Covid-19 Update

Covid-19 Update
3:00 PM 18-MarCasesDeathsParishes
Louisiana257713
St. Mary Parish00 
United States7,324108
Italy35,7132,978
World212,5948,726

Above are the numbers as of mid-afternoon on Wednesday. I will likely be blogging daily during the coming weeks tracking the progress of the outbreak and providing information from verifiable and peer-reviewed data and studies on the outbreak. I am including Italy in the update numbers because they unfortunately are about two weeks ahead of the rest of the western word in this outbreak. They are the best indication of how this will progress and an example of how bad things can get.

All indications are that we are at a critical inflection point in the US outbreak. How well we self-isolate and stay away from gatherings over the next two weeks will determine how devastating this outbreak will become. It seems completely illogical but we want this outbreak to drag on. A longer duration outbreak, with a slower rise in cases over months is far more palatable to the continued nearly vertical slope in the number of confirmed cases. If we do not “flatten the curve,” the number of those critically ill with Covid-19 will outstrip the number of critical care beds in Louisiana and the US as a whole. We could be put in the position Italy now fines itself, where they are literally having to decide who gets ventilators and ICU beds and who does not. Who dies and who does not. As the governor and president have said, how we act as a state and nation in the coming two weeks will determine just how bad things get.

The graph above says it all. If by self-isolating someone prevents one case of Covid-19 today, it will prevent 2,200 new cases in next 30 days. If we say “oh its not that bad” and wait a week before preventing that one case, we only prevent 500 new cases. A difference of say 700 cases. That is how fast this virus spreads!

We are all seeing the number of cases climb exponentially in Louisiana and across the US and world. But even those numbers are somewhat deceiving. Let’s look at Louisiana. We now have 257 confirmed cases. That is based on just under 600 people being tested in Louisiana. There are over 4 million people in Louisiana. Of those positive tests, 40% are in people under the age of 50. They were tested because they either were exposed or had symptoms. But, in that age demographic, most healthy people do not have serious symptoms from the virus and may not even know they have it. So imagine the number of people who likely have the virus in that age group but have no idea or are just treating their illness as a cold or the flu. Each person out there infected, unknowingly, will lead to 2200 new cases in 30 days. The impact is staggering.

We must also remember that Covid-19 has an incubation period of somewhere between 5 and 14 days. That means it could be a week or more between when you are infected and begin to show symptoms. But by the second or third day, your body begins to shed the virus to your surroundings. All the while, you are spreading the disease and do not even know it. And once you see the onset of symptoms, they will initially resemble a run of the mill upper respiratory infection possibly leading to even more people becoming infected pending testing. The bottom line is that those who acquire the virus are likely to spread it for up to 10 days before they are aware they are a threat. This is why Governor Edwards said today we must all assume we have the virus and do not know it, if we are to flatten the curve.

The graphic above is from the World Health Organization and shows the symptoms associated with Covid-19. For the most part, they are the same as any upper respiratory infection, bronchitis or pneumonia. If you have any of these symptoms, contact your health care provider, If you do not have a doctor, call 211 in Louisiana for a referral. Only be identifying and isolating those with the virus will we ever slow its growth.

I will close with another great graphic countering the sentiment still seen online that Covid-19 is no different than seasonal flu outbreaks.

This graphic clearly demonstrates the Covid-19 outbreak is twice as contagious as the flu, has an incubation period up to four times longer, is nine times more likely to lead to hospitalization and is up to 34 times more deadly. This is far worse than the seasonal flu! And by the way, the seasonal flu will affect 30 million in the US this year and kill around 20,000. And we have a vaccine for it.

Finally, there are stories all over the internet that ibuprofen may make a Covid-19 infection worse. This is baseless. The World Health Organization and US Centers for Disease Control and Prevention both said today that there is no scientific basis for this claim and ibuprofen is a perfectly reasonable alternative to acetaminophen, especially for those who cannot use Tylenol and other acetaminophen products.

Until next time, stay safe and flatten the curve by following the recommendations of state and federal officials.

The Disease Process – Part 2

When we left off in Part I, the SARS CoV 2 virus had hijacked Type 2 pneumocytes, the surfactant producing cells of the lungs, and made the cells produce more and more virus, eventually destroying the lung cells. As these cells are destroyed, the virus releases a number of chemicals which trigger the body’s immune system to investigate. These chemicals, whose names we do not need to worry about, begin a cascade of changes within the infected body.

Two of those changes will have a dramatic effect on the course of the Covid-19 disease process. The first change is known as vasodilation, which basically means the blood vessels expand. Think of taking a piece of material from an old pair of pantyhose. Leave it in its normal state and it is basically a solid piece of material. But if you were to stretch the material strongly, you would begin to see that the solid material now looks much more like a piece of mesh with a matrix of small openings. This is what happens with the capillaries and other vessels in the lung as well. Just as with the pantyhose, the walls of the vessels expand and we get something called “increased capillary permeability,” which simply means that plasma begins leaking out of the vessels. It leaks out into the area around the blood vessels and into the alveoli as well.

As the fluid leaks into the alveoli and gathers around them, the small breathing sacs begin to get squeezed. In addition, because the cells which create surfactant have been destroyed, the alveoli begin to have trouble holding themselves open. At the same time, the debris from the lung cells destroyed by the virus begin to fill the inside of the cells. Between the fluid building up, the squeezing and collapse of the alveoli, and the debris cluttering the lung cells, it becomes almost impossible for the cells to exchange oxygen and carbon dioxide. This leads to an increased “work of breathing” and a biological state known as hypoxemia, basically an abnormally low level of oxygen in the bloodstream.

At the same time, the body sensing the destruction of the lung cells begins to mount a response with the immune system. Very quickly, the immune system figures out it has no natural antibodies to this virus and instead mounts a brute force attack by rushing soldier cells called neutrophils into the lungs. Lacking specific antibodies which could target the virus alone, the neutrophils release chemicals which are capable of disrupting or destroying a wide number of cells, including the healthy lung tissue. This leads to more and more damaged alveoli, between the virus and the immune response. As the damaged cells begin to fill more and more alveoli with fluid and debris, something called consolidation, larger sections of the lung become incapable of gas exchange adding to the hypoxemia and work of breathing. This leads to shortness of breath and as the body tries to clear the lungs, a wet cough begin as the body tries to eject the fluid and debris built up in the lungs.

Outside the lungs, those chemicals released in the lungs have reached the brain, specifically a region known as the hypothalamus, which for our needs can be thought of as the body’s thermostat. This leads to development of a fever, as the body raises its temperature trying to use heat to kill the invader. By the way, most of us know that average body core temperature is 98.6° F. But fever is a different matter. For medical purposes, any temperature equal to or greater than 100.4° F is considered “fever.”

As the assault on the lungs continues, oxygen levels continue to drop. With oxygen essential for function of all the major organs, the brain acts to compensate for the low oxygen levels by triggering the nervous system to increase heart rate, medically known as tachycardia, and increasing breathing rate, in medical terms called tachypnea. In the majority of  cases, things will level off here with the only other major symptom being wracking body aches caused by inflammation as the body sends white blood cells throughout the body to fight the disease process.

In those who have compromised immune systems and contributing factors such as high blood pressure, heart disease, lung disease, diabetes, and kidney disease, things can continue to worsen. As more and more alveoli are attacked by the virus and fill with fluid and debris, we see larger areas of consolidation, what is more commonly known as pneumonia. This is still not a fatal condition, as many will survive Covid-19 pneumonia just as they do from common pneumonia. When consolidation reaches a point where the person can no longer pull in enough oxygen on their own to support their major organ systems, they develop a Acute Respiratory Distress Syndrome, or ARDS. It is ARDS which can lead to a need for ventilator support.

If we get enough inflammation in the lungs, we can see the inflammatory response spread to other parts of the body, leading to septicemia, basically a full blown infection of the body, also called septic shock. As in the lungs, we see both vasodilation and capillary permeability spread from the lungs to the whole body, dumping large amounts of fluids from the blood vessels into the surrounding tissue. This reduces blood volume causing hypotension or low blood pressure and decreased blood flow to major organs, which can lead to organ failure. It is this cascade of failing organs that leads to death from Covid-19

In Part 3, we will look at what one can expect if they get the disease, whether self-isolating at home or ending up in the hospital.

