COVID-19 Update: New Data & Analysis from the CDC and VDH
Dr. Steven Bishop was back for another interactive Facebook Live event on Wednesday, May 27, to provide another weekly update on COVID-19.
CDC Data & Analysis
CDC published updated scenarios based on nationwide data that includes some encouraging news. "Scenario 5" has been identified by the CDC as the most probable scenario. Within this scenario, the fatality rate for COVID-19 is about 0.4%. This is still 3 to 4 times higher than a typical flu season, but much better than had originally been anticipated at less than 1%.
The 0.4% fatality rate is aggregate of everyone who tested positive for the coronavirus, including both young people who are less likely to die and older people much more likely to die from COVID-19. The CDC data confirms that the older an individual is, the more likely they are to get sick and die from COVID-19. Most of the fatalities are the elderly, and especially in nursing home environments.
The data also indicate that about 35 to 50% of people who contract COVID-19 have mild to no symptoms. This speaks to the ability of individuals to spread the disease simply because they are not aware that they have it and are contagious. This information leads into the mask controversy. Politics and legal issues aside, from a medical perspective, wearing a mask will reduce the likelihood of transmission. PartnerMD therefore recommends the use of a mask in public and in groups.
VDH Data & Analysis
VDH update their site with a new dashboard for Covid information. The 7-day moving average that gives us a good perspective on what's happening with respect to time. We appear to have plateaued, which might look bad, but this is actually a good sign as we test more and more people.
The testing tab of the dashboard shows that Virginia is testing very large numbers of people. The number of positive results will continue to climb as we test more people who have had Covid but did not get sick or die. For example, some hospitals requiring people to get tested for elective and other procedures even if they are not actively sick. So, any positive test results from this type of scenario will add to the overall positive count.
Looking at the hospitalizations and deaths tabs, the data show those numbers are coming down quite a bit. It seems that even though cases are steady in Virginia, we are testing more people and hospitalization rates are coming down.
The positive test rate was recently at 14.7% and is now 13.9%. This is also a good sign of things moving in the right direction. The dashboard allows you to toggle between PCR test and antibody tests. Virginia tested 300,000 individuals with both tests, and if we include all those numbers, the infection rate is only 12%.
Read the Q&A recap below and watch the video for more detail.
Do fabric masks provide enough protection vs. surgical masks? Mask materials do matter. Surgical masks are better at preventing transmissions. That said, fabric masks are still fine and better than nothing at all. PPE is still hard to come by, so it's better to let the healthcare workers have access to these masks. If you do have surgical masks, want to use them, or are high risk, it's certainly ok to use these instead of fabric masks.
Is a "second round" likely in the fall? This is something we are concerned about. We will see a surge of respiratory illness in the fall as we do every year. Covid will likely also increase at this time because it is also a respiratory disease. We hope this doesn't happen, but we are planning for it. Going forward a surge in Covid cases may be something we see every year as winter approaches.
Is it possible for case to decline so much in the summer as to impair testing for the vaccine? Are there plans to test in other areas of the world where the number of cases is higher? We don't have a clear answer. We will probably still be able to conduct trials, but it depends on how quickly we can get to phases 2 and 3 of the trials. It is possible that testing may be conducted in other parts of the world. Vaccine trials in the U.S. will likely coincide with a fall resurgence, which will make it a very good time for those tests, but we have to wait and see. We could very well have a viable vaccine candidate that still needs more testing by the end of the year.
There is a lot of conflicting information regarding transmission outdoors, by children to adults, and from asymptomatic individuals. Are there any documented cases, within the U.S., of any of these forms of transmission? The short answer is no. Much of this is still conjecture, without a lot of documentation, and based on what we know about viruses and virus patterns.
It stands to reason that transmission will be lower outdoors than indoors, especially if there is distance between people. Like any infection, you need a certain rate of exposure to be infected. Being outside reduces the opportunity.
Adult to child infection also still has no good data and is mostly conjecture. Most likely an asymptomatic person in their household was the source, though, there is clear documentation on chain of infection for asymptomatic people.
Even if a vaccine is available, how long would you anticipate it being available to the general public? We don't know, but 12 to 18 months is a safe guess. Again, we are hