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Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)
Reporter: Gail S. Thornton, M.A.
The following link is reprinted from Johns Hopkins University. The web site is a valuable resource for real-time updates on virus cases by country, region and even state.
The deadly coronavirus has been met with a bit of a shrug among some in the under-50 set in the United States. Even as public health officials repeatedly urged social distancing, the young and hip spilled out of bars on Bourbon Street in New Orleans. They gleefully hopped on flights, tweeting about the rock-bottom airfares. And they gathered in packs on beaches.
Their attitudes were based in part on early data from China, which suggested covid-19 might seriously sicken or kill the elderly — but spare the young.
Stark new data from the United States and Europe suggests otherwise.
Earlier this week, French health ministry official Jérome Salomon said half of the 300 to 400 coronavirus patients treated in intensive care units in Paris were younger than 65, and, according to numbers presented at a seminar of intensive care specialists, half the ICU patients in the Netherlands were younger than 50.
Trump, White House coronavirus task force briefing in 2 minutes
President Trump and the coronavirus task force discussed on March 18 the administration’s ongoing efforts to deal with the growing health crisis. (Video: Mahlia Posey/Photo: Jabin Botsford/The Washington Post)
At a White House news conference on Wednesday, Deborah Birx, the response coordinator of the nation’s coronavirus task force, warned about the concerning reports from France — and Italy, too — about “young people getting seriously ill and very seriously ill in the ICUs.”
She called out younger generations in particular, for not taking the virus seriously, and warned of “disproportional number of infections among that group.”
President Trump reinforced her warning, saying: “We don’t want them gathering, and I see they do gather, including on beaches and in restaurants, young people. They don’t realize, and they’re feeling invincible.”
The CDC report looked at 4,226 covid-19 cases, with much of the data coming from the outbreaks among older adults in assisted living facilities. As in China, the highest percentage of severe outcomes were among the elderly. About 80 percent of people who died were older than 65.
A group of young women walk past New Orleans police officers on Bourbon Street after midnight when the police department enforced a statewide shutdown of bars and restaurants ordered by Louisiana Gov. John Bel Edwards on Mar. 16. (Max Becherer/Advocate via AP)
However, the percentage with more moderate or severe disease requiring hospitalization is more evenly distributed between the old and the young, with 53 percent of those in ICUs and 45 percent of those hospitalized age 65 and older.
“These preliminary data also demonstrate that severe illness leading to hospitalization, including ICU admission and death, can occur in adults of any age with COVID-19,” researchers wrote.
Severe outcomes among patients with covid-19.
There was more encouraging news about children in the United States. Those age 19 and younger who were tested appear to have milder illness with almost no hospitalizations. A much larger sample of children in China, as detailed in the journal Pediatrics this week, found that most children had mild to moderate illness.
The CDC report did not specify whether the younger patients had underlying conditions that might make them more vulnerable, but Anthony S. Fauci, the head of the National Institute of Allergy and Infectious Diseases, commented on CNN on Wednesday night that some did.
One younger adult, Clement Chow, a genetics researcher at the University of Utah, has been tweeting about his experiences. “Important point: we really don’t know much about his virus. I’m young and not high risk, yet I am in the ICU with a very severe case,” he wrote. He said he was facing respiratory failure and put on oxygen.
Public health experts say it’s difficult to compare coronavirus numbers by age across countries at this stage because of the limited numbers tested and because differences may be related to the environment, lifestyle, demographics or something about the virus itself.
There may be a high percentages of young smokers in some areas of France, for example. Or “the high proportion of critically ill young people in the Netherlands may reflect the relatively younger population,” the Dutch news service NRC surmised.
Maybe some young people who were tested happen to be in cities or industrial areas with a lot of pollution that may affect their susceptibility to serious respiratory illness. Or the bar for admission to the hospital and the quality of treatment may vary enough by country that it affects the course of the illness.
Adolfo Garcia-Sastre, the director of the Global Health and Emerging Pathogens Institute at the Icahn School of Medicine at Mount Sinai in New York City, said the numbers are difficult to interpret because so few people have been tested. He said some populations may be overrepresented because of public health officials focusing on testing clusters of people who live together and may be of similar ages.
However, Garcia-Sastre said, the numbers show it’s clear “everybody has risk. Even in young people, there is a percentage that has serious infection.”
Ariana Eunjung Cha is a national reporter. She has previously served as The Post’s bureau chief in Shanghai and San Francisco, and as a correspondent in Baghdad.Follow
Coronavirus Outbreak: U.S. Surgeon General Says Will ‘Get Bad’ This Week
Reporter: Gail S. Thornton, M.A.
The following article is reprinted form Haaretz.
U.S. Surgeon General Says Coronavirus Outbreak ‘To Get Bad’ This Week
Statistically, the United States is on a track similar to those of devastated European countries such as Italy and Spain
Trump watches as Vice Admiral Jerome Adams, Surgeon General of the United States, speaks during a news conference, amid the coronavirus disease (COVID-19) outbreak, in Washington, March 22, 2020March 22, 2020. REUTERS/Yuri Gripas
The U.S. surgeon general issued his starkest warning to date on Monday about the health risk posed by the coronavirus outbreak, warning Americans that the crisis was “going to get bad” this week.
The country’s top public health official, Surgeon General Jerome Adams, sounded the alarm as nearly one-third of Americans awoke to “stay at home orders.”
As of Sunday night, states with a population totaling more than 100 million people have imposed restrictions to curtail the virus, which has infected nearly 35,000 people and killed 428 in the United States, putting the country on a track similar to those of devastated European countries such as Italy and Spain.
“This week it’s going to get bad,” Adams told NBC’s “Today” show, saying there were more people out to see Washington’s famed annual cherry blossoms than there were blossoms. “This is how the spread is occurring. Everyone needs to be taking the right steps right now: stay home.”
Trump imposed a 15-day national action plan a week ago urging Americans to follow the direction of the “stay at home” orders of state and local officials.
At the same time, he has also been far more optimistic than health experts have been about the prognosis for the outbreak while also voicing concern about the negative effect of shutting down wide swathes of the economy.
“We cannot let the cure be worse than the problem itself,” Trump tweeted in all capital letters overnight. “At the end of the 15-day period, we will make a decision as to which way we want to go.”
Although there is a growing number of case reports and studies related to COVID-19, an emerging pandemic, there is limited understanding of how the virus impacts pediatric patients specifically. In mid-March, Pediatrics published the first nationwide study of cases of COVID-19 in pediatric patients in Wuhan, China. The study shows that, in general, children with COVID-19 experience milder illness with less mortality compared with adults.
“The clinical course really seems to be more muted in children than adults,” says Frank Esper, MD, pediatric infectious disease expert at Cleveland Clinic Children’s, who was not involved in the study. “This doesn’t mean that children are unaffected by COVID-19 — they can certainly still be infected and can be a vector for community transmission — but it does appear that a smaller proportion of pediatric patients are developing severe illness.”
Most cases have been mild to moderate
In this most recent, retrospective study, researchers analyzed 2,143 cases reported to the Chinese Center for Disease Control and Prevention from January 16 through February 8, 2020. Although children of all ages appear to be susceptible to COVID-19, most cases were mild or moderate. Of the cases included in this analysis, 4.4% of patients were asymptomatic, 50.9% experienced mild symptoms and 38.8% suffered from moderate illness. Only 5.9% of the cases were classified as severe or critical, compared to 18.5% of adult cases of COVID-19. There was one death.
“The clinical course really seems to be more muted in children than it does in adults,” notes Dr. Esper. “The vast majority of people developing symptoms and being identified as having COVID-19 are adults. Studies estimate that 2% to 10% of COVID-19 cases reported thus far have been in pediatric patients under the age of 20.”
Just as in the adult population, however, there are children at greater risk for more severe illness. “It is still unclear how much childhood diseases worsen the infection. As a common rule, if you have lung, heart problems, we consider you at higher risk. The Pediatrics report suggests the youngest infants (those under the age of 1) may get more severely sick; however, those numbers are really small — a small fraction of a small fraction,” Dr. Esper continues.
“It’s still early, but this analysis is reassuring. Nearly 90% had low to moderate symptoms — they probably weren’t even hospitalized. Only 10% of patients in the study required oxygen, and an even smaller percent were critically ill. It’s a double-edged sword, really. It’s great that kids don’t get sick, but they may be less likely to stay home, and may spread the infection. We still don’t know if, or to what extent, asymptomatic individuals can transmit the infection.”
Common symptoms in pediatric patients
Among pediatric patients who do develop symptoms, there seems to be a spectrum of disease, from milder symptoms akin to rhinovirus, to more severe, influenza-like symptoms. Dr. Esper predicts that case fatality will be somewhere above the 0.1% observed with influenza but well less than the 10% seen with SARS. These respiratory viruses present similarly, with fever, dry cough, body aches and sore throat. According to Dr. Esper, one notable difference between COVID-19 and influenza or the common cold is that COVID-19 seems to cause fever more often, especially in adults.
“Pediatricians are very much overwhelmed right now. The most important thing is to evaluate which patients need to be tested, and to practice preventive and precautionary measures for the safety of caregivers and patients. We should do our best to reassure families with the data we have, but we should remind them to remain extremely cautious. Children can be infected with COVID-19, and some will get very sick. Children deserve all the protections we have in place for adults, including social distancing and hand washing, which can be particularly challenging for toddlers who may not have the fine motor skills to use soap very well. Parents should be advised to wash their children’s hands more frequently, with soap and water, especially before and after eating, following a diaper change. Additionally, alcohol-based rubs may improve compliance in children under 2 years,” Dr. Esper concludes.
An Arizona man has died after ingesting chloroquine phosphate — believing it would protect him from becoming infected with the coronavirus. The man’s wife also ingested the substance and is under critical care.
The toxic ingredient they consumed was not the medication form of chloroquine, used to treat malaria in humans. Instead, it was an ingredient listed on a parasite treatment for fish.
The man’s wife told NBC News she’d watched televised briefings during which President Trump talked about the potential benefits of chloroquine. Even though no drugs are approved to prevent or treat COVID-19, the disease caused by the coronavirus, some early research suggests it may be useful as a therapy.
“We were afraid of getting sick.”
The name “chloroquine” resonated with the man’s wife, who asked that her name not be used to protect the family’s privacy. She’d used it previously to treat her koi fish.
“I saw it sitting on the back shelf and thought, ‘Hey, isn’t that the stuff they’re talking about on TV?'”
The couple — both in their 60s and potentially at higher risk for complications of the virus — decided to mix a small amount of the substance with a liquid and drink it as a way to prevent the coronavirus.
“We were afraid of getting sick,” she said.
Within 20 minutes, both became extremely ill, at first feeling “dizzy and hot.”
“I started vomiting,” the woman told NBC News. “My husband started developing respiratory problems and wanted to hold my hand.”
She called 911. The emergency responders “were asking a lot of questions” about what they’d consumed. “I was having a hard time talking, falling down.”
Shortly after he arrived at the hospital, her husband died.
On Monday, Banner Health, based in Arizona, said the couple took the additive called chloroquine phosphate.
The couple unfortunately equated the chloroquine phosphate in their fish treatment with the medication —known as hydroxychloroquine — that has recently been touted as a possible treatment for COVID-19, which has infected more than 42,000 people in the U.S. and killed at least 462.
Dr. Daniel Brooks, medical director of Banner Poison and Drug Information Center, said in a statement: “Given the uncertainty around COVID-19, we understand that people are trying to find new ways to prevent or treat this virus, but self-medicating is not the way to do so.”
On Friday, the Nigeria Centre for Disease Control pleaded with its people not to engage in self-medication with chloroquine, as it “will cause harm and can lead to death.” The country had reported at least two such poisonings.
NCDC
✔@NCDCgov
#FactsNotFear@WHO has NOT approved the use of chloroquine for #COVID19 management. Scientists are working hard to confirm the safety of several drugs for this disease.
Please DO NOT engage in self-medication. This will cause harm and can lead to death.#COVID19Nigeria
The Food and Drug Administration has not approved chloroquine to treat the coronavirus, and studies of its safety and effectiveness are just beginning.
The Arizona woman now warns others to listen to medical professionals for the best coronavirus advice.
“Be careful and call your doctor,” she said.
“This is a heartache I’ll never get over.”
Erika Edwards
Erika Edwards is the health and medical news writer and reporter for NBC News and “TODAY.”
Vaughn Hillyard
Vaughn Hillyard is a political reporter for NBC News.
The following article is reprinted from The Frontline Dispatch.
Covering Coronavirus: Cremona, Italy
A reporter’s emotional journey back to her homeland in Italy, now the global epicenter of the COVID-19 outbreak. “I never thought that I would be making a film like this in Italy,” says FRONTLINE correspondent Sasha Achilli. “I feel immensely proud of the way that the Italian doctors are doing everything they can.” Italy’s doctors, she says, are looking at how America is responding now, and finding similarities with how their own country reacted weeks ago. “Doctors [here] are saying, absolutely self-isolate and do it in the interest of yourself. But in the interests of everybody else around you and who you love. Because this is very, very real.”
When it became clear that the COVID-19 pandemic would reach Israel, Dr. Elli Rosenberg was one of a small number of medical professionals at the Soroka Medical Center in Beersheva to answer a call for volunteers to treat the sick.
Rosenberg, a clinical immunologist who works as an internist at Soroka, now runs the coronavirus unit there. As of last week, his hospital — the largest in southern Israel — had 14 confirmed coronavirus patients.
Rosenberg spoke with the Jewish Telegraphic Agency about the unique elements and challenges of caring for coronavirus patients, Israel’s handling of the pandemic and the changes that ordinary people should make in their lives to reduce the risk of infection.
This conversation has been edited for length.
JTA: Were you prepared for this?
Rosenberg: We imagined this day might come, but we never really translated that into operational contingencies. Everything is new here. Setting up an isolation unit for patients with this disease has definitely been a challenge. The last two weeks have been a learning process and a training process for something that might get much worse very quickly.
What did you do on Day 1?
When the first patient was admitted to our unit, I remember suiting up and getting into all the layers of protective gear and entering an airlock that separates the clear zone from the infected zone. It was an astronaut-like experience. As I held the door of the airlock, I felt, wow, I’m stepping into the unknown and taking part in something that’s a worldwide challenge. It was a mixture of fear and excitement and a reminder of why I chose to do what I do. Then I walked into the unit, approached the patient and introduced myself.
How do you provide care given the risk of contagion?
Our unit is divided into two sections: the confirmed corona section, where everyone who has the same disease can interact, and another unit for patients with high suspicion of corona where each patient is isolated in his or her room until they receive test results.
What we’re trying to do is maximize patient care with minimal staff exposure. Technology helps. A coin-sized monitor taped to their chest — developed by an Israeli startup company — continuously transmits vital signs by Bluetooth to our control center. We also have tablets for the patients that measure their temperature and can serve as a stethoscope. Students and faculty from the engineering department at Ben-Gurion University of the Negev are building a telemedicine robot to our specifications.
What is the course of treatment?
There is no evidence-based treatment yet. There’s a lot of research being carried out right now around the world on various forms of medication that interfere with the virus’s ability to impede the inflammatory response the virus may cause, or the virus’ ability to attach to DNA. We’re basing what we do on developing supportive care, usually with oxygen, and waiting for the patient’s own immune response to kick in and eliminate the virus.
How long does it typically take for patients to get through coronavirus?
Between several days and a few weeks. That’s the challenge with this disease. If there’s an influx of patients that require hospitalization for long stays, that might overwhelm the health care system’s capacity. There won’t be enough beds, there won’t be enough staff, there won’t be enough respirators. That’s the real concern. We’re trying our best to prepare for an uncontrollable wave of patients.
How are the patients managing the emotional burden of isolation with coronavirus?
It’s very difficult. The uncertainty is very intense. They don’t know what the course of their disease will be. They don’t know how long they will be hospitalized. Every cough, every fever, every change in their oxygen saturation level is usually a cause of a lot of stress. The cough and shortness of breath are nasty. The isolation from family is very difficult. They’re essentially locked in. It’s a very unsettling experience. Using telemedicine, they speak daily with a social worker to try to vent their feelings, their concerns, their fears.
We understand the emotional impact of being there with them is crucial, and that’s why we see every patient every day face to face even if there’s not a medical necessity for it. I think they feel much more secure when we’re in there with them. The human contact, putting a comforting hand on their shoulder, has a psychological impact.
We’ve been blessed with patients who are very positive. They eat their meals together in a common dining room, they’re playing board games together, building puzzles, helping each other pass the time.
Dr. Elli Rosenberg, a clinical immunologist at Soroka Medical Center in Beersheva, Israel, is managing his hospital’s medical response to the coronavirus. (JTA/COURTESY ROSENBERG)
Are you well-staffed for coronavirus?
