No new Ebola cases this week.  The world is safe(ish) from Ebola yet again.

Coronavirus section will be bona fide short this time.

–The CDC finally got a serology test together and is testing for antibodies in asymptomatic or never symptomatic patients in “outbreak” areas in the US.  Again, this is the best test of how far the virus has spread, since many patients (up to half or more on cruise ships and Iceland) will have no symptoms at all, or only very mild ones they thought nothing of.  Those who see the virus should make antibody to it.  That said, the local coronavirus expert here has never been impressed by coronavirus serology, because the immune system does not make great antibodies against it.  With that caveat though, a SARS-CoV-2 antibody present in a patient is evidence the patient HAS been exposed to the virus, and if asymptomatic and showing IgG antibodies to SARS-CoV-2, is good evidence they have “beat” the virus and likely have immunity now.  (yes, reports of “reactivation” persist—this is an extraordinary claim for a coronavirus, and I look forward to extraordinary proof of it)  If we get a good serology test, that is what will be pushed as a “back to work” test, as those with IgG are unlikely to catch SARS-CoV-2 now.  This is also the best measure of what the true case fatality rate is, and sets the denominator.  My guess right now is less than 3%, probably in the neighborhood of 1%, and higher than the flu no matter where it lands—but that is a total guess.

–To continue to stress it, you can also use the serology test, if successful, to return -everyone- to work if a sufficiently powered population study showed that enough people now had antibodies that SARS-CoV-2 would be unlikely to reignite enough cases to overwhelm hospitals and ICU beds.

–Increasingly looks like it is the reaction of the patient’s immune system to the virus that is doing the damage.  Most fatal cases show ARDS (acute respiratory distress syndrome).  I know there are several groups looking at the best timing of when to use anti-inflammatory agents, as the fear is if you use them too early, while the virus is still rampant, the virus itself will do more damage.

–Hydroxychloroquine continues to get mixed evidence.  Quite a lot of anecdotal swearing by it.  Others less impressed.  Still not enough evidence to know for sure one way or another.  Other drugs have also had some strong anecdotal claims of efficacy too.

–Most states in the union (Indiana included) are showing only linear growth of cases.  Numbers are actually encouraging for that part of the state my lab currently serves—I think the Ro is right around 1 and falling soon if not now.  A little more concerned about the northwest part of Indiana that is basically a suburb of Chicago, where new cases appear to be a little more brisk.  New York, New Jersey, Michigan (Detroit), Illinois (Chicago) and Georgia (Atlanta) are all looking exponential in their growth right now:  https://www.politico.com/interactives/2020/coronavirus-testing-by-state-chart-of-new-cases/  Other big states that are still linear (linear = better control) are California and Florida. 

–Speaking of California, there have been preliminary talks here to run some of the flu negative cases that the Indiana state department of health has stored from January-December, similar to Cali’s suspicions about their fall flu season.  There is suspicion that the “weak flu A” that was burning through the vaccine around then with a day or two of fever and muscle ache, followed by 3-7 days of cough may not ALL have been a weak flu strain.  Current patients are the major priority for right now. 

–Have not seen many of the press conferences, but have heard its “we are winning; cases leveling off; looking better than early projections” and “DOOOOOOOOOOOM”—often in the same conference.  Again, cannot stress this enough, perception of effectiveness is what they can actually control.  If it’s the best of times and the worst of times, they have the soundbites to show they were right no matter what happens.  You want to actually BE effective?  Look to the local level.  Stronger local decision making is far more robust, far less fragile (as Taleb uses the term) than centralized, nation-level decision making—and this advantage only compounds as the nation gets larger, and encompasses more varied local regions.

You’ll have to make do with your own memes this week—sorry.

Your chances of catching coronavirus remain quite good pretty much no matter where you are in the world right now.  Prevention, prevention, prevention.

<Paladin>