Covid-19 Attack – Part 1

I have been asked by a couple readers to try and simply explain how the SARS CoV 2 virus enters humans leading to such a deadly assault on the body. The problem in doing such a blog is that the material is quite complex. Most of those out there reading do not have a strong understanding of cell biology, immunology and pulmonary function. But I am willing to try and present this on a level most can understand. If you are strong in biology and medicine there are plenty of papers out there with the complex details. My hope is to present this in a way most can understand.

So today starts a three part series which will look first at how the virus hijacks lung cells. Part Two will look at how the virus turns our immune system against us. Finally in Part Three, we will look at how Covid-19 is being treated, along with what the future may hold.

So today we look at how the virus enters the body through a single type of cell in our lungs and makes that cell produce thousands of copies of the virus. Those copies then invade more cells in the body with plenty left to spread to others we come in contact with. The figure below, Figure 1, will be our road-map through this complex subject. Each heading refers to one of the numbered locations on the figure. If my explanation seems to simple for you, great! I am not looking to talk down to anyone, just ensure as many as possible can understand what is a complex process.

So, here we go…

Figure 1Courtesy ChemistryViews

Point 1 – The Virus Arrives

Quite simply, the virus enters our body by either breathing it in or picking it up on our hands and touching our face, allowing the virus to enter the respiratory system. Once it enters the mouth or nose, the virus works its way down our trachea and into our lungs. Its target is the small air sacs in our lungs where we exchange oxygen and carbon dioxide. These are called the alveoli and they are where the virus really stakes it claim.

Figure 2 – Alveloi and their components

As seen in Figure 2, alveoli are basically small balloons, held open by surface tension, the same physical property which makes water bead into a ball on a solid surface. These small balloons are surrounded by tiny blood vessels known as capillaries, which are so small that blood cells and such have to move through one by one. These capillaries are where the smallest veins and arteries come together in the lung.

Back to Figure 2, we see that there are three types of cells which make up the alveoli and yes they have strange names. Let’s simplify it a bit. The Type I Pneumocytes are the gas carriers; Type II Pneumocytes, which produce something called surfactant, keep the balloon from collapsing; and those Alveolar Macrophages, are simply trash collectors and will be more important in Part Two of this series.

It is the Type II Pneumocyte that we care about. They produce a substance which keeps the balloon inflated, a vital function of breathing. Unfortunately, these cells have to be able to bring in certain chemicals to work properly. This is done by something called an ACE2 receptor. Just understand this as being a door to the cell. Now that door has a lock and only a perfectly matched key can open the door.

Let’s stop for a moment and look at the virus. Think of it as an egg with tiny three types of keys on the surface. The egg shell is the capsule which keeps the outside world from damaging the virus. The white of egg is the protein layer which protects the strand of genetic material in the yolk of the egg. Finally, one of the three types of keys, known as the “S Spikes” on the virus, are perfectly matched keys to the lock on the ACE2 door of the Type 2 pneumocyte cell.

When that key perfectly mates with the ACE2 receptor lock, a door opens and the whole virus is pulled into the inside of the cell. It is now in a position to take over the cell and make it stop producing surfactant and instead start making thousands of copies of the SARS CoV 2 virus to infect other cells and people.

Point 2 – New Instructions

With the virus now in the cell, it can begin executing its sole purpose for existing, to multiply. This begins by the egg shell capsule of the virus dissolving along with egg white, the protective protein layer. Now the most important part of the virus can go to work. This is a small strand of genetic material, similar to what makes up our chromosomes and genes, but smaller. It is much smaller than most of the single genes in the human body and we have over 20,000 such genes in the body. Think of this strip of genetic material as a detailed instruction manual on how to make new virus particles.

