaccine. Another is how long people who’ve recovered have immunity; reinfection after months or years is common with other human coronaviruses. Finally, it’s not clear what percentage of people must be immune to protect the “herd.” That depends on the contagiousness of the virus. (D)

“Herd immunity is disease-specific and is influenced by the ease with which the disease spreads from person to person, or the level of contagiousness. The specifics about coronavirus and herd immunity are not yet characterized. Regardless of the specifics, achieving herd immunity by the repeated process of infection of one person, recovery and immunity will take a long time – many, many months or even years.

It will take a long time to achieve worldwide herd immunity. It may take less time in some cities or countries, but it will take time. Those individuals who are immune will be able to get back to work and be protected from reinfection and, probably, not transmit the virus or disease.” (E)

“The point at which we reach herd immunity is mathematically related to the germ’s propensity to spread, expressed as its reproduction number, or R0. The R0 for the coronavirus is between 2 and 2.5, scientists estimate (pdf), meaning each infected person passes it to about two other people, absent measures to contain the contagion.

To imagine how herd immunity works, think of coronavirus cases multiplying in a susceptible population this way: 1, 2, 4, 8, 16, and so on. But if half the people are immune, half of those infections won’t ever happen, and so the spreading speed is effectively cut in two. Then, according to the Science Media Centre, the outbreak simmers along like this instead: 1, 1, 1, 1 … The outbreak is snuffed out once the infection rate is less than 1.

The current germ’s rate of spread is higher than that of the ordinary flu, but similar to that of novel emergent influenzas that have occasionally swept the globe before. “That is similar to pandemic flu of 1918, and it implies that the end of this epidemic is going to require nearly 50% of the population to be immune, either from a vaccine, which is not on the immediate horizon, or from natural infection,” Harvard University epidemiologist Marc Lipsitch told a gathering of experts on a video call this weekend.

The more infectious a virus is, the more people need to be immune for us to achieve herd immunity. Measles, one of the most easily transmitted diseases with an R0 over 12, requires about 90% of people to be resistant for unprotected people to get a free ride from the herd. That’s why new outbreaks can start when even small numbers of people opt out of the measles vaccine.

Similarly, if the coronavirus spreads more easily than the experts think, more people will need to get it before herd immunity is reached. For an R0 of 3, for example, 66% of the population has to be immune before the effect kicks in, according to the simplest model.

Whether it’s 50% or 60% or 80%, those figures imply billions infected and millions killed around the world, although the more slowly the pandemic unfolds, the greater the chance for new treatments or vaccines to help.

The newest epidemiological models developed in the UK now recommend aggressive “suppression” of the virus. The basic tactics being urged would be to isolate sick people, try to reduce social contacts by 75%, and close schools. Those economically costly measures could continue for many months.

“Suppressing transmission means that we won’t build up herd immunity,” says Azra Ghani, the lead epidemiologist on the new model of the outbreak from Imperial College London. The trade-off of success is “that we are driving it down to such a low level that we have to keep those [measures] in place.” “ (F)

“Which brings us to why herd immunity could never be considered a preventative measure.

If 70 percent of your population is infected with a disease, it is by definition not prevention. How can it be? Most of the people in your country are sick! And the hopeful nonsense that you can reach that 70 percent by just infecting young people is simply absurd. If only young people are immune, you’d have clusters of older people with no immunity at all, making it incredibly risky for anyone over a certain age to leave their house lest they get infected, forever.

It’s also worth thinking about the repercussions of this disastrous scenario – the best estimates put COVID-19 infection fatality rate at around 0.5-1 percent. If 70 percent of an entire population gets sick, that means that between 0.35-0.7 percent of everyone in a country could die, which is a catastrophic outcome.

With something like 10 percent of all infections needing to be hospitalised, you’d also see an enormous number of people very sick, which has huge implications for the country as well.

The sad fact is that herd immunity just isn’t a solution to our pandemic woes. Yes, it may eventually happen anyway, but hoping that it will save us all is just not realistic. The time to discuss herd immunity is when we have a vaccine developed, and not one second earlier, because at that point we will be able to really stop the epidemic in its tracks.

Until we have a vaccine, anyone talking about herd immunity as a preventative strategy for COVID-19 is simply wrong. Fortunately, there are other ways of preventing infections from spreading, which all boil down to avoiding people who are sick.

So stay home, stay safe, and practice physical distancing as much as possible.” (G)

“But even assuming that immunity is long-lasting, a very large number of people must be infected to reach the herd immunity threshold required. Given that current estimates suggest roughly 0.5 percent to 1 percent of all infections are fatal, that means a lot of deaths.

Perhaps most important to understand, the virus doesn’t magically disappear when the herd immunity threshold is reached. That’s not when things stop — it’s only when they start to slow down.

Once enough immunity has been built in the population, each person will infect fewer than one other person, so a new epidemic cannot start afresh. But an epidemic that is already underway will continue to spread. If 100,000 people are infectious at the peak and they each infect 0.9 people, that’s still 90,000 new infections, and more after that. A runaway train doesn’t stop the instant the track begins to slope uphill, and a rapidly spreading virus doesn’t stop right when herd immunity is attained.

If the pandemic went uncontrolled in the United States, it could continue for months after herd immunity was reached, infecting many more millions in the process.

By the time the epidemic ended, a very large proportion of the population would have been infected — far above our expected herd immunity threshold of around two-thirds. These additional infections are what epidemiologists refer to as “overshoot.”

Herd immunity doesn’t stop a virus in its tracks. The number of infections continues to climb after herd immunity is reached.

Some countries are attempting strategies intended to “safely” build up population immunity to the coronavirus without a vaccine. Sweden, for instance, is asking older people and those with underlying health issues to self-quarantine but is keeping many schools, restaurants and bars open. Many commentators have suggested that this would also be a good policy for poorer countries like India. But given the fatality rate, there is no way to do this without huge numbers of casualties — and indeed, Sweden has already seen far more deaths than its neighbors.

As we see it, now is far too early to throw up our hands and proceed as if a vast majority of the world’s population will inevitably become infected before a vaccine becomes available.

Moreover, we should not be overconfident about our ability to conduct a “controlled burn” with a pandemic that exploded across the globe in a matter of weeks despite extraordinary efforts to contain it.

Since the early days of the pandemic, we have been using social distancing to flatten its curve. This decreases strain on the health care system. It buys the scientific community time to develop treatments and vaccines, as well as build up capacity for testing and tracing. While this is an extraordinarily difficult virus to manage, countries such as New Zealand and Taiwan have had early success, challenging the narrative that control is impossible. We must learn from their successes.

There would be nothing quick or painless about reaching herd immunity without a vaccine.” (H)

“While much of Europe has gone into lockdown, one country has bucked the trend: Sweden.

Restaurants, schools and playgrounds in the Scandinavian country are open. Sweden’s Foreign Minister Ann Linde has said it’s not following the herd immunity theory, but rather relying on its citizens to voluntarily be responsible to prevent the spread of the coronavirus.

But Sweden’s state epidemiologist, Anders Tegnell, claimed herd immunity could be reached in the nation’s capital, Stockholm, within weeks.

“In major parts of Sweden, around Stockholm, we have reached a plateau (in new cases) and we’re already seein the effect of herd immunity and in a few weeks’ time we’ll see even more of the effects of that,” Tegnell said in an interview with CNBC.

The strategy hasn’t come without costs.

WHO has said it’s “imperative” that Sweden take stronger measures to control the spread of the virus.

Compared to other European nations that haven taken stricter measures, Sweden’s “curve” — the rate of infections and deaths caused by the coronavirus — is steeper. As of Wednesday, Sweden has at least 1,937 reported coronavirus-related deaths, compared to Norway’s 185 and Finland’s 149 deaths, according to data from Johns Hopkins University.” (I)

“Sweden’s ambassador to the U.S. has said the country’s capital Stockholm could reach herd immunity from the coronavirus within a few weeks, despite questions over whether people who have recovered from COVID-19 are actually protected from a second infection.

Herd immunity means the majority of a population have become immune to an infectious disease, either by recovering from it or by being vaccinated.

Karin Ulrika Olofsdotter, Swedish ambassador to the United States, told NPR: “About 30 percent of people in Stockholm have reached a level of immunity. We could reach herd immunity in the capital as early as next month.”

How much of the population needs to have been infected to achieve herd immunity depends on the disease. With COVID-19, the figure is unclear, but it is estimated at least 50 to 60 percent of the population would need to have been infected.

There is no official lockdown in Sweden and schools, restaurants and stores have stayed open during the pandemic. The government has issued social distancing guidelines and told citizens to avoid unnecessary travel. Gatherings of more than 50 people and visits to care homes have been banned.

Officials forced five bars and restaurants in Stockholm to close after they failed to respect social distancing guidelines.

Olofsdotter said that additional research and testing is necessary to understand more about immunity to COVID-19. She said the Swedish government would change its approach to tackling the coronavirus if necessary.” (J)

“Governments everywhere are facing a stark “jobs vs. deaths” Hobbesian choice.

How long will the public tolerate lockdowns that paralyze the economy and limit essential social mobility?

In response, many countries are seemingly lining up behind two unproven strategies based on contradictory hypotheses of virus behavior. This with similar hopes that they can thread the needle by limiting the human toll to “acceptable” levels, keep hospitals from being overwhelmed, and maintain vital economic activity.

The first “elimination hypothesis” has been implemented on physical or virtual islands such as Singapore, Taiwan, South Korea, Iceland, and New Zealand. It is based on the presumption that the virus can be eliminated via a two-pronged strategy: stop importation at borders and ports of entry and reduce domestic outbreaks by stringent containment procedures.

In countries such as the U.K., the U.S., Italy, and Spain, where the virus has long ago escaped containment and mitigation phase, a variant of the elimination model is being deployed. Cycles of suppression lockdowns alternating with the relaxation of social distancing interventions accompanied by aggressive containment measures are anticipated.

Significant second and further resurgent waves of infection are likely if the importation of virus or domestic foci re-emerge. Armies of virus hunter tracking teams would need to be deployed in ongoing containment firefights.

The public messaging accompanying the elimination model is for absolute safety to avoid exposure at all costs. Acquired immunity is thwarted, and an effective vaccine features prominently as the end-game.

The second “herd immunity hypothesis“ is actively or implicitly practiced in Sweden, Mexico, and Belarus. It assumes a virus that cannot be sealed off or contained. It is presumed to be best controlled through managed spread through the population, leading to progressively greater levels of acquired immunity. Since the virus cannot be indefinitely evaded, it is accommodated and gently accepted. It was initially slowing then ultimately halting the spread through herd immunity….

As these grand experiments play out, it would be a tragic missed opportunity not to take full global advantage. Each country should make explicit the assumptions and presumed scientific basis of its strategy clear. To allow valid national comparisons, there should be a cooperative global “Big Data” acquisition and analysis framework set up to measure the impact of each strategy.

This race is more marathon than a sprint. Long-term health winners will be judged on the cumulative “area under the epidemic curve” measured in total infections, severe cases, and deaths. Also, when measures of effective immunity are eventually determined, population immunity rates will be critical. If the herd-immunity hypothesis is correct, the early numerical lead of the elimination countries will dissipate over time.” (K)

“Social distancing and frequent handwashing are currently the only ways to help prevent you and those around you from contracting and potentially spreading SARS-CoV-2, the virus that causes COVID-19.

There are several reasons why herd immunity isn’t the answer to stopping the spread of the new coronavirus:

-There isn’t yet a vaccine for SARS-CoV-2. Vaccinations are the safest way to practice herd immunity in a population.

-The research for antivirals and other medications to treat COVID-19 is ongoing.

-Scientists don’t know if you can contract SARS-CoV-2 and develop COVID-19 more than once.

-People who contract SARS-CoV-2 and develop COVID-19 can experience serious side effects. Severe cases can lead to death.

-Doctors don’t yet know exactly why some people who contract SARS-CoV-2 develop severe COVID-19, while others do not.

-Vulnerable members of society, such as older adults and people with some chronic health conditions, could get very sick if they’re exposed to this virus.

-Otherwise healthy and younger people may become very ill with COVID-19.

-Hospitals and healthcare systems may be overburdened if many people develop COVID-19 at the same time.”  (L)

“President Trump on Sunday night said that the government would reassess the recommended period for keeping businesses shut and millions of workers at home after this week, amid millions of job losses caused by the efforts to contain the spread of the novel coronavirus.

“WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF,” Mr. Trump tweeted in all capital letters shortly before midnight. “AT THE END OF THE 15 DAY PERIOD, WE WILL MAKE A DECISION AS TO WHICH WAY WE WANT TO GO!”” (M)

“We won’t get to herd immunity in the near future. A miracle drug is not in sight. The only way to restart the economy, then, is to put a highly effective system in place to test millions of people, trace their movements, and quickly quarantine those who might have been infected.

But even as the past few days have brought bad news about the science of the pandemic, they have brought terrifying news about its politics: It now seems less likely than ever that the United States will do what is necessary to reopen the economy without causing a second wave of deadly infections.

America is still behind on testing for COVID-19. Although Trump promised almost two months ago that anyone who wanted a test could get one, the U.S. has still conducted only about 5.4 million. The country needs to increase its testing rate at least threefold to reopen safely.

America is also behind on test and trace. Some countries, such as South Korea, now have robust systems in place to inform people that they have been exposed to the coronavirus, and need to self-isolate. But implementing such a system requires two things the United States sorely lacks: widespread trust in the government and a coordinated response from the White House.

In the absence of a federal strategy, some states, such as New York and Massachusetts, are trying to develop their own test-and-trace systems. But without help from Washington, they will likely lack both the resources to build a comprehensive system and the ability to persuade a large majority of their residents to sign up for an app that tracks their movements. Even if, against the odds, they should succeed in both these tasks, they face another obvious obstacle: Viruses don’t respect state lines.

If he were truly interested in limiting the damage to America’s economy, and opening up the country, Trump would be laser-focused on remedying these problems. Instead, the president has doubled down on culture wars and quack cures.

Early last week, Trump fanned the flames of the irresponsible protests against stay-at-home orders that are now being staged in cities across the country. A few days later, he vowed to “suspend immigration” to the United States. Then he suggested that scientists look into the possibility of injecting patients with bleach.

For all his blustering demands to get the country back to normal, the president is failing to take the steps that are required to reopen the economy without a horrific death toll. And for all the ingenuity shown by individual governors, the absence of a coordinated federal strategy may prove impossible to overcome.

Ihaven’t written much about the pandemic recently. The reason is, quite simply, that I didn’t feel there was much to say. Though every day brought a ton of news, a lot of it was contradictory; for long, painful weeks, I felt as though my overall understanding of the situation was barely improving.

Now I finally feel on firmer ground. Some of what we have learned over the past few weeks has been positive. The fatality rate from COVID-19 is likely to be significantly lower than early estimates suggested. Americans have followed social-distancing guidelines to an impressive degree. So far, we have succeeded in flattening the curve, and have not had to turn thousands of people in desperate need of medical treatment away from the emergency room. Even in New York City, the American epicenter of the pandemic, the number of new infections and new fatalities is ebbing.

