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!
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.
As of midday today, 21 states have ordered residents to stay at home and the president is considering quarantining sections of the northeast hardest hit by the Covid-19 outbreak. All the while, the Covid-19 curve continues its steep climb. Today we will look at a number of graphs showing the current rate Covid-19 case growth.
Here we see the rate at which cases are doubling in a number of countries worldwide. The United States is doubling cases at just over every two days, while Italy, about three weeks ahead of us in the outbreak, is finally seeing cases double ONLY every three days. South Korea has best managed to flatten the curve thus far.
How did they do it? They tested a large cross-section of the population, tracked down anyone an infected person had been in contact with, and finally took the infected and placed them together with no visitation even by family until the disease had passed. In the US, that means testing a representative cross-section of 320 million rather than a mere 50 million in South Korea. It means having enough personnel to track down every contact of those infected, even as the number doubles every two days. Finally, most of us will likely not be too happy to see our parents, grandparents, children or siblings carted off because they are infected and warehoused without contact until they are no longer a threat.
As for what the growth of cases looks like in Louisiana and other key states, check out the graphs below:
It is pretty obvious that case growth in these states continues to rise exponentially. Hopefully in coming weeks we will begin to see the slopes on these graphs begin to flatten and growth slow thanks to the shelter in place orders. But we are the ones controlling that and things do not look good so far. The more we avoid contact and self isolate, the faster we will see a flattening of these curves. If that does not happen, many areas, including some in our state, will begin to see their health care systems overloaded and unable to meet growing demand.
When the clock strikes midnight, I will reach the milestone of 60 years old. While many see this as a sign of aging or life getting shorter, I don’t think that way. Rather, I am glad God has let me walk this planet for 60 years. I am happy to be in love with the most caring and wonderful woman on Earth; belong to a close-knit, loving family; enjoying coaching young men and women; and mostly just happy to be where I am and with those with I love and care for.
All that said, as the clock strikes midnight, my chances of dying from the coronavirus double. Sure it is just a statistic, a probability. But is is based upon fact. As someone 50-59 years of age, I have a 2% chance of dying from the Covid-19. But once I reach 60, my chances of succumbing to the disease climb to 4%, effectively doubling the odds. Those 70-79 have a mortality rate of 6% and those 80 and up close to 9%.
They aren’t just numbers. They are the reality of what is happening across the world. Currently, the mortality rate for Covid-19 is 4.5% worldwide. The US numbers are lower, though likely due to the infancy of the outbreaks in may states. The mortality rate in Louisiana currently is running at 3.6%. It trails places like Washington and New York because they are a week or two ahead of us in the outbreak, while leading those states whose outbreaks are a week or two behind ours. The scariest numbers come out of Italy, where the outbreak is about three weeks ahead of the US and the mortality rate stands at 10.1%.
Covid-19 is a killer and it is far from the selective killer once thought. Those in much younger demographics are dying as the outbreak spools up in America. They are dying in much lower numbers than those say 60 and older, but dying nonetheless. Covid-19 virus has one driving imperative, to reproduce. And it will kill whatever cells or organisms that gets in its way if it can.
We are now seeing growing evidence why the 60+ age groups are more often in the cross hairs. It has to do with the prime receptor the virus binds to in the human body, the ACE2 receptor. As I have noted before, ACE2 stands for the “angiotensin converting enzyme” which works with a process known as the renin-angiotensin system to regulate blood pressure, blood volume and the natural elimination of bodily fluids.
Because of the strong correlation between high blood pressure and cardiovascular disease, many of those 60 and older are on drugs known as ACE2 inhibitors. There is some evidence, though it is not yet conclusive, that ACE2 inhibitors might increase the number of ACE2 receptors open to the SARS CoV 2 virus. If this is true, it would mean that many in this demographic have bodies more easily attacked by the virus.
However, many doctors are cautioning that this is likely only a minor contributing factor. Rather, it is the damage caused by heart disease, lung disease, and kidney disease, along with what these disease processes do to the immune system, that is largely responsible for the higher mortality rates. And no one should stop taking prescribed ACE2 inhibitor medications. If these drugs are controlling your disease well and allowing for a healthier lifestyle, that is surely more important than what the meds might do.
Regardless, less than 10 hours from now my mortality rate from Covid-19 will double. I will spend much more time tomorrow thanking God for the wonderful life he has given me and spending time talking with family and friends locally than I will worrying about the jump. Things like case growth rates and mortality rates are just another part of our new normal.
Life does go on and for that I am thankful. Stay safe and Stay Home!
As the Covid-19 outbreak grows exponentially across the globe and particularly in the United States, there has been a run on medical masks of all types. This has created an acute shortage of masks for those in most in need of them, the doctors, nurses and emergency response personnel on the front line of the fight against this growing killer. All the while, masks which would be a big help in hospital settings are being used by average citizens who falsely believe they provide them with an adequate level of protection. To discuss masks, we must first look at the three major types of masks available: respirators, manufactured surgical masks, and mostly homemade cloth masks. All of these have their place and uses, as we will see. However, those uses may not be applicable to the Covid-19 outbreak and SARS CoV 2 virus which causes it.
RESPIRATORS
Respirators are tightly fitting masks specifically designed to filter out the overwhelming majority of airborne particles. The most common respirator one will come across today is the N95 respirator. They are tight-fitting masks that filter out at least 95% of small and large airborne particles, according to the CDC. They are recommended for use by health care workers in the treatment of the coronavirus. However, even when properly fitted, an N95 mask “does not completely eliminate the risk of illness or death,” according to the Us Food and Drug Administration.