Point 3 – Cranking Up Production

Once in the fluid on the inside of the, this instruction manual is run through a structure in the cell called a ribosome, a sort of cell computer. First, this cell computer produces a few copies of the full instruction manual, just in case. Then the original copy of the detailed instruction manual is run through this computer again, where each individual chapter, which details how to produce one specific part of the virus, is split off.

Point 4 – Dividing the Task

Now we have a set of instructions telling the cell how to produce each part of the virus. One set details how to make several interlocking sections which will make up the capsule, our egg shell. Another details how to produce the inner protein layer, the egg white. Finally, a chapter details how to produce the three types of spikes, our keys. All the structural components of the virus now have recipes. So the cell computer begins doing just that, making the cell produce the raw materials needed to make many new viruses. These mega-materials are known as polyproteins.

Point 5 – Production Begins

While these polyproteins have all the ingredients needed to make the viral components, they are all packed together in huge bundles and need to be broken down into smaller units so the actual components can be built. Basically, they are creating and stockpiling all of the parts needed needed to build the components of the new viruses

Point 6 – Building Virus Parts

Using the numerous parts stockpiled in the past step, the virus now begins to use cellular machinery to build thousands of copies of the building blocks. If you remember any high school or college biology, we are talking about the endoplasmic reticulum and golgi bodies. For our purposes they are the cells factories. These factories begin to crank out thousands of virus parts which are going to be put together down the road. There might be three or four pieces of the capsule, egg shell, which can perfectly come together to form a complete sphere. The same goes for the protein protective layer, the egg white, which lines the inside of the capsule and protects the genetic material. The completely formed protein spikes, our keys, are ready to attach to the capsule, or egg shell, when assembly begins.

Point 7 – Making New Manuals

While the cell has been busily building pieces of the physical structure of new viruses, it was not forgotten that each of these shells has to have its own instruction manual in the form of identical strands of RNA genetic material. So all the while, the cells’ genetic coding section has been making copy after copy of the instruction manual, so one can be inserted in each new virus assembled.

Point 8 – Assembly and Packaging

With all the parts at the ready, those strangely named endoplasmic reticulum and golgi bodies, our cell factories, begin to take the parts and build copies of the virus by the thousands. Brand new, fully functional, virus particles are now just floating in little pockets of the cell, known as vesicles.

Point 9 – New Virus Particles

The new viral particles, floating within the cell, exit in one of two ways. First, the cell can expel the vesicles into the alveoli or capillaries in a manner no unlike taking out the garbage. Its technically called exocytosis. Just think of it as the virus putting out the trash. The cell can release a large number of the virus over time via this process. In addition, viral growth sometimes reaches such as level that the cell just can’t hold all of the copies and it bursts, dumping all of the new viral particles at once into the alveoli and bloodstream.

These brand new virus clones are now free to infect nearby cells and set up new production factories, whose entire purpose is to make more viral particles, which make more virus particles … Well you get the picture. If there are no more cells to attach to, around day 2 of the infection, the viral particles begin to be exhaled via breathing, coughs, and/or sneezes. They can also be passed on via contact with unwashed hands covered in virus particles. The virus can hang around in the environment for days just waiting for a new human host to come along and provide it a new breeding factory where the process begins again.

On to Part 2 …

In the next blog, we will look at how the virus causes illness in the body once it has gained a reproductive foothold there. Contrary to what many think, the virus does not produce any toxin or such which causes illness and damage. The progression of Covid-19 is merely the virus reproducing and how our own body attempts to fight off the assault.

REMEMBER: ONLY WE CAN STOP THE SPREAD OF COVID-19. NOT THE GOVERNMENT OR DOCTORS.

JUST ALL OF US FOLLOWING THE GUIDELINES TO THE LETTER. ANYTHING SHORT OF THAT WILL CAUSE MORE PEOPLE TO DIE. SIMPLE MATH TELLS US EVENTUALLY IT WILL BE SOMEONE YOU KNOW AND CARE FOR!

Masks: Take Two

Just a quick update from my earlier blog, http://cajunwx.org/2020/03/24/masks-and-covid-19/, on the efficacy of using masks. There has been no change in the science relating to how masks protect from Covid-19. So why are we reading that the federal Coronavirus Task Force is likely to recommend everyone wear a cloth mask when outside the house?