We are not in the worst of all possible timelines. And yet, our hopes for the pandemic’s quick resolution should clearly be shelved. Taken together, the three major developments of the past few days paint a bleak picture of the months that lie ahead: COVID-19 is too deadly to let it rip through the population. An effective cure is not in sight. And the federal government is incapable of formulating a coherent pandemic response.” (N)

“You’re tired of Zoom cocktail hours, the never-ending pile of dishes, Netflix.

You miss your friends. You want to hug your parents. You want to see people’s faces, no masks please.

And if you are among the more than 30 million Americans who filed for unemployment since mid-March, you are probably freaking out about your finances too.

Perhaps you are beginning to wonder if the people protesting stay-at-home orders around the state and across the country have a point: Maybe this extended physical distancing is doing more harm to our collective health than good.

Just how bad would it be to let everyone struggling to pay their bills go back to work? To eat at a restaurant again? To go to the beach on a hot day without being scolded by your governor?

After all, doesn’t this pandemic end with either a vaccine, herd immunity or some combination of the two? If everything reopened and a few more people got sick, might that be a reasonable price to pay?

If only it were that simple….

“The hospitals are really the bottleneck here,” she said.

Shelter-in-place orders have effectively kept many hospital systems across the country from becoming overburdened by COVID-19 patients, but that could change quickly as restrictions are eased.

“Because of confinement, there is an appearance that we can manage this,” Bourouiba said.”

But if those measures were suddenly lifted with nothing to replace them, we would overwhelm the healthcare system and doctors would start having to choose who lives and who dies, she said.

“That’s the ethical question people in our society need to be thinking about,” Bourouiba added.

So, what will it take to ease the stay-at-home measures with minimal risk to society? Public health experts agree on the essentials: the capacity to rapidly test people who may be infected, isolate those who test positive, and track and quarantine their close contacts.

And unfortunately, communities must be willing to go back into lockdown if there is an explosion of cases in their midst….” (O)

• A.Chris Christie says ‘there are going to be deaths no matter what’ from coronavirus, but Americans need to get back to work, by Kayla Epstein, https://www.businessinsider.com/christie-there-will-be-deaths-no-matter-what-from-coronavirus-2020-5
• B.No, You Should Not Have or Participate in a Coronavirus Party. Here’s What to Know About Herd Immunity, by JASMINE AGUILERA, https://time.com/5825386/herd-immunity-coronavirus-covid-19/
• C.What is Herd Immunity and How Can We Achieve It With COVID-19?, by GYPSYAMBER D’SOUZA AND DAVID DOWDY, https://www.jhsph.edu/covid-19/articles/achieving-herd-immunity-with-covid19.html
• D.How Herd Immunity Works, a Possible Key to the Covid Pandemic’s End, by Lisa Beyer and Shawn Hasto, https://www.bloomberg.com/news/articles/2020-04-14/how-herd-immunity-works-offering-key-to-pandemic-s-end-graphic
• E.COVID-19 science: Understanding the basics of ‘herd immunity’, by Eduardo Sanchez, https://www.heart.org/en/news/2020/03/25/covid-19-science-understanding-the-basics-of-herd-immunity
• F.What is herd immunity and can it stop the coronavirus?, by Antonio Regalado, https://www.technologyreview.com/2020/03/17/905244/what-is-herd-immunity-and-can-it-stop-the-coronavirus/
• G.Here’s Why Herd Immunity Won’t Save Us From The COVID-19 Pandemic, by GIDEON MEYEROWITZ-KATZ, https://www.sciencealert.com/why-herd-immunity-will-not-save-us-from-the-covid-19-pandemic
• H.What the Proponents of ‘Natural’ Herd Immunity Don’t Say, by Carl T. Bergstrom and Natalie Dean, https://www.nytimes.com/2020/05/01/opinion/sunday/coronavirus-herd-immunity.html
• I.What is herd immunity and why some think it could end the coronavirus pandemic, by Alicia Lee, https://www.cnn.com/2020/04/23/health/coronavirus-herd-immunity-explainer-wellness-scn-trnd/index.html
• J.SWEDEN’S U.S. AMBASSADOR SAYS STOCKHOLM IS CLOSE TO CORONAVIRUS HERD IMMUNITY DESPITE QUESTIONS OVER REINFECTION, by LYDIA SMITH, https://www.newsweek.com/sweden-stockholm-coronavirus-herd-immunity-reinfection-1500342
• K.The pandemic winner: Will It be Sweden or New Zealand?, by DR. STEVEN PHILLIPS, https://thehill.com/opinion/international/495823-the-pandemic-winner-will-it-be-sweden-or-new-zealand
• L.What Is Herd Immunity and Could It Help Prevent COVID-19?, https://www.healthline.com/health/herd-immunity
• M.President Trump speaking Sunday at a coronavirus task force news conference in Washington, by Maggie Haberman and David E. Sanger, https://www.nytimes.com/2020/03/23/us/politics/trump-coronavirus-restrictions.html
• N.No Testing, No Treatment, No Herd Immunity, No Easy Way Out, by Yascha Mounk, https://www.theatlantic.com/ideas/archive/2020/04/stop-waiting-miracle/610795/
• O.The coronavirus lockdown is miserable. Rushing herd immunity could be worse, by DEBORAH NETBURN, https://www.latimes.com/science/story/2020-05-01/why-we-cannot-rush-coronavirus-herd-immunity

CORONOVIRUS TRACKING

Links to Parts 1-24

Doctor, Did You Wash Your Hands?®

Curated Contemporaneous Case Study Methodology

Jonathan M. Metsch, Dr.P.H.

