Coronavirus Update

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Daily Updates Contributed By Dr. Eskild Petersen


Update 5/31/20 9AM

Hidalgo County NM (includes Rodeo) has one case at the Lordsburg Detention Center

Portal Data: No confirmed cases. 2 Deaths in Cochise County

Forecast for Arizona is not good: IHME

We are projected to be one of the worst hit states by August 4.

https://covid19.healthdata.org/united-states-of-america/arizona

Help to make this projection not become true.

This is the time to be extra careful and follow the principles of being safe, calm and kind. Wear your mask when physical distancing is not possible. 

 The rest of Arizona is having increasing numbers of COVID-19. Let us not allow the virus to establish itself in our communities.


The Risks - Know Them - Avoid Them

A very good article about how you get infected, where it is spread and what you can do to minimize your risk as the society is opening up. 

The Risks - Know Them - Avoid Them 



The Covid-19 epidemic in US is changing This epidemic will not come to an end soon. We are still in the first of many waves of infections. There are about a dozen states where cases are still growing. The high-risk states include Arizona. 


Recent genetic analysis of the viral strains shows that the virus first established sustained infections in Washington State later than originally thought. It occurred late in February 2020. We missed the opportunity to stop the infection spread then by not having the ability to test for the virus. https://www.biorxiv.org/content/10.1101/2020.05.21.109322v1


Models: One of the better models for forecasting of deaths in US and in individual States is /

https://reichlab.io/covid19-forecast-hub/

Another site for accurate data is https://covidtracking.com/


Waves:

CIDRAP in Minnesota has different scenarios for the coming waves; https://www.cidrap.umn.edu/sites/default/files/public/downloads/cidrap-covid19-viewpoint-part1_0.pdf

 “Whichever scenario the pandemic follows (assuming at least some level of ongoing mitigation measures), we must be prepared for at least another 18 to 24 months of significant COVID-19 activity, with hot spots popping up periodically in diverse geographic areas. As the pandemic wanes, it is likely that SARS-CoV-2 will continue to circulate in the human population and will synchronize to a seasonal pattern with diminished severity over time, as with other less pathogenic coronaviruses, such as the beta coronaviruses OC43 and HKU1, and past pandemic influenza viruses have done.” 

 


US Data: We have now over 105,000 deaths in the US. There were 1,015 new deaths on 5/30. True number of deaths estimated to be over 135,000 so far. New cases in US increased by 23,290 cases yesterday for a total of over 1,8 million. The true number of infected is estimated to be about 10 times higher at more than 18 million so far. The increase in new deaths and the constant number of daily cases hovering around 20,000 suggest that we still have some months with widespread infection and deaths. We are the country with both most deaths and most cases by far, but Brazil and South America now are becoming the new epicenters. We have about 1/3 of all cases worldwide and 1/4 of all deaths. There are now more than 6 million cases in the world. The uptick of new infections in rural areas outside NY and NJ is very concerning, AZ is one of the states that could be in trouble with Yuma and Nogales most likely two of the new hot spots in the nation.


Only a handful of nations on Earth have arguably done a worse job of handling the coronavirus pandemic than the United States. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31140-5/fulltext


Comparisons US versus Germany, UK and Canada

Tests/100.000 population US 5,221, Germany 4,719, UK 5,959, Canada 4,226

Cases /100,000 population US 549, Germany 219, UK 402, Canada 239

      Deaths/100,000 population US 31.9, Germany 10.3, UK 56.6, Canada 18.8


Testing: The US is the country with most total tests but in tests/per capita US lacks behind many other countries, but we are doing better and are catching up. In the number of deaths and cases however we continue to be the undisputed number One in the world.


NM Data: NM has done very well with testing its population where it is in the top 6 for the nation. There are 7,624 total cases in NM. Total deaths are 351 with 7 new deaths. Gallup has about 30% of all cases in NM and has 12 times the per capita infections of Albuquerque. 


Navajo Nation in NM and AZ has been extremely hard hit and already has 5,145  cases and 231 deaths. Navajo Nation has the highest rate of Covid-19 in the nation – higher than New York. You can help them by either donating money or supplies like masks: https://www.nndoh.org/donate.html

Hidalgo County, NM has 1 case of Covid-19; A male in his 20’s at the Detention Center in Lordsburg. 249 persons tested. Clearly an extensive testing system has been set in place in Lordsburg at the Detention Center. A few days ago, only 108 tests had been done but now we stand at 249. Luna County (Deming) next to Hidalgo has 1 death and 8 cases. Grant County (Silver City) has 15 cases. 