The answer lies in two emerging threads of information gleaned from the outbreaks in Europe and the United States. First, with regards to the outbreak here in the US and Louisiana, it is unfortunate but many still put their personal desires above those of the community, including their own families, by violating the restrictions in place. Second, we know that most of those infected with Covid-19 will spread the virus unknowingly for up to five days before they become symptomatic. Add to this the fact that many, especially healthy young adults, may not have symptoms no worse than the common cold or flu and never feel a need to be tested, while all the while spreading the virus.

When you put all that together, we have a large number of people with Covid-19 on the streets spreading the virus wherever they go. If everyone were to wear cloth masks, then those who are infectious would not be able to as easily spread the virus. Cloth masks will contain the larger droplets emitted via coughs, sneezes, and even respiration. Viral particles will still get through, but it is believed these masks could provide an additional 5-percent protection against you getting the disease from someone who has it.

Put simply, the masks are to slow someone with the virus from spreading it, not protect a healthy person from getting it. But with the explosive growth of the virus and those who refuse to comply with restrictions, we should embrace any help we can get.

But let me be clear: DO NOT PURCHASE SURGICAL MASKS OR N95 RESPIRATORS! These are vitally needed by the valiant health care workers we are counting on to keep us alive when we get the Covid-19. Sew or buy a cloth mask and use it as directed, should that order come.

That’s it for now. Today’s blog on how the virus enters the lungs will be up later today.

Local Covid-19 Cases Soar

Just a short note today following the release of the daily Covid-19 numbers the Louisiana Department of Public Health. Louisiana cases soared over the past 24 hours to 5,237, an increase of 1,212 cases in 24 hours or right at 30% growth. There are now 22 cases in St. Mary Parish, an increase of 12 cases in 24 hours or a jump of 120%. Nearby parishes are seeing major jumps as well: Vermillion 167%, Iberia 89%, St. Martin 60%, Lafourche 45%, Lafayette 44%, Terrebbonne 18%, and Assumption 18%.

There were an additional 59 deaths in Louisiana, bringing the death toll to 239. That gives Louisiana a mortality rate of 5.9%. Worldwide, the mortality rate stands at 4.8%, while the United States is seeing its rate steadily climb. It was 1.0% last week, 1.2% yesterday and now stands at 1.5% as the first wave of cases across many states with newer outbreaks reaches the critical day 9-14 period where deaths emerge. Italy still leads the world with a mortality rate of 12.2% meaning that for every 100 cases, 12 people died, or better than 1 in 10.

It becomes clearer every day that Covid-19 is not just the flu. It is a killer for which we have no natural immunity nor a vaccine. Thankfully, some drugs are emerging that seem to at least moderate the symptoms in some victims. Much more research is needed and drugs like this are not the answer, just a better, more comfortable way to treat this disease.

Worst of all, Louisiana is not flattening the curve but rather amplifying it. As a community, we must take responsibility for not only our personal needs but our collective needs. Only by following the restrictions currently in place can we possibly avoid far stricter ones. Only when we social distance, practice meticulous hygiene, and avoid contact with others outside our immediate households can we flatten the curve and avoid the staggering death toll a runaway outbreak will bring.

I know many of you reading this are doing the right thing. But we need to start calling out those who don’t. This isn’t like normal vices where bad choices kill the user for the most part. Now it kills family members, neighbors, and even total strangers working desperately to protect their families.

STAY AT HOME! WASH YOUR HANDS! AND PLEASE STAY SAFE!

Soapbox

30-Mar NoonCasesDeaths
St Mary Parish100
Louisiana4,025180
United States148,0892,193
World755,59136,221

I have thus far used this platform to try and bring you information on the Covid-19 outbreak, the SARS CoV 2 virus which drives it, and the social and health implications of the worldwide pandemic. And I will continue to do so. But today, instead of facts and graphs, I want to just talk from the heart.