PART 1. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

PART 2. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

PART3. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)

PART 4. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….

PART 5. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”

POST 6. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””

PART 7. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

PART 8. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”

PART 9. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

Part 10. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.

PART 11. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”

Part 12. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”

Part 13. CORONAVIRUS. March 14, 2020. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”

PART 14. CORONAVIRUS. March 17, 2020. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”

PART 15. CORONAVIRUS. March 22, 2020. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.

PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT

PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.”  “New York’s private and public hospitals unite to manage patient load and share resources.

PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.

PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”

PART 20. April 20, 2020. CORONAVIRUS. “…nothing is mentioned in the “Opening Up America Again” plan about how states should handle a resurgence.”

PART 21. April 23, 2020. CORONAVIRUS. “We need to ask, are we using ventilators in a way that makes sense for other diseases but not this one?”

POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”

POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)

POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.

 [JM1]

Abstract from April 28^th letter from New Jersey Department of Health on serologic testing for Coronavirus.

“Currently, these tests may be useful to determine the prevalence of COVID 19 in a population or to identify individual patients who may be candidates to donate plasma for therapeutic purposes. There is, of course, also great interest in identifying individuals who may be immune to SARS-CoV-2 due to previous infection. However, due to the lack of current evidence that detection of SARS-CoV-2 antibody on any serologic test is indicative of durable immunity, and that false positives can occur with any of these serologic tests, they should not be used for this purpose at this time. Additionally, serologic tests do not have a role in diagnosing acute infection in symptomatic individuals since antibody responses to infection may take days to weeks to be detectable. A negative serologic test does not rule out active infection and a positive serologic test may reflect prior infection with a human coronavirus other than SARS-CoV-2. A positive test is not indicative of immunity and should not be used for return-to-work decisions.”

to read Posts 1-23 in chronological order, highlight and click on

“Some antibody tests, which check for prior Covid-19 infection, had high rates of false positives in screenings performed by a consortium of California laboratories, according to a recently released report. 

A false positive means someone would be told they’d already had coronavirus when they had not – a potential danger as people could then think they were immune to the virus when they’re actually still vulnerable. 

Of the 12 antibody tests that were studied by the COVID-19 Testing Project, one of the tests gave false positives more than 15% of the time, or in about one out of seven samples. Three other tests gave false positives more than 10% of the time. 

“That’s terrible. That’s really terrible,” said Dr. Caryn Bern, one of the authors of the study that looked at the 12 tests.  She said while it’s unrealistic to think all tests will be 100% accurate all the time, their false positive rates should be 5% or lower, or ideally 2% or lower. 

“This was a real wake up call for me. We’re not at the point where any of these tests can be used reliably,” added study coauthor Dr. Alexander Marson. “There’s a big danger in relying on them at all, but we hope we get to a point soon where we can rely on these tests.” …

Of the 12 tests in the California review, only one company has this FDA stamp of approval. That’s a test by Mount Sinai Laboratory in New York City, which the California group tweaked to use in their own lab.

That test got only one false positive out of 108 blood samples…

The California researchers obtained as many tests as possible, but so far have been unable to screen antibody tests by large test makers such as Roche and Abbott, because they require proprietary instruments to run the tests, which the California tests did not have.

They hope to continue screening more antibody tests to see if they work but warned that even if a reliable test shows you have antibodies, doctors still don’t know what that means. Having antibodies could indicate you’re immune and won’t get infected a second time or it could indicate you have no immunity at all. It could also mean something in between — for example, that you have some limited immunity for a period of a few months.

“We have this huge knowledge gap,” Bern said. “That’s the most important message.” (A)

“The Food and Drug Administration has allowed about 90 companies, many based in China, to sell tests that have not gotten government vetting, saying the pandemic warrants an urgent response. But the agency has since warned that some of those businesses are making false claims about their products; health officials, like their counterparts overseas, have found others deeply flawed.

Tests of “frankly dubious quality” have flooded the American market, said Scott Becker, executive director of the Association of Public Health Laboratories. Many of them, akin to home pregnancy tests, are easy to take and promise rapid results.

And the federal guidance that does exist is so confusing that health care providers are administering certain tests unaware that they may not be authorized to do so. Some are misusing antibody test results to diagnose the disease, not realizing that they can miss the early stages of infection.

“People don’t understand how dangerous this test is,” said Michael T. Osterholm, an infectious disease expert at the University of Minnesota. “We sacrificed quality for speed, and in the end, when it’s people’s lives that are hanging in the balance, safety has to take precedence over speed.”