Staff is a weak point. We started this epidemic when the Israeli health care system is generally understaffed. Right now our unit is based on volunteers — people that expressed a willingness to take part in this. We’re not forcing anybody. There is a lot of concern among all lines of work in the hospital — ranging from doctors and nurses to radiology technicians and orderlies and maintenance staff.
In the beginning, there were no maintenance workers willing to enter the unit to mop the floors, clean the bathrooms, empty the garbage cans. Only after I lectured them and promised to go in with them and help them out did two workers agree to go into the unit. They were petrified in the beginning, but once they were inside and met the patients and saw that it’s not as bad as they imagined, they did their job very well and agreed to volunteer to join our team.
What are the greatest risks to you and your staff?
The true front lines are the people working in emergency rooms. Any patient that walks in potentially has corona, and the staff there doesn’t have the ability to protect themselves from every single patient. That uncertainty increases the risk of accidental exposure. In our unit, there’s no uncertainty.
Do you check yourself or your staff for the virus?
No. The protocol is that as long as we feel well we’re not tested on a routine basis. If any of us develops fever or respiratory symptoms suggestive of the disease, we’ll obviously test. The consequence of positive results among any of our staff would be quarantine for everybody. And that has extensive repercussions, so we’re hoping we all stay healthy.
I have extensively limited my exposure to other wards in the hospital. I canceled all my outpatient clinics. Our unit has to be specially cared for so as not to expose to potential infection. I’m also limiting my exposure to places where I might contract the virus. I haven’t been in stores, I haven’t gone to shul.
We’re also developing written protocols for how the unit should function if I am neutralized because of illness or quarantine.
What does your family say about your work?
I think they understand the importance of what I’m involved in. My 12-year-old daughter specifically pointed out that she’s proud of me, which moved me greatly.
What do you tell your family about how to stay safe?
Wash hands very frequently. Don’t touch your face. Try not to come into physical contact with other people. Try to limit your distance to anybody outside of the family to 2 meters (about 6 feet). In my house, there have been extensive changes in dining etiquette. There’s no more drinking straight from the milk carton or sharing spoons. That’s been a major change in our household.
I have been limiting myself to very little physical contact with my wife or my children. They’ve decreased their social contacts extensively. We don’t let them have sleepovers with friends, even though theoretically it is allowed. I feel they should take the required actions a step further because of my exposure. I’ve told my 16-year-old daughter and her boyfriend to stay 2 meters apart.
What’s your take on Israel’s handling of the pandemic?
I’ve gone through a swing of the pendulum. In the beginning, I thought this was handled way too aggressively and that the measures the government decided on were extreme. As time progressed, especially with examples coming in from different countries around the world of how governments responded and what the consequences were — for better and for worse — I slowly shifted to the point right now where I hope we’re not too late with the actions we’re taking. If we want to beat this, social distancing and personal hygiene and increased testing have to be implemented and enforced at the highest level, and I feel we’re not there yet.
How long do you think this will last, and how bad will it get?
Nobody really knows. I’m mentally preparing for a few months. I’m also preparing for a situation where it gets worse before it gets better. We’re trying to make the most out of the resources we have, to maximize our ability to provide care in the event that this turns out to be very significant. Will we be overwhelmed, will we find ourselves in a similar position to what’s happening unfortunately in Italy, where doctors are making horrible choices of who to treat and who to turn away? I dread that possibility. We’re trying to do the best with what we have to avoid that situation.
U.S. hospitals, public health authorities, and digital health companies have quickly deployed online symptom checkers to screen patients for signs of Covid-19. The idea is simple: By using a chatbot powered by artificial intelligence, they can keep anxious patients from inundating emergency rooms and deliver sound health advice from afar.
Or at least that was the pitch.
Late last week, a colleague and I drilled more than a half-dozen chatbots on a common set of symptoms — fever, sore throat, runny nose — to assess how they worked and the consistency and clarity of their advice. What I got back was a conflicting, sometimes confusing, patchwork of information about the level of risk posed by these symptoms and what I should do about them.
A chatbot posted on the website of the Centers for Disease Control and Prevention determined that I had “one or more symptom(s) that may be related to COVID-19” and advised me to contact a health care provider within 24 hours “and start home isolation immediately.”
SCREEN CAPTURE
But a symptom checker from Buoy Health, which says it is based on current CDC guidelines, found that my “risk of a serious Novel Coronavirus (COVID-19) infection is low right now” and told me to keep monitoring my symptoms and check back if anything changes. Others concluded I was at “medium risk” or “might have the infection.”
Most people will probably consult just one of these bots, not eight different versions as I did. But experts on epidemiology and the use of artificial intelligence in medicine said the wide variability in their responses undermines the value of automated symptom checkers to advise people at a time when — above all else — they are looking for reliable information and clear guidance.
“These tools generally make me sort of nervous because it’s very hard to validate how accurate they are,” said Andrew Beam, an artificial intelligence researcher in the department of epidemiology at the Harvard TH Chan School of Public Health. “If you don’t really know how good the tool is, it’s hard to understand if you’re actually helping or hurting from a public health perspective.”
The rush to deploy these chatbots underscores a broader tension in the coronavirus outbreak between the desire of technology companies and digital health startups to pitch new software solutions in the face of a fast-moving and unprecedented crisis, and the solemn duty of medical professionals to ensure that these interventions truly benefit patients and don’t cause harm or spread misinformation. A 2015 study published by researchers at Harvard and several Boston hospitals found that symptom checkers for a range of conditions often reach errant conclusions when used for triage and diagnosis.
Told of STAT’s findings, Buoy’s chief executive, Andrew Le, said he would synchronize the company’s symptom checker with the CDC’s. “Now that they have a tool, we are going to use it and adopt the same kind of screening protocols that they suggest and put it on ours,” he said. “This is probably just a discrepancy in time, because we’ve been attending all of their calls and trying to stay as close to their guidelines as possible.”