The N95 respirator is designed to filter out 95% of particles which are 300 nanometers (nm) in size or larger. This makes them effective against most airborne pathogens but not all. In fact, they are slightly less efficient against SARS CoV 2 as the average size of viral particles is only 100 nm. Thus a single SARS CoV 2 virus could race right through an N95 respirator.
Thankfully, the infected human body puts out thousands of these particles, many of them attach to mucous or water molecules in coughs and sneezes. The latter virus particles, attached to say mucous or even a water molecules, are much then too big to pass through N95 pores.
While free floating virus particles may be smaller than the pores of the mask, thankfully there are so many of them that they clog pores when more than two try to enter. Think of this analogy: one teenage boy can easily fit through a standard doorway, but if three of them try to get through at the same time, it just does not work. So, in this case, we use the massive reproduction of the SARS CoV 2 against itself.
All that said, it is not a complete solution. By their very nature, N95 respirators only block 95% of those particles 300 nm and larger. On average 5% get through. The small size of SARS CoV 2 likely bumps that percentage up even more. This also assumes the respirator is properly fitted and applied. This is not always that easy.
“Achieving an adequate seal to the face is essential,” according to the CDC. “United States regulations require that workers undergo an annual fit test and conduct a user seal check each time the respirator is used. Workers must pass a fit test to confirm a proper seal before using a respirator in the workplace. When properly fitted and worn, minimal leakage occurs around edges of the respirator when the user inhales.” This makes N95 respirators very uncomfortable to wear and dangerous for those with various health conditions, including those who are pregnant, due to the reduction in air flow. Nor can they be effectively used by those with facial hair.
N95 respirators are also supposed to be single use masks for health care workers, but with the acute shortage of this vital protective device worldwide, many health care workers are being asked to save their N95s and reuse them. This also decreases efficiency. In addition, it becomes more difficult to assure good face seals with repeated use. Finally, the continued use of N95 respirators by health care workers can cause skin breakdown along the seal area from the constant pressure of the mask.
CDC Graphics compares N95 respirators and Surgical Masks
SURGICAL MASKS
“A surgical mask is a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment,” according to the CDC. “Surgical masks are regulated under 21 CFR 878.4040. Surgical masks are not to be shared and may be labeled as surgical, isolation, dental, or medical procedure masks. They may come with or without a face shield. These are often referred to as face masks, although not all face masks are regulated as surgical masks.”
These are the masks used by dentists, doctors and nurses in normal daily activities. They are also the same as most such masks sold at drug stores and such. Some face masks may not be designed to the statute noted above and thus are not labeled as “surgical masks.” However, for our purposes, we will treat all these the same as their protective qualities are quite similar.
Where an N95 respirator can stop particles down to 300 nm in size, surgical masks are designed to stop particles down to 5000 nm in size. We go from three virus particle-width pores to 50 particle-width pores. This size of opening is not even completely effective against larger, virus laden, mucous particles in coughs and sneezes. This is because surgical masks are not designed to stop such small particles.
“If worn properly, a surgical mask is meant to help block large-particle droplets, splashes, sprays, or splatter that may contain germs (viruses and bacteria), keeping it from reaching your mouth and nose,” according to the CDC. “Surgical masks may also help reduce exposure of your saliva and respiratory secretions to others.”
They are designed to protect the health care workers from fluids that may be splashed or projected towards them in procedures. They also help prevent coughs or sneezes from transmitting as many particles from the health care worker reaching the patient. They are not designed to protect the health care worker from whatever disease the patient has. That job goes to the N95 respirators.
Finally, surgical masks are not fit to the person’s face. By their very design, they allow air flow around the mask. Thus, virus laden air flow can just travel right around the sides and infect the wearer. This makes them very ineffective against Covid-19.
CLOTH MASKS
The last form of masks are cloth masks being sewn across the country by those trying to help health care workers face growing shortages. For the most part, anything written about surgical masks applies to cloth masks as well. They are not adequate replacements for N95 respirators, nor truly as effective as surgical masks. A study published in The Annals of Occupational Hygiene showed that up to 70% of infective particles were able to penetrate average cloth masks. It must also be remembered that efficacy is based upon the type of cloth used, the number of layers and other factors. In general, though, hand-sewn cloth masks should not be considered as effective as surgical masks and are nowhere near the effective nature of N95 respirators.
That said, the sewing of such masks for use by health care workers is highly encouraged. Any protection is better than no protection at all, which is what many health care workers will soon be facing. These efforts are admirable and health care workers across the country are applauding the assistance.
CONCLUSION
The only masks which offer any true protection against the SARS CoV 2 virus are N95 respirators. The CDC does not recommend the use of N95 respirators outside of hospitals and other medical workplace settings. This scarce resource is essential to protecting health care workers on the front lone of the Covid-19 outbreak. Using them anywhere else puts a health care worker in danger and potentially reduces the health care workforce which you may need if or when you get Covid-19.
“Most often, spread of respiratory viruses from person-to-person happens among close contacts (within 6 feet),” notes the CDC. Rather, all of us should use everyday preventive actions to prevent the spread of Covid-19, such as avoiding people who are sick, avoiding touching your eyes or nose, and covering your cough or sneeze with a tissue or your elbow. People who are sick should stay home and not go into crowded public places or visit people in hospitals.
Simply washing your hands as often as possible and social distancing are far more effective means of preventing the spread of, or acquiring, Covid-19 than any use of face masks, even N95 respirators.