Even as government agencies, companies and academic researchers scramble to validate existing tests and create better ones, there are doubts they can deliver as promised. Most tests now available mistakenly flag at least some people as having antibodies when they do not, which could foster a dangerously false belief that those people have immunity.

And even if the tests do improve, their availability could be hampered by the same manufacturing shortages that have prevented the Covid-19 diagnostic tests from scaling up adequately.

As President Trump presses to reopen the country and several states are considering lifting lockdowns in the next few weeks, widespread screening is considered critical. On Friday, Mr. Trump cheered the F.D.A.’s emergency approval of some antibody tests, saying they would support efforts to get Americans back to work “by showing us who might have developed the wonderful, beautiful immunity.”” (B)

“Testing for the coronavirus has been very much in the news. The first and most urgent focus is on increasing access to tests to diagnose people with current infections. But now other tests are appearing as well. Antibody tests, which can identify people with signs of past infection, are starting to be available. And a third type of test is on the way.

Here’s a quick guide to sorting out the pluses and minuses to each type of test.

Diagnostic or PCR test

What it does: Doctors use this test to diagnose people who are currently sick with COVID-19. This is the one we’ve been hearing so much about.

Antibody test

What it does: Antibody tests identify people who have previously been infected with the coronavirus. They do not show whether a person is currently infected. This is primarily a good way to track the spread of the coronavirus through a population.

In general, these tests aren’t reliable enough for individuals to act based on the results. And researchers say, even if you were certain you had antibodies to the coronavirus, it’s still unknown if that protects you from getting sick again. Still, these tests can provide good information about rates of infection in a community, where errors in an individual result have less impact.

Antigen test

What it does: This test identifies people who are currently infected with the coronavirus. It may be used as a quick test to detect active infections. Initially it will not be used to diagnose disease, but it may be used to screen people to identify those who need a more definitive test.”  (C)

“Should I get an antibody test right now?

I would recommend it, but only if you’re part of a research study where your results are contributing to an understanding of what results actually mean. Otherwise, it’s generally not advisable to get tests unless we know what to do with the results, and we don’t yet. We don’t even know if most of the tests that have come on the market are accurate. There are now more than 150 tests, most of which have not been approved by the Food and Drug Administration.

Why does FDA approval matter?

The FDA is maybe best known for its role in helping make sure that drugs are safe and effective before they go to market. But the FDA does the same for tests, too. That includes nasal-swab tests to detect the coronavirus during an infection, and blood tests to detect antibodies after an infection. The approval process slows down the availability of tests, but the idea is that patients and doctors should have some assurance that the tests they’re using are at least somewhat accurate. Even the coronavirus antibody tests that are “approved” right now by the FDA are only being used under a special “emergency use authorization,” for which standards are looser than usual. The others could be total scams. You can sell almost anything and call it a coronavirus antibody test right now; the market is operating mostly on an honor system.

What makes one antibody test better than another?

The two key features are sensitivity and specificity. A test has to be sensitive enough not to miss the antibodies if they’re actually present, but specific enough not to accidentally show a positive result…

Why are we putting so much emphasis on antibody testing if the results don’t necessarily mean I’m superhuman?

Right now, the antibody tests are being used to help map out where the coronavirus has spread, like tracking the footprints it has left. Combined with other types of research, this information will eventually help identify who is most susceptible to infection, and why. Even if we can’t tell individuals that they are totally protected, we could theoretically begin to allocate scarce resources away from a city where 50 percent of people have antibodies to one where only 5 percent of people do.” (D)

“The World Health Organization has pushed back against the theory that individuals can only catch the coronavirus once, as well as proposals for reopening society that are based on this supposed immunity.

In a scientific brief dated Friday, the United Nations agency said the idea that one-time infection can lead to immunity remains unproven and is thus unreliable as a foundation for the next phase of the world’s response to the pandemic.

“Some governments have suggested that the detection of antibodies to the SARS-CoV-2, the virus that causes COVID-19, could serve as the basis for an ‘immunity passport’ or ‘risk-free certificate’ that would enable individuals to travel or to return to work assuming that they are protected against re-infection,” the WHO wrote. “There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.”

The statement comes days after Chile announced it would begin issuing immunity cards that effectively act as passports, allowing travelers to clear security at airports with a document that purportedly shows they have recovered from the virus. Authorities and researchers in other countries — such as France and the United Kingdom — have expressed interest in similar ideas, while some officials in the U.S., such as Los Angeles Mayor Eric Garcetti, have mentioned it as one possible facet of a reopening strategy.

The concept for such a card is largely based on the premise that an individual can only contract the coronavirus once before developing the necessary antibodies to fight it off. That premise undergirds another common theory: the concept, known as herd immunity, that if enough people have been infected with the coronavirus — and are therefore immune — its transmission will slow and the risks of infection will diminish even for those who haven’t caught it yet.

But these ideas depend to a large degree on the supposition that one cannot catch the coronavirus a second time — an idea that world health authorities said leaders should not count on right now. As of Friday, the WHO said, “No study has evaluated whether the presence of antibodies to SARS-CoV-2 confers immunity to subsequent infection by this virus in humans.”