The CDC did not respond to a request for comment.
Before I continue, I should note that neither I nor my colleague is feeling ill. We devised a simple test to assess the chatbots and limited the experiment to the web- and smartphone-based tools themselves so as not to waste the time of front-line clinicians. We chose a set of symptoms that were general enough to be any number of things, from a common cold, to the flu, to yes, coronavirus. The CDC says the early symptoms of Covid-19 are fever, cough, and shortness of breath.
But the widely varying recommendations highlighted the difficulty of distinguishing coronavirus from more common illnesses, and delivering consistent advice to patients.
The Cleveland Clinic’s tool determined that I was at “medium risk” and should either take an online questionnaire, set up a virtual visit, or call my primary care physician. Amy Merino, a physician and the clinic’s chief medical information officer, said the tool is designed to package the CDC’s guidelines in an interactive experience. “We do think that as we learn more, we can optimize these tools to enable patients to provide additional personal details to personalize the results,” she said.
SCREEN CAPTURE
Meanwhile, another tool created by Verily, Alphabet’s life sciences arm, to help determine who in certain northern California counties should be tested for Covid-19, concluded that my San Francisco-based colleague, who typed in the same set of symptoms, was not eligible for testing.
But in the next sentence, the chatbot said: “Please note that this is not a recommendation of whether you should be tested.” In other words, a non-recommendation recommendation.
A spokeswoman for Verily wrote in an email that the language the company uses is meant to reinforce that the screening tool is “complementary to testing happening in a clinical care situation.” She wrote that more than 12,000 people have completed the online screening exam, which is based on criteria provided by the California Department of Public Health.
The challenge facing creators of chatbots is magnified when it comes to products that are built on limited data and guidelines that are changing by the minute, including which symptoms characterize infection and how patients should be treated. A non-peer-reviewed study published online Friday by researchers at Stanford University found that using symptoms alone to distinguish between respiratory infections was only marginally effective.
“A week ago, if you had a chatbot that was saying, ‘Here are the current recommendations,’ it would be unrecognizable from where we are today, because things have just moved so rapidly,” said Karandeep Singh, a physician and professor at the University of Michigan who researches artificial intelligence and digital health tools. “Everyone is rethinking things right now and there’s a lot of uncertainty.”
To keep up, chatbot developers will have to constantly update their products, which rely on branching logic or statistical inference to deliver information based on knowledge that is encoded into them. That means keeping up to date on new data that are being published every day on the number of Covid-19 cases in different parts of the world, who should be tested based on available resources, and the severity of illness it is causing in different types of people.
Differences I found in the information being collected by the chatbots seemed to reflect the challenges of keeping current. All asked if I had traveled to China or Iran, but that’s where commonality ended. The Cleveland Clinic asked whether I had visited a single country in Europe — Italy, which has the second most confirmed Covid-19 cases in the world — while Buoy asked whether I had visited any European country. Providence St. Joseph Health, a hospital network based in Washington state, broke out a list of several countries in Europe, including Italy, Spain, France, and Germany.
After STAT inquired about limiting its chatbot’s focus to Italy, Cleveland Clinic updated its tool to include the United Kingdom, Ireland, and the 26 European countries included in the Schengen area.
But Providence St. Joseph asked only whether I had experienced any one of several symptoms, including fever, sore throat, runny nose, cough, or body aches. I checked yes to that question, and no to queries about whether I had traveled to an affected country or come in contact with someone with a lab-confirmed case of Covid-19. The bot (built, like the CDC one, with tools from Microsoft) offered the following conclusion: “You might be infected with the coronavirus. Please do one of the following — call your primary care physician to schedule an evaluation” or “call 911 for a life threatening emergency.”
All of the chatbots I consulted included some form of disclaimer urging users to contact their doctors or otherwise consult with medical professionals when making decisions about their care. But the fact that most offered a menu of fairly obvious options about what I should do seemed to undercut the value of the exercise.
Beam, the professor at Harvard, said putting out inaccurate or confusing information in the middle of a public health crisis can result in severe consequences.
“If you’re too sensitive, and you’re sending everyone to the emergency room, you’re going to overwhelm the health system,” he said. “Likewise, if you’re not sensitive enough, you could be telling people who are ill that they don’t need emergency medical care. It’s certainly no replacement for picking up the phone and calling your primary care physician.”
If anyone would be enthusiastic about the possibilities of deploying artificial intelligence in epidemiology, Beam would be the guy. His research is focused on applying AI in ways that help improve the understanding of infectious diseases and the threat they pose. And even though he said the effort to deploy automated screening tools is well intentioned — and that digital health companies can help stretch resources in the face of Covid-19 — he cautioned providers to be careful not to get ahead of the technology’s capabilities.
“My sense is that we should err to the centralized expertise of public health experts instead of giving people 1,000 different messages they don’t know what to do with,” he said. “I want to take this kind of technology and integrate it with traditional epidemiology and public health techniques.”
“In the long run I’m very bullish on these two worlds becoming integrated with one another,” he added. “But we’re not there yet.”
Erin Brodwin contributed reporting.
This is part of a yearlong series of articles exploring the use of artificial intelligence in health care that is partly funded by a grant from the Commonwealth Fund.
The following article is reprinted from Pro Publica.
A Medical Worker Describes Terrifying Lung Failure From COVID-19 — Even in His Young Patients
“It first struck me how different it was when I saw my first coronavirus patient go bad. I was like, Holy shit, this is not the flu. Watching this relatively young guy, gasping for air, pink frothy secretions coming out of his tube.”