Any hope we had that this outbreak might not effect us in the United States or here in South Louisiana is now long past. A look at any of the world maps of the outbreak show that less than a dozen countries are reporting no cases thus far. And a number of them, we know are just unwilling to post case numbers. North Korea for instance.

But the bottom line is the Covid-19 is not a Chinese fight or an Italian fight, it is a fight which every country and region of the world is having to fight. Even the research bases in Antarctica have been impacted by the outbreak. It is also now obvious that this outbreak is not something which will pass soon. The president has extended the “Flatten the Curve” advisory form the initial 15 days to a full 45 days, now ending April 30, with the note that this may need to be extended.

The best science available seems to indicate it might take another 12-18 weeks, if we do things right to flatten the curve and help our health system not be completely outpaced by the disease. Even with this effort, US officials over the weekend indicated we will likely lose a minimum of 150,000 to 200,000 Americans before it is over, with numbers approaching 1 million not out of the question.

To those still writing on social media that this is really no worse than the flu: CDC numbers show a maximum of 30,000 will die from 30 million flu cases in America this season. Covid-19 will kill five times as many at a minimum with far fewer number of cases, if we do everything right and get lucky.

That means obeying the restrictions put in place by informed government leaders at the advice of the brightest medical minds we have. Thus far, those restrictions are largely being enforced by the will of reasonable adults. Unfortunately, many of those here in Louisiana and across the nation do not appear to have the ability to act as adults. They feel that their desires far outweigh the needs of the general public.

A perfect example comes right here in Louisiana. While the overwhelming majority of churches in this state have suspended services and closed the doors to protect their members and society as a whole, Rev Tony Spell feels his Life Tabernacle Church in Central City, about 15 miles north of Baton Rouge, is above the good of the population. As hospitals across the state and country begin to overflow with Covid-19 victims and bodies are loaded in refrigerated trucks because morgues are overflowing, Rev Spell continues to bus in people from five parishes to fill his seats.

I’m not sure what book Rev Spell teaches from but the Bible is pretty explicit about putting the needs of the many over the needs of the one. Millions of Christians across America are making sacrifices out of their belief that we must always put the needs of the many above our personal needs. Anyone believe Rev Spell is holding these services and not passing an offering basket? I sure don’t. This is the exploitation of the scared faithful for personal gain.

And this is not the first time it has happened in the Covid-19 pandemic. As of today, a total of 5,161 coronavirus (COVID-19) cases out of 9,961 total cases in South Korea, are directly tied to the Shincheonji Church in Daegu, accounting for about 52 percent of all infections. The now infamous “Patient 31” in South Korea was a member of this church, which also felt it was above the rules and more important than the rest of the population. Subsequent testing of the 200,000 members of the church have shown as many as 9,000 may be infected, with formal tests pending. The City of Daegu has since closed the church and filed suit against it to recoup the massive price tag their defiance cost the city and nation.

It should not have to come to that. We are talking about peoples’ lives. When I still see posts asking “Does anyone know anybody who actually has Covid-19?” I can’t believe the stupidity. Yes, I do know someone! Michelle and I have a family member who has had all of the symptoms and is merely awaiting confirmation of her Covid-19 test. She is not completely out of the woods but seems to be turning the corner after 10 days of illness. She describes her moderate version of the disease as being the worst she has felt in decades, if ever. Days of high fever, chills, body-wracking pain, constant coughing and awful headaches. But she is lucky. She avoided the hospital so far. Look at the numbers. In Louisiana, 29% of those positive for the Covid-19 virus have been hospitalized. Nearly one in three. Of those currently hospitalized, one in three require ventilator support to stay alive.

Those like Rev Spell who continue to defy the restrictions best enjoy their fun now. Because experience shows when the populace cannot act as adults and work for the common good, the government, law enforcement and the military can surely enforce those rules and even tighten them. If we end up locked in our homes unable to go out, as is life for many in northern Italy today, every one remember it is Rev Spell and others like him who put us there. Not the government or even the virus, but those who think they are better than the rest of us.

Stay safe and Stay Home. Regular, non-soapbox blogs continue tomorrow.