What’s more, data reported from the world’s early COVID-19 hot spots, such as South Korea and China, have shown that a growing number of recovered patients appear to have suffered a relapse of the disease…

“People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice. The use of such certificates may therefore increase the risks of continued transmission.”” (E)

“Zehnder, who helped coordinate Stanford’s antibody test development, said it’s reasonable to assume the antibodies provide some level of protection, since most other viruses generally confer immunity after exposure. But out of an abundance of caution, we cannot say for sure if these antibodies grant immunity to COVID-19.

“It’s important to not make assumptions of being protected before you actually know because that could lead to dangerous behavior and spreading of a disease,” Zehnder said….

The main use of antibodies tests, at least now, is to help researchers understand the prevalence of COVID-19. We’re quickly learning that many people who were symptom-free, or even tested negative for COVID-19 on a diagnostic test, actually had the infection.

With that information, we can get a clearer read on how infectious the coronavirus is.

“If there are enough tests, it would be important to expand the testing to everyone so we understand the extent of viral spread in populations in the future,” Iwasaki said.

Antibody tests alone can’t open up the economy, but used alongside diagnostic tests, contact tracing, distancing and quarantining, these measures can help health officials get a better handle on the coronavirus. If we want to open up the economy, we need to know exactly what is going on with the infection, Zehnder said.” (F)

“The fact that most antibody tests can’t detect neutralizing antibodies is also relevant because some politicians are pushing the idea that these tests be used to clear those with past COVID-19 infections to interact with others again, a so-called immunity passport. Researchers are trying to determine whether the antibodies detected by current kits can act as a proxy for protective immunity, says Smith.

Another complicating factor for immunity passports is that antibody tests can’t rule out that a person is no longer infectious, says Smith. A study published in Nature this month found that viral RNA declines slowly after antibodies are detected in the blood. The presence of viral RNA could mean that the person is still shedding infectious virus.

Despite the challenges, once reliable antibody tests are available, they could be important to understanding which groups of people have been infected how to stop further spread, says Collignon. They could even be used to diagnose active infections when PCR tests fail, adds Smith.” (G)

“A new type of coronavirus test expected to offer clarity on how and when to reopen the nation has instead sowed confusion.

A blood test that can detect whether a person’s had the virus has been heralded as an important tool for policymakers. Not only would it help answer critical questions such as how widespread it is, the test would inform them when people can safety return to work or school and not worry about becoming ill.

But hopes for quick answers have been dashed as a lack of evidence raises questions about the accuracy and reliability of a wide swath of antibody tests now being marketed to hospitals, doctors and consumers.

Public health experts are questioning the precision of antibody tests now being deployed in communities nationwide. And they warn elected officials, business leaders and consumers should be careful about making decisions based on test results.

Colin West is a Mayo Clinic internal medicine doctor and professor who has tracked the accuracy of COVID-19 tests.

“We need to stop pretending the tests are perfect,” West said. A person who gets tested should not “suddenly stop wearing a mask or stop washing their hands. Or stop physically distancing.”

The problem, West said, is tests don’t have evidence to prove they are good enough to ease policies on social distancing.

“Hopefully we will get there at some point,” he said. “Right now, it feels premature.” (H)

“Experts said the FDA likely felt pressure to quickly allow antibody testing after it took several weeks to authorize commercial labs to perform diagnostic tests during the early weeks of the pandemic…

Because shortages made diagnostic testing hard to get during the early months of the pandemic, many are seeking antibody tests to answer whether they recovered from COVID-19…

Hospital systems such as Cedars-Sinai in Los Angeles are taking a different approach. It is working to validate commercial tests before offering to test to the public, said Dr. Rekha Murthy, an infectious disease specialist and associate chief medical officer.

“We need to allow science to drive our decision-making,” Murthy said…

Baird said such inaccurate testing could misinform decision-makers about critical things like fatality rates of COVID-19. More “false positive” tests could dramatically skew results, Baird said.

“It may cause you to erroneously believe that the fatality rates was much lower because you had many cases but few people died,” said Baird, acting chair and professor at the University of Washington Department of Laboratory Medicine.

West said questions about antibody testing accuracy are not meant to undermine the usefulness of the tests. The key is to balance the speed of testing while ensuring the accuracy science demands to produce useful results.

“We are dealing with a pandemic that demands rapid action,” West said, “but developing a robust evidence base with rigorous methodology is not a rapid process.” (I)

“Meanwhile, a flood of new test kits with varying rates of accuracy is now hitting the market. In the U.K., for example, Prime Minister Boris Johnson touted finger-prick antibody tests as a “game changer,” only for the government to realize that the 3.5 million tests it bought from China were not reliable enough to use. Of particular concern here is the false-positive rate: If the prevalence of COVID-19 is quite low in the population—say, 5 percent—and a test can identify people who are truly negative with 95 percent reliability, half of the “positives” it returns will be false positives. In other words, half of the people the test says have antibodies wouldn’t actually have them. “I wouldn’t want to tell a nurse or physician ‘Go back to work’ based on that,” Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told me.