A medical worker treats a COVID-19 patient in an intensive care unit in Italy. Across the globe, health care providers are using ventilators to treat COVID-19 patients. (Flavio Lo Scalzo/Reuters)
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As of Friday, Louisiana was reporting 479 confirmed cases of COVID-19, one of the highest numbers in the country. Ten people had died. The majority of cases are in New Orleans, which now has one confirmed case for every 1,000 residents. New Orleans had held Mardi Gras celebrations just two weeks before its first patient, with more than a million revelers on its streets.
I spoke to a respiratory therapist there, whose job is to ensure that patients are breathing well. He works in a medium-sized city hospital’s intensive care unit. (We are withholding his name and employer, as he fears retaliation.) Before the virus came to New Orleans, his days were pretty relaxed, nebulizing patients with asthma, adjusting oxygen tubes that run through the nose or, in the most severe cases, setting up and managing ventilators. His patients were usually older, with chronic health conditions and bad lungs.
Since last week, he’s been running ventilators for the sickest COVID-19 patients. Many are relatively young, in their 40s and 50s, and have minimal, if any, preexisting conditions in their charts. He is overwhelmed, stunned by the manifestation of the infection, both its speed and intensity. The ICU where he works has essentially become a coronavirus unit. He estimates that his hospital has admitted dozens of confirmed or presumptive coronavirus patients. About a third have ended up on ventilators.
His hospital had not prepared for this volume before the virus first appeared. One physician had tried to raise alarms, asking about negative pressure rooms and ventilators. Most staff concluded that he was overreacting. “They thought the media was overhyping it,” the respiratory therapist told me. “In retrospect, he was right to be concerned.”
He spoke to me by phone on Thursday about why, exactly, he has been so alarmed. His account has been condensed and edited for clarity.
“Reading about it in the news, I knew it was going to be bad, but we deal with the flu every year so I was thinking: Well, it’s probably not that much worse than the flu. But seeing patients with COVID-19 completely changed my perspective, and it’s a lot more frightening.”
This is knocking out what should be perfectly fit, healthy people.
“I have patients in their early 40s and, yeah, I was kind of shocked. I’m seeing people who look relatively healthy with a minimal health history, and they are completely wiped out, like they’ve been hit by a truck. This is knocking out what should be perfectly fit, healthy people. Patients will be on minimal support, on a little bit of oxygen, and then all of a sudden, they go into complete respiratory arrest, shut down and can’t breathe at all.”
They suddenly become unresponsive or go into respiratory failure.
“We have an observation unit in the hospital, and we have been admitting patients that had tested positive or are presumptive positive — these are patients that had been in contact with people who were positive. We go and check vitals on patients every four hours, and some are on a continuous cardiac monitor, so we see that their heart rate has a sudden increase or decrease, or someone goes in and sees that the patient is struggling to breathe or is unresponsive. That seems to be what happens to a lot of these patients: They suddenly become unresponsive or go into respiratory failure.”
The lung is filled with so much fluid, displacing where the air would normally be.
“It’s called acute respiratory distress syndrome, ARDS. That means the lungs are filled with fluid. And it’s notable for the way the X-ray looks: The entire lung is basically whited out from fluid. Patients with ARDS are extremely difficult to oxygenate. It has a really high mortality rate, about 40%. The way to manage it is to put a patient on a ventilator. The additional pressure helps the oxygen go into the bloodstream.
“Normally, ARDS is something that happens over time as the lungs get more and more inflamed. But with this virus, it seems like it happens overnight. When you’re healthy, your lung is made up of little balloons. Like a tree is made out of a bunch of little leaves, the lung is made of little air sacs that are called the alveoli. When you breathe in, all of those little air sacs inflate, and they have capillaries in the walls, little blood vessels. The oxygen gets from the air in the lung into the blood so it can be carried around the body.
“Typically with ARDS, the lungs become inflamed. It’s like inflammation anywhere: If you have a burn on your arm, the skin around it turns red from additional blood flow. The body is sending it additional nutrients to heal. The problem is, when that happens in your lungs, fluid and extra blood starts going to the lungs. Viruses can injure cells in the walls of the alveoli, so the fluid leaks into the alveoli. A telltale sign of ARDS in an X-ray is what’s called ‘ground glass opacity,’ like an old-fashioned ground glass privacy window in a shower. And lungs look that way because fluid is white on an X-ray, so the lung looks like white ground glass, or sometimes pure white, because the lung is filled with so much fluid, displacing where the air would normally be.”
A screenshot of chest radiographs of a man suspected to have COVID-19. (Obtained by ProPublica via the Radiological Society of North America, cited in the paper “Severe Acute Respiratory Disease in a Huanan Seafood Market Worker: Images of an Early Casualty” by Lijuan Qian, Jie Yu and Heshui Shi.)
This severity … is usually more typical of someone who has a near drowning experience … or people who inhale caustic gas.
“With our coronavirus patients, once they’re on ventilators, most need about the highest settings that we can do. About 90% oxygen, and 16 of PEEP, positive end-expiratory pressure, which keeps the lung inflated. This is nearly as high as I’ve ever seen. The level we’re at means we are running out of options.
“In my experience, this severity of ARDS is usually more typical of someone who has a near drowning experience — they have a bunch of dirty water in their lungs — or people who inhale caustic gas. Especially for it to have such an acute onset like that. I’ve never seen a microorganism or an infectious process cause such acute damage to the lungs so rapidly. That was what really shocked me.”