Forecast for deaths from COVID-19 in NM

https://reichlab.io/covid19-forecast-hub/


Where the cases are in NM

https://www.nytimes.com/interactive/2020/us/new-mexico-coronavirus-cases.html


AZ Data: 19,936 cases in AZ with 906 deaths with 3 new deaths yesterday. Overall the state is moving in the wrong direction with more deaths and more cases, however the disease spread is very variable with some counties doing well. The state by easing restrictions and opening up in the setting of a non-controlled epidemic is quite worrisome.

Cochise County, AZ has 72 cases We now have 2 deaths. Neither Portal nor San Simon have any documented cases. Cases in Cochise county are mainly in Sierra Vista and Douglas (29 cases). Community spread is occurring in Cochise County, but not in Portal. 3,065 have been tested for viral PCR in Cochise County. Do not become complacent just because we so far have avoided the Covid-19 in our community. COVID-19 will eventually arrive here. It is matter of when rather than if– either with this wave or the next ones.

Forecast for deaths from COVID-19 in AZ

https://reichlab.io/covid19-forecast-hub/

 

Comparing Counties in AZ

https://www.nytimes.com/interactive/2020/us/arizona-coronavirus-cases.html



Comparisons of AZ, NM and Cochise County: 

Viral PCR Tests/100.000 population AZ3,94, NM 8,978, Cochise County 2,345

Cases /100,000 population AZ 277, NM 357, Cochise County 56.6

Deaths/100,000 population AZ 12.6, NM 16.4, Cochise County 2.3


How and when COVID-19 was introduced to AZ for sustained transmission.

A very interesting and informative article about COVID-19 in AZ

Defining the Pandemic at the State Level:

Sequence-Based Epidemiology of the

SARS-CoV-2 virus by the Arizona COVID-19

Genomics Union (ACGU)

https://doi.org/10.1101/2020.05.08.20095935



CVID-19 on a cruise ship 

COVID-19: in the footsteps of Ernest Shackleton

Interesting article depicting how infection spread on a cruise ship. All crew and every passenger got tested. Most infections were asymptomatic, and people got infected despite extensive infection control measures on the ship

https://thorax.bmj.com/content/early/2020/05/27/thoraxjnl-2020-215091


Diagnosis: The new Abbots rapid PCR test that can return results in 5-15 minutes misses between 33% to 50% of cases when compared to standard PCR tests https://www.biorxiv.org/content/10.1101/2020.05.11.089896v1


Treatment: Remdesivir has been approved for treatment of Covid-19.  It is a very minor step forward. It decreases the time a patient is symptomatic from 15 days to 11 days. The drug does not affect mortality, the viral load or the time a patient is infectious. Beigel JH, et al "Remdesivir for the Treatment of Covid-19 -- Preliminary Report" N Engl J Med 2020; DOI: 10.1056/NEJMoa2007764.


Chloroquine/hydroxy chloroquine is causing harm in COVID-19. They cause increased mortality and cardiac arrhythmias. It is not effective. Do not take it. The Lancet:https://marlin-prod.literatumonline.com/pb-assets/Lancet/pdfs/S0140673620311806.pdf


Vaccine:If there is a silver lining to the flawed U.S. response to the coronavirus pandemic, it is this: The relatively high number of new cases being diagnosed daily — upward of 20,000 — will make it easier to test new vaccines.” https://khn.org/news/analysis-get-ready-for-the-vaccine-theyre-never-simple/?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&utm_medium=email&_hsmi=88292426&_hsenc=p2ANqtz-95om0XuiFMq24TcXDnRW-EjqKx-iDfe32Jjeyqpd6DMjexrGWeERGkdr3dLt6zyHlcCGE_c0_31S8zggNMvgfGCgQMsw&utm_content=88292426&utm_source=hs_email

The first results from vaccine testing in animals are promising. Both a Chinese study and an American/British study in Rhesus monkeys protected the animals to viral challenge. Vaccine candidates are in early tests in humans in US, UK, Germany and China. More than 100 candidate vaccines are being tested. The Moderna vaccine is getting a lot of press. It is more hype than reality at this point. It is in a very early testing in humans. It is not the leading candidate for a vaccine. It is just one of many vaccines who are in this phase of testing. Some of the other vaccine candidates are actually much further on in their development and they have been proven to protect rhesus monkeys and being safe in humans.

https://www.sciencemag.org/news/2020/04/covid-19-vaccine-protects-monkeys-new-coronavirus-chinese-biotech-reports

https://www.businessinsider.com/monkeys-given-new-oxford-vaccine-coronavirus-free-strong-exposure-encouraging-2020-4


  1. SARS-CoV-2 the virus causing COVID-19 is mutating.

The virus mutates but at a much slower rate than Influenza virus. Mutations in themselves are not a bad thing and there is nothing to suggest SARS-CoV-2 is mutating faster or slower than expected. We cannot say whether SARS-CoV-2 is becoming more or less lethal or contagious. Only one type of the virus is currently circulating. 


No, the coronavirus wasn’t made in a lab. A genetic analysis shows it’s from nature. https://www.sciencenews.org/article/coronavirus-covid-19-not-human-made-lab-genetic-analysis-nature


  1. Covid-19 is not just a respiratory infection but a systemic infectious disease. It infects lungs, blood, heart, liver, kidney and intestinal tract. People die mainly from respiratory failure, but many deaths are caused from heart involvement. Diabetes, obesity, chronic lung disease, hypertension and cardiovascular disease are risk factors for severe disease. All ages get Covid-19 but the severity and mortality are higher in age 65 and older. 
  2. Transmission: COVID-19 is primarily spread from person to person. You can become infected from respiratory droplets when an infected person coughs, sneezes, or talks. You may also be able to get it by touching a surface or object that has the virus on it, and then by touching your mouth, nose, or eyes. Fecal-oral route is possible but likely rare. Food is not thought to be a factor. After a person gets infected the virus spreads throughout the body to nearly all organs.
  3. The spectrum of signs and symptoms seen in Covid-19 is expanding. Strokes are seen in younger people with otherwise mild symptoms. Hypoxemia without shortness of breath like seen in high altitude sickness is a frequent sign. Symptoms like Severe fatigue is the most common followed by fever/cough, chest pain and shortness of breath. Loss of sense of smell and diarrhea are other frequent signs.


  1. Useful Websites & Phone Numbers

Arizona Department of Health website ihttps://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/index.php#novel-coronavirus-home 

New Mexico Department of Health Website

 https://cv.nmhealth.org/

Cochise County Website

 https://covid-cochisehealth.hub.arcgis.com/


Information about how, where and criteria for getting tested for COVID-19:

Arizona: 1-844-542-8201 The Arizona Poison Control System at the University of AZ in Tucson is available for the general public for information relating to testing, isolation, and quarantine guidance. Anyone in Arizona can now be tested.  

New Mexico: 1-855-600-3453 Coronavirus hotline. 

In Hidalgo County the Animas Valley Clinic has test kits in limited supply


Seniors in AZ and NM that have problems getting groceries:

AZ Helpline information for seniors is posted above.

For Cochise County 520-432-2528

NM Senior Food Hotline: 1-800-432-2080



News from Walker Family Medicine Clinic in Portal 5/7/20

The Walker Family Medicine Portal and San Simon Clinics are again open for Friday hours.  We still will not be seeing Walk-in patients, but appointments can be made by calling 520-766-5000 Monday through Friday or 520-558-5000 during Portal office hours.

Thank you all for following good physical distancing and washing your hands often. We’ll get through this if we keep vigilant.


Lastly, for those Portal/Rodeo residents who are not WFM patients:  If you have symptoms, questions, concerns and are not able to reach your PCP, please feel free to call Jackie, 558-2287, Carolyn, 558-1234, Deborah, 558-0119 or Frances, 558-2345.  Any one of us is willing to do a phone or home assessment as to the severity of your symptoms.  We do this as community-oriented Samaritans and not as representatives of Portal Rescue or WFM.  
Debb, Frances and Dawn


Report from Portal Rescue – Jackie Lewis 4/8

Dear Community,

It's allergy season and there are still other active flu viruses.  The chart below compares symptoms.  Information on how to treat symptoms and when you should seek help is below the chart.  Thank you for reading to the end.  

As mentioned in the earlier email from Walker Family Medicine, we have several people who are willing to check on you.  If you have symptoms, questions, concerns and are not able to reach your PCP, please feel free to call Jackie, 558-2287, Carolyn, 558-1234, Deborah, 558-0119 or Frances, 558-2345.  Any one of us is willing to do a phone or home assessment as to the severity of your symptoms.  We do this as community-oriented Samaritans and not as representatives of Portal Rescue or WFM. 


Most symptoms can be treated at home

·         Let your fever rise if you can because that is what helps our bodies fight the virus.

·         Consider fever reduction when adult temperature is at 102-103 degrees. 

·         Stay hydrated.  Juice and water.  You can make your own electrolyte solution by mixing 3 Tablespoons of sugar, 1/2 teaspoon salt and 1-liter water. 

·         Rest. 

Isolate from the rest of your household. 

·         Clean up (sanitize/disinfect) after yourself when at all possible. 

·         Wear a mask. 

·         Wash your hands. 

If you start to develop breathing problems, please seek help BEFORE it is too late.  In these times it’s important we take responsibility for our personal and community health, and this includes being prepared with protective gear and potential transport if it becomes needed.  We do have several people in the Portal area that are willing to drive your vehicle if you don't have a household member that can do so.  We will be in full PPE.  You will be requested to wear a mask and sit as far as possible away from the driver.  Call Jackie Lewis at 558-2287 if you will need assistance getting to the hospital. 


Protect yourself and your community.

·         Stay home when at all possible. 

·         Wear a mask to reduce the spread of your germs to someone else. 

·         Keep 6' between you and the person you are talking to. 

·         Be diligent about washing your hands. 

·         Sanitize and disinfect surfaces. 

·         Use color assigned towels in homes that have multiple family members. 


In concern for your health,

Jackie Lewis

Portal Rescue EMS Chief


This is our time to be kind, to be calm and to be safe.

Social Distancing is really:  Physical distancing but Social engaging. Keep your distance from each other at 6 feet. Wear a mask if you cannot keep a safe distance.

Our Post Offices are essential to us. Please be extremely careful when you pick up mail- wear a mask. Be nice to our postmasters and follow their instructions. 


Let us support our local businesses like Sky Island Grill and Grocery and Portal Café. Please use them as they are vital to our community. Consider buying gift cards for future use. Order from their menus to take out. Buy from their groceries. 


Humor:

Monkey steals blood samples from COVID-19 patients in India: Video

https://www.livescience.com/monkey-steals-covid-19-blood-samples.html?utm_source=Selligent&utm_medium=email&utm_campaign=18653&utm_content=20200529_Coronavirus_Infographic+&utm_term=4366454&m_i=3Gh2g4XM82hXyMzt5iWJLZplReLioH%2B6BCqylOCxhu7J1rHYt9IZ372sNB6TQ5LJYF4rHwvV9ijkBMH0hLmpqEeoWToADU


CV

The Following Charts And Graphs Are Compiled 

By Howard Topoff

May 31, 2020


ARIZONA


The Arizona Poison & Drug Information Center Is Available To Take Calls From Arizona Providers & The General Public: 1-844-542-8201


May 31, 2020

Cochise County: 74 CASES 

(24 CASES in Douglas)


NEW MEXICO

Coronavirus Hot Line: 1-855-600-3453 


May 30, 2020

The state is offering help to New Mexico seniors. The Aging and Long Term Services Department says if you’re a senior or a disabled adult who cannot access groceries to call the number 1-800-432-2080 due to the coronavirus.

Leave a message with your name, telephone number, and the city/town you reside in. Aging and Long Term Services will be in contact with you within 2 hours of your call if not sooner. 


 ONE Case In Hidalgo County

Screen Shot 2020-05-31 at 9.21.18 AM

Ten Most Infected Countries

_________________________

                        How To Wash Your Hands

It's generally best to wash your hands with soap and water. Over-the-counter antibacterial soaps are no more effective at killing germs than is regular soap.

Follow these steps:

  • Wet your hands with clean, running water — either warm or cold.
  • Apply soap and lather well.
  • Rub your hands vigorously for at least 20 seconds. Remember to scrub all surfaces, including the backs of your hands, wrists, between your fingers and under your fingernails.
  • Rinse well.
  • Dry your hands with a clean towel or air-dry them.

                           How To Use An Alcohol-Based Hand Sanitizer

Alcohol-based hand sanitizers, which don't require water, are an acceptable alternative when soap and water aren't available. If you use a hand sanitizer, make sure the product contains at least 60% alcohol. Follow these steps:

  • Apply the gel product to the palm of one hand. Check the label to find out the appropriate amount.
  • Rub your hands together.
  • Rub the gel over all the surfaces of your hands and fingers until your hands are dry.