Moreover, Osterholm said, antibody tests don’t give a snapshot of the present. It can take two weeks for a patient to develop a detectable amount of antibodies in their blood, so antibody surveys are necessarily backward-looking. But when public-health officials are deciding whether schools or businesses are safe to reopen, the key piece of information is the number of people currently infected. “I want to know what is happening now,” Osterholm said, “and antibody testing will not get that to you.”

The key strategies for stopping the disease are still the same ones experts have been promoting from the beginning: testing, contact tracing, isolating for those who test positive for COVID-19, and social distancing for everyone else. “There’s going to have to be some level of new normal for a while,” Dean said. Ongoing antibody surveys will help clarify the true scope of the pandemic and the true proportion of asymptomatic carriers, and those data can indeed help inform public-health decisions. But as far as antibody testing goes, Gronvall said, “it’s not the silver bullet for everything.” “(J)

‘Dr. Anthony S. Fauci, the federal government’s top infectious disease expert, spends 19-hour days helping to lead the fight against the coronavirus.

To relieve the stress, he runs daily. But what he really wants, like so many sports fans, is just to go to a baseball game.

“I don’t think there’s any place that I relax more than sitting in Nats Park and watching my now world champion Nats play a game,” Fauci, 79, who grew up in Brooklyn rooting for the Yankees and is now a Washington Nationals fan, said in an interview this week.

That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)

• A.Coronavirus antibody tests have ‘really terrible’ accuracy, researcher says, by Elizabeth Cohen, https://www.cnn.com/2020/04/28/health/coronavirus-antibody-tests-terrible/index.html
• B.Antibody Test, Seen as Key to Reopening Country, Does Not Yet Deliver, by Steve Eder, Megan Twohey and Apoorva Mandavilli, https://www.nytimes.com/2020/04/19/us/coronavirus-antibody-tests.html?referringSource=articleShare
• C.How Reliable Are COVID-19 Tests? Depends Which One You Mean, by RICHARD HARRIS, https://www.npr.org/sections/health-shots/2020/05/01/847368012/how-reliable-are-covid-19-tests-depends-which-one-you-mean
• D.Should You Get an Antibody Test?, by JAMES HAMBLIN, https://www.theatlantic.com/health/archive/2020/05/coronavirus-antibody-test-immunity/611005/
• E.’No Evidence’ Yet That Recovered COVID-19 Patients Are Immune, WHO Says, by COLIN DWYER, https://www.npr.org/sections/coronavirus-live-updates/2020/04/25/844939777/no-evidence-that-recovered-covid-19-patients-are-immune-who-says
• F.Coronavirus Antibody Test: What Is It And What Does It Reveal?, Experts share what you need to know about the blood tests that show a COVID-19 infection and possible immunity, by Julia Ries, https://www.huffpost.com/entry/coronavirus-antibody-test-what-is-_l_5ea09110c5b6a486d08351a4
• G.Will antibody tests for the coronavirus really change everything?, by Smriti Mallapaty, https://www.nature.com/articles/d41586-020-01115-z
• H.Antibody tests were supposed to help guide US reopening plans. They’ve brought more confusion than clarity amid coronavirus., by Ken Alltucker, https://www.msn.com/en-us/news/us/antibody-tests-were-supposed-to-help-guide-us-reopening-plans-they-ve-brought-more-confusion-than-clarity-amid-coronavirus/ar-BB13s2EA
• I.Antibody tests were supposed to help guide reopening plans. They’ve brought more confusion than clarity, by Ken Alltucker, https://www.usatoday.com/story/news/health/2020/04/30/coronavirus-antibody-tests-immunity-mayo-clinic-who/3038740001/
• J.The False Hope of Antibody Tests, by SARAH ZHANG, https://www.theatlantic.com/science/archive/2020/04/antibody-tests-herd-immunity/610762/
• K.Fauci, Leading Fight Against Coronavirus, Misses Baseball, Too, by James Wagner, https://www.nytimes.com/2020/05/01/sports/baseball/coronavirus-fauci-baseball-running.html?referringSource=articleShare

CORONOVIRUS TRACKING

Links to Parts 1-23

Doctor, Did You Wash Your Hands?®

Curated Contemporaneous Case Study Methodology

Jonathan M. Metsch, Dr.P.H.

PART 1. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

PART 2. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

PART3. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)

PART 4. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….

PART 5. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”

POST 6. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””

PART 7. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

PART 8. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”

PART 9. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

Part 10. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.

PART 11. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”

Part 12. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”

Part 13. CORONAVIRUS. March 14, 2020. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”

PART 14. CORONAVIRUS. March 17, 2020. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”

PART 15. CORONAVIRUS. March 22, 2020. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.

PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT

PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.”  “New York’s private and public hospitals unite to manage patient load and share resources.

PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.

PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”

PART 20. April 20, 2020. CORONAVIRUS. “…nothing is mentioned in the “Opening Up America Again” plan about how states should handle a resurgence.”

PART 21. April 23, 2020. CORONAVIRUS. “We need to ask, are we using ventilators in a way that makes sense for other diseases but not this one?”

POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”

POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)

May 3, 2020

 [JM1]