You’ll try to rip the breathing tube out because you feel it is choking you …
“It first struck me how different it was when I saw my first coronavirus patient go bad. I was like, Holy shit, this is not the flu. Watching this relatively young guy, gasping for air, pink frothy secretions coming out of his tube and out of his mouth. The ventilator should have been doing the work of breathing but he was still gasping for air, moving his mouth, moving his body, struggling. We had to restrain him. With all the coronavirus patients, we’ve had to restrain them. They really hyperventilate, really struggle to breathe. When you’re in that mindstate of struggling to breathe and delirious with fever, you don’t know when someone is trying to help you, so you’ll try to rip the breathing tube out because you feel it is choking you, but you are drowning.
“When someone has an infection, I’m used to seeing the normal colors you’d associate with it: greens and yellows. The coronavirus patients with ARDS have been having a lot of secretions that are actually pink because they’re filled with blood cells that are leaking into their airways. They are essentially drowning in their own blood and fluids because their lungs are so full. So we’re constantly having to suction out the secretions every time we go into their rooms.”
I do not want to catch this.
“Before this, we were all joking. It’s grim humor. If you are exposed to the virus and test positive and go on quarantine, you get paid. We were all joking: I want to get the coronavirus because then I get a paid vacation from work. And once I saw these patients with it, I was like, Holy shit, I do not want to catch this and I don’t want anyone I know to catch this.
“I worked a long stretch of days last week, and I watched it go from this novelty to a serious issue. We had one or two patients at our hospital, and then five to 10 patients, and then 20 patients. Every day, the intensity kept ratcheting up. More patients, and the patients themselves are starting to get sicker and sicker. When it first started, we all had tons of equipment, tons of supplies, and as we started getting more patients, we started to run out. They had to ration supplies. At first we were trying to use one mask per patient. Then it was just: You get one mask for positive patients, another mask for everyone else. And now it’s just: You get one mask.
“I work 12-hour shifts. Right now, we are running about four times the number of ventilators than we normally have going. We have such a large volume of patients, but it’s really hard to find enough people to fill all the shifts. The caregiver-to-patient ratio has gone down, and you can’t spend as much time with each patient, you can’t adjust the vent settings as aggressively because you’re not going into the room as often. And we’re also trying to avoid going into the room as much as possible to reduce infection risk of staff and to conserve personal protective equipment.”
Even if you survive … it can also do long-lasting damage.
“But we are trying to wean down the settings on the ventilator as much as possible, because you don’t want someone to be on the ventilator longer than they need to be. Your risk of mortality increases every day that you spend on a ventilator. The high pressures from high vent settings is pushing air into the lung and can overinflate those little balloons. They can pop. It can destroy the alveoli. Even if you survive ARDS, although some damage can heal, it can also do long-lasting damage to the lungs. They can get filled up with scar tissue. ARDS can lead to cognitive decline. Some people’s muscles waste away, and it takes them a long time to recover once they come off the ventilator.
“There is a very real possibility that we might run out of ICU beds and at that point I don’t know what happens if patients get sick and need to be intubated and put on a ventilator. Is that person going to die because we don’t have the equipment to keep them alive? What if it goes on for months and dozens of people die because we don’t have the ventilators?
“Hopefully we don’t get there, but if you only have one ventilator, and you have two patients, you’re going to have to go with the one who has a higher likelihood of surviving. And I’m afraid we’ll get to that point. I’ve heard that’s happening in Italy.”
One of Alaska’s first confirmed coronavirus patients tells his story
March 19, 2020
A Ketchikan man who contracted the illness caused by the new coronavirus is speaking out about his experience.
In a social media post and an interview with the Ketchikan Daily News, he described his symptoms, how he was tested and his experience communicating with Alaska public health officials.
Brown said in a Facebook post that he was feeling better and was notified by public health officials that he’d tested positive for COVID-19 on Tuesday afternoon.
“I became sick Saturday morning with fever, headache, general achiness and chills,” Brown wrote.
Brown said he has “no idea” how he contracted the illness.
“I interacted with no one in recent weeks who was exhibiting obvious symptoms,” he wrote.
According to a statement Tuesday from the Ketchikan Emergency Operations Center saying one of its employees tested positive for the virus, the employee had a history of travel to the Lower 48. The Ketchikan Emergency Operations Center on Wednesday confirmed Brown is the employee.
After public health officials told Brown his diagnosis, he said that he went through more than an hour of questions with them, he told the Ketchikan Daily News.
“I used everything from cellphone records to work calendars to debit card bills, to recall everybody that I may have had contact with,” Brown told the Ketchikan Daily News. “I wanted to provide that information to public health, (so) that they could alert those people and really hope to kind of arrest this thing.”
Brown told the paper that public health officials focused on two days before he developed symptoms of the illness. Brown had been “working closely with borough staff and upper management” in those days as part of his job, the paper reported.
“I apologize for causing undue concern for anyone, especially my co-workers at the Borough,” Brown said in the Facebook post.
Ketchikan Gateway Borough employees in direct contact with Brown were instructed to self-quarantine for two weeks, according to the Ketchikan Emergency Operations Center statement.
The statement also said that the borough had hired a service to disinfect the now-closed White Cliff Building, which houses the Ketchikan Borough offices.
According to the Ketchikan Daily News, the last time Brown was at the borough’s White Cliff Building was Friday.
The paper reported that as of Tuesday night, there were no plans to test people who had been in direct contact with Brown.
A public information officer for Ketchikan’s Emergency Operations Center told the Ketchikan Daily News that she understood that to be tested, people would need to have “several” symptoms of the virus.
“I would also ask that you join me and all of Ketchikan to actively minimize community transmission so that we can protect our seniors or other medically vulnerable folks in Ketchikan,” Brown wrote. “I pray that we all make it through this largely unharmed, and together.”
The first person in Alaska to test positive for COVID-19 was an air cargo pilot who arrivedat Ted Stevens Anchorage International Airport on March 11, officials announced last week. He went through the airport’s North Terminal, which is separate from the domestic terminal.
