Covid-19 Trajectory

28-Mar NoonCasesDeaths
St. Mary Parish70
Louisiana3,315187
United States105,5731,695
World622,45028,794
Italy86,4989,134

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.

https://informationisbeautiful.net/visualizations/covid-19-coronavirus-infographic-datapack/
From: informationisbeautiful.com

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.

For now, Stay Safe and Stay Home.

Goodbye 59

Noon 26-MarchCasesDeathsParishes
St Mary Parish50
Louisiana2,3058353 of 64
United States69,684994
World495,98622,295
Italy74,3867,503

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!

Masks and Covid-19

Noon 24-MarchCasesDeathsParishes
St. Mary Parish20
Louisiana1,3884643 of 64
United States45,786544
World407,48518,227
Italy69,1766,820

MASKS

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.

What is it Like to Have Covid-19?

10 AM 22-MarCasesDeathsParishes
St Mary Parish10
Louisiana8372036
United States30,491390
World328,27514,366
Italy46,6385,476

UPDATE: AT 2 PM GOVERNOR EDWARDS ANNOUNCED A STAY HOME AND SHELTER IN PLACE ORDER FOR THE ENTIRE STATE BEGINNING AT 5 PM MONDAY, MARCH 23, IN AN EFFORT TO SLOW THE NUMBER OF COVID-19 CASES IN LOUISIANA. WE NOW LEAD THE WORLD IN THE GROWTH OF CASES. THIS IS NOT A TIME WE WANT TO BE NUMBER 1!!

I have concentrated in past on the virus itself and how it is spreading. Today I will look at the course of the disease itself. Before I start describing the evolution of the disease process, it needs to be understood that not everyone has the severe course we will discuss. In fact, as previously noted, some will not even know they have anything other than a mild cold or allergies. That said, no matter how dangerous the severity of the course of the disease, the person infected can spread the disease to anyone they come in contact with.

Most of those infected will either have been within 6-9 feet of someone infected or come in contact with virus particles on a surface. The virus particles make their way to the nose, mouth, and/or nose of the victim and are further transferred into the body and lungs via respiration and swallowing. Once in the body, the virus seeks out cells with ACE2 receptors. Then like a lock and key, the spike protein on the SARS CoV 2 virus attaches perfectly with an ACE2 receptor, allowing the strand of RNA in the virus to hijack the cell and begin reproducing more virus particles.

By the third day post contact, the virus is reproducing in such quantities that the body begins to shed thousands of virus particles with each breath. It is likely that saliva, tears, and possibly other bodily secretions also contain the virus. As the virus spreads throughout the body, the immune system senses an invasion by an outside organism and begins to mount an immune response. The myriad of antibodies in our body begin to see which ones might be able to attack the virus. Once antibodies begin to attach to the virus particles, the body begins to produce more of those specific antibodies. Within a few days, these antibodies can be detected in the body.

As the body cranks up its immune response, we begin to see the body try and fight off the virus. This is Day 1 of the illness. The body acts by raising the its temperature, fever, and trying to get rid of the invader by coughing. So the early symptoms are a dry cough, fever, headache, body aches, and fatigue, similar to when you have the seasonal flu. In about 80 % of cases, symptoms will get only slightly worse than the seasonal flu.

But in those cases involving elderly patients and those with other aggravating illnesses and compromised immune systems, things continue to worsen. Those 20% or so remaining victims will likely require hospitalization for their symptoms and distress. This normally occurs on about Day 7. The lungs are the primary target of the Covid-19 virus and as the virus works down the respiratory tract, we see the symptoms to evolve into case similar to bronchitis and eventually pneumonia.

Our lungs are made up of tiny air sacs known as alveoli. As the immune response battle moves to the lungs, the dry cough becomes a moist one. The alveoli come under attack by the virus and the virus is attacked by the immune system. This leads to an increase in secretions in the lungs and a thickening or swelling of the lining of the alveolar sacs, all of which leads to a build up of secretions in sections of the lungs, which causes a decrease in the capacity to process oxygen. Shortness of breath and a wet cough enter the symptom mix.

With less oxygen entering the system, organs such as the liver, kidneys and brain begin to work less efficiently and even fail. As more fluids build up in the lungs, consolidation, the blocking of entire sections of the lung by secretions, leads to expanding pneumonia. Things happen quicker now and by Day 8 a small percentage, about 5-7%, will develop acute respiratory distress syndrome (ARDS). They require intensive care and ventilator support to deliver more oxygen to the body.

Should the lungs be damaged too much, we see organ failure and death. This is the end game for those faced with serious ARDS cases of the Covid-19 virus. Unlike cases of pneumonia caused by bacteria, there are no antibiotics which can fight the Covid-19 virus. Antibiotics may be used to prevent bacterial pneumonia from forming as well but will have no impact on the virus itself. By Day 11 or 12, those with serious ARDS will normally succumb to the illness.

Those who survive past day 12 and go on to survive the illness will normally be feeling better by Day 17 and those hospitalized in the ICU are normally released after a little over two weeks. They will now have a natural immunity to the virus. We do not know how long this immunity lasts, but history tells us we should be good for a year or so, Hopefully long enough to see a vaccine enter the picture.

As always, Stay Home, and Stay Safe. Follow the instructions of federal, state and local officials. It will save lives!

St Mary Reports First Covid-19 Case

In its 5:30 PM update, the Louisiana Department of Public Health added St Mary Parish to the growing list of parishes with confirmed Covid-19 cases. There are now 763 cases in 35 parishes and 16 dead in Louisiana. More in tomorrow’s blog.

Stay Safe!