_________________________

The following information regarding Coronavirus (COVID-19) is being supplied by Dr. Eskild Petersen. It will be updated as new information is published.


Coronavirus Update Portal March 14, 2020

Definitions:

Disease: COVID-19

Virus: SARS-CoV-2


Origin:  Close to Wuhan where it spread from bats to human directly or via a wild animal.  

It has been isolated from bats in caves and there is serological evidence for that people living near the caves have been infected at some time.

When: Outbreak noted in late December 2019 but more likely started in September 2019.


US infections:

At this point US is past containment stage to care. Our containment efforts like travel restrictions won’t reduce the number who get infected in the US but may slow the spread.

How many in the US already have the virus?  No one knows.

The number of known cases in US is artificially low as we have only tested few.

We are way behind other countries in testing for COVID-19. About 10,000 people in US has been tested so far. In contrast South Korea 10,000 are tested daily

We in the US are currently where Italy was one to two weeks ago.  There is nothing to indicate we will be substantially different.

40-70% of the US population might be infected over the next 12-18 months.  After that level you can start to get some protective immunity in the community (herd immunity).  Unlike flu this virus is entirely novel to humans, so there is no latent immunity in the global population.

Seasonal flu’s average kills 50,000 Americans per year.  Assume 50% of US population gets COVID-19, that’s 160 million people infected.  With 1% mortality rate that's 1.6 million Americans who will die over the next 12-18 months. Hopefully this number will be much less. 

The fatality rate is in the range of 10 times that of flu assuming no drug is found effective.

From over 72,000 cases in China we know the death rate varies hugely by age.  Over age 80 the mortality rate could be 15%.  (see attached graph and table)

We don’t know whether COVID-19 is seasonal but if it is and subsides over the summer, it is likely to roar back in the fall as the 1918 flu did.

We can only tell you two things definitively: It’s going to get worse before it gets better.  And we'll be dealing with this for the next year at least.  Our lives are going to look different for the coming year.


What should we do now?  

One can be infectious before being symptomatic.  We don’t know how infectious before symptomatic but know that highest level of virus prevalence coincides with symptoms.  We currently think folks are infectious 2 days before through 14 days after onset of symptoms.

All ages have more or less the same infection rate, but children and young adults are less likely to have symptoms or be seriously sick, but they still can transmit.

How long does the virus last on surfaces? Hours to days depending on surface type  

The virus is very susceptible to common anti-bacterial cleaning agents:  bleach, hydrogen peroxide, alcohol-based hand sanitizers

Do the basic hygiene, hand washing and avoiding touching face.

Stockpile your critical prescription medications.  Many pharma supply chains run through China.  Pharma companies usually hold 2-3 months of raw materials.

Pneumonia and flu shots might be helpful.  Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.

Anyone over 60 should try to minimize interactions in large groups. Minimize air travel and no cruises for the next 2 months then reevaluate.

Three routes of infection

1) Droplet transmission. 2) Hand to mouth/face. 3) Fecal oral route possibly.

What about testing to know if someone has COVID-19?  

There is not enough testing capacity to be broadly useful. Why?

Currently, the only way to determine that a person has COVID-19 is a PCR test.  No other test can yet distinguish COVID-19 from flu or from the other dozen respiratory bugs that are circulating.

The PCR test requires kits with reagents and requires clinical labs to process the kits. 

While the kits are becoming available, the lab capacity is not growing.  

The leading clinical lab firms, Quest and LabCorp have capacity to process 1000 kits per day.  For the nation.

How well is society preparing for the impact?

Not well. Public Health systems have been severely weakened for some years.

 Wuhan has 4.3 beds per thousand while US has 2.8 beds per thousand.  Wuhan built 2 additional hospitals in 2 weeks.  Even so, most patients were sent to gymnasiums to sleep on cots

Public Health systems are prepared to deal with short-term outbreaks that last for weeks, like an outbreak of meningitis.  They do not have the capacity to sustain for outbreaks that last for months

Where do you find reliable news?


The Worldometers site offers constantly updated epidemiological data:

https://www.worldometers.info/coronavirus/coronavirus-cases/

The New York Times and BBC are good on scientific accuracy.

New viruses emerge every few years:  SARS, Ebola, COVID-19.  

There will be other new epidemics. We don’t know when and which agent it will be.

The worst impact of pandemics like COVID-19 will be in the countries with the least resources, Africa.


© Howard Topoff 2011