Alaska’s chief medical officer, Dr. Anne Zink, said last week the man had self-isolated and was “stable.”
On Monday, officials said two older men in Fairbanks were diagnosed with the illness. Both had recently traveled to the Lower 48, Zink said, but were not traveling together.
In addition to the Anchorage case, the case in Ketchikan and the two in Fairbanks, officials on Tuesday announced that two more people had become sick with the virus — one in Fairbanks and one in Anchorage — bringing the total number of confirmed cases as of Wednesday morning to six.
Zink said that both of those cases were also travel-related. None of the three people who tested positive for COVID-19 on Tuesday were hospitalized, Zink said.
Fairbanks Memorial Hospital released a statement Tuesday saying a woman with a history of recent travel had tested positive for COVID-19.
“She self-isolated prior to testing,” the statement said. “This patient has been notified and is in stable condition and does not require hospitalization.”
A University of Alaska Fairbanks employee was one of the people who had recently tested positive for the virus in Alaska, university officials said Tuesday.
State and local officials have taken a series of steps to stem the spread of COVID-19 in Alaska, including closing schools, calling on hospitals to halt elective surgeries and shutting down dine-in service at all restaurants, bars, breweries, cafes and similar businesses.
Morgan Krakow is a general assignment reporter for the Anchorage Daily News. She is a 2019 graduate of the University of Oregon and spent the past summer as a reporting intern on the general assignment desk of The Washington Post. Contact her at mkrakow@adn.com.
3/19/2020
New Jersey Physician Assistant was first COVID-19 patient
Reporter: Gail S. Thornton, M.A.
The following article is reprinted from MedPage Today.
Physician Assistant With COVID-19 Speaks Out
— “I don’t know how many days I can last”
by Kristina Fiore,Director of Enterprise & Investigative Reporting, MedPage Today
A New Jersey physician assistant who was the state’s first COVID-19 patient is speaking out from his hospital bed, calling his illness “severe” and raising concerns about his treatment.
James Cai, a 32-year-old non-smoker with no other health conditions, has been at Hackensack University Medical Center for about a week and says his illness has worsened significantly over that time.
“In the beginning, they just treat me like normal flu. They say I’m young, I’m not going to die, but they don’t know the truth about corona[virus],” Cai said during an interview posted to Twitter over the weekend.
Cai didn’t respond to MedPage Today‘s request for an interview, but he told CBS New York that his illness progressed rapidly. He’s now having trouble breathing and will likely need to be placed on a ventilator soon. He’s one of 15 cases in New Jersey as of press time. On Tuesday, the state reported its first death: a 69-year-old man with underlying conditions.
His story came to light over the weekend when Bill Pulte, a self-described Twitter philanthropist, posted a live interview with Cai that garnered social media attention. (Pulte is the grandson of William Pulte, founder of the large U.S. home construction company.)
Pulte said in a tweet that Cai’s family reached out to him for support and he took up the cause because Cai “needs a patient advocate right now.” He said he wanted to help amplify Cai’s request to transfer to Mount Sinai Hospital in New York, where his brother works, and to get into a clinical trial of the antiviral remdesivir, first developed to treat Ebola but now repurposed as a potential coronavirus therapy.
Hackensack University Medical Center confirmed Cai is a patient there, but would not comment further. Gilead, which makes remdesivir, told MedPage Today it couldn’t comment on individual patient cases.
During the interview, Cai appeared at times to be struggling to breathe, and Pulte halted the interview at one point to give him time to catch his breath.
“For the last one week, it’s been hell,” Cai said during the broadcast. His symptoms have included dyspnea, chest pain, high fever, watery eyes, and diarrhea. A repeat CT scan performed over the weekend showed evidence of disease worsening, he said.
At one point, he said his oxygen saturation dipped below 80%.
“I don’t think they really understand what’s going on here,” he said. “My brother at Mount Sinai main campus, he understands. He can advocate for me.”
In addition to going to his brother’s hospital, he said he hopes he can start taking remdesivir soon.
“I need those two things,” he said. “I don’t know how many days I can last.”
Cai worries for his 90-year-old grandparents, his wife and his 9-month-old daughter, and confirmed his family is currently in isolation.
He believes he contracted the virus during a medical conference he attended at a Times Square hotel in New York City the weekend prior to his hospitalization on Tuesday, March 3.
Cai urged on CBS New York that people should “take coronavirus seriously. It’s very serious.”
His pleas come as experts sound alarms that the U.S. healthcare system isn’t prepared for a substantial influx of COVID-19 patients and may quickly be overwhelmed.
Last Updated March 11, 2020
3/12/2020
Cancer Clinical Resources from ASCO
Reporter: Gail S. Thornton, M.A.
NORD, a 501(c)(3) organization, is a patient advocacy organization dedicated to individuals with rare diseases and the organizations that serve them. NORD, along with its more than 300 patient organization members, is committed to the identification, treatment and cure of rare disorders through programs of education, advocacy, research and patient services. rarediseases.org
The following article is reprinted from the NORD web site.
Is there definitive data showing cancer patients are at increased risk of complications from COVID-19? Do we have data from Italy or China about the risk of COVID-19 infection in temporarily neutropenic patients? The American Society of Clinical Oncology (ASCO) has developed resources for clinicians that may be helpful for anyone affected by cancer to read.
Currently, limited clinical cancer-specific data is available and information is evolving. This document answers questions ASCO has received based on evidence gathered through a PubMed search of the medical literature, a search of relevant websites with information on infectious diseases (CDC, WHO, IDSA, etc.), and input provided by clinical oncologists and infectious disease experts. ASCO will update this information as new questions emerge and evidence develops.
Please click on the link below for access to a frequently asked question document that can be shared with medical professionals managing rare cancer patient care.
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