—Several big developments over the weekend.

—First is subtle but important.  The FDA basically waved hands and approved the CDC assay for Covid-19 diagnosis.  This means any lab in the US capable of doing it can now bring it up free and clear.  I expect rapid movement on this.  For example, as of Friday evening, IDT (my favorite supplier of PCR reagents from all the way back in residency/fellowship) has an expedited order pathway for the CDC assay already.  You can get the most important reagents from them, in order, and to you within 48 hours or so.  By the end of the week, I expect a number of labs (hospital, university, state labs) to have reagents ordered and the test up and running.  Certainly by the end of next week.

—This is important for a number of reasons.  First, it localizes control of testing for Covid-19.  Before, like UC Davis, you were beholden to the geographic restrictions of your state lab or the CDC.  If the patient did not check the right travel exposure boxes, no test for you.  Now, though, it will be much easier for the pulmonologist to call down to their lab (if they have the assay up) and say “hey, I know this guy doesn’t meet the criteria exactly, but I have a bad feeling this is coronavirus.  Can you run the test?”  And it is -much- more likely to get done. Including all flu negatives.

—So within a few weeks, we will start getting a much better handle on how far coronavirus has penetrated the US.  We will be able to trace cases a bit easier, which will let public health agencies at local, state and federal level get the smallest quarantine necessary in place. It will allow appropriate contact precautions for patients in the hospital to go up quicker (unlike UC Davis’ case) to minimize spread.  It gives a much better chance of controlling the rate of cases to keep hospitals from being overwhelmed.  This is a -very- big step.

—Also, and this cannot be overstated, we get a better sense of the scope of coronavirus infection.  I would still like a serologic test for that, but I will take someone screening even mild disease.

—THERE IS A CHANCE THAT, SIMILAR TO OTHER CORONAVIRUSES, MILD AND ASYMPTOMATIC INFECTION IS VERY COMMON.  IF SO, THE DENOMINATOR FOR CASE FATALITY RATE IS MUCH BIGGER THAN IT IS CURRENTLY.  That would mean the TRUE case fatality rate is less than the 1% it appears to be right now.  And probably closer to the flu or less.  So in many ways, finding a LOT more mild and asymptomatic disease, in some ways, would be a very good thing.

—Until then, it has to be assumed to be 1% mortality, mostly the elderly (so far, kids are NOT getting severe disease, knock on wood), with up to 20% requiring some kind of hospital support, that the data show so far.

—Also, by Friday afternoon, the CDC and at least the state of Indiana has expanded the testing criteria to include any country with a travel advisory for coronavirus (so including Iran, South Korea, Japan and Italy now).  Shame does wonders, it seems.

—To be clear, it wouldn’t have mattered who was president.  Coronavirus would have got here considering the alert was not raised by China until a number of their citizens were traveling sick and kicking off all these chains that you now see everywhere over the globe.  The government is doing what it can, but the nature of the bureaucratic beast is to always be a little slow.  Hence, the importance of pushing diagnostics out to the local level.

—It also helps that Trump has figured out what Jim Cramer, of all people, put so elegantly—“This isn’t an economic problem; it’s a biology problem.”  Common wisdom has been stock market high = Trump re-election and that has certainly been Trump’s focus.  Even into the early response to US cases last week.  By this weekend, it is clear that the new common wisdom has taken hold:  the market gonna do what it gonna do, mostly by what the virus is doing to supply chain critical countries everywhere.  Trump’s November now comes down to perception of the response to coronavirus.  That should help—for instance, the government claims they now have dedicated mask production for 35 million masks per month.  And they are extending, albeit a week or two late, travel restrictions and advisories to countries that are our allies.  And I’m sure a phone call or two “helped” FDA with its diagnostic decision making too.

—It’s a start.  We’re still going to fight with the army we have—but at least that army is -beginning- to stir.

—Of course, the danger remains that the government will focus more on -perception- of response.  And the danger of banal bureaucracy—such as the state department understandably deciding to bring all the US passengers on the cruise ship in Japan home the moment the Japanese government let them.  But then stupidly flying the sick and well together in the same plane, and with staff and crew wearing -no- protective gear whatsoever.

—So again, prepare yourselves so that government miscues don’t hose -you-.

—Given multiple foci of community spread already in the US, with more cases under at least observation every day, and the way the US population moves, more cases are likely to be found across the US.  Don’t where.  Don’t how many.  But they will turn up.

—If the trend stays towards 1% case fatality rate and a big enough body’s of cases pops up, there remains a good chance some locale gets quarantined for a bit somewhere.  So again, prepare now, just in case it is your town asked to do it.

—Better to have and not need, then need and not have.

—If you did not get a mask in time, it is NOT doom.  Frankly, if you are inside for a few weeks for a quarantine, you don’t need it on when it’s just you and the family hanging out inside all day.  What it will do is give a little more peace of mind if you -need- to go out during a quarantine or if a bunch of cases hit nearby, but your boss still wants you to come to work and/or school is not going digital (like in Japan—possibly until the end of their school year).

—You are much better off preparing for supply chain disruptions.  For example, on Friday, the FDA announced a drug company told them there will be a shortage of something they make because a supplier of a necessary ingredient is closed due to coronavirus.  The FDA did NOT announce which company or which drug.  But stuff like this seems likely for awhile.

Finally, “Love” in the Time of Coronavirus:

Spain recently had to quarantine 119 people—in a brothel.  So if you needed -another- reason to maybe not go to a brothel if you are married, there you go.

In the meantime, let’s all pour one out for all the homies with a ring now stuck in the brothel for a few weeks.

Top Ten Excuses When You Get Quarantined In A Brothel:
1.  “My car broke down, and that was the nearest place to call for a tow truck.”

2.  “I found a hurt puppy by the road, and that was the nearest place to call an emergency vet.”

3.  Shaggy Defense:  https://www.youtube.com/watch?v=Qv5fqunQ_4I

4.  Jim Belushi Defense:  https://www.youtube.com/watch?v=QZqfxoCYfxw

5.  “I was just there for the wings.”

6.  “So I raced in, yelling ‘EVERYONE OUT!  THE BUILDING IS ON FIRE!'”

7.  “So there was this girl, whose car broke down on the side of the road.  I couldn’t fix it.  She was late for work.  Crying.  Hysterical.  Going to get fired.  She asked me to drop her off–I said yes.  Turns out, where she works…”

8.  “I have never told you this before, to protect you–but I work for the CIA.  We were tracking this notorious and unsavory trafficker to where he worked…”

9.  “I had stopped in the parking lot to answer your text, and all of a sudden, there’s these guys in hazmat suits surrounding the car, FORCING me inside…”

10.  Catch Covid-19.  Die.  It will just be easier that way.

<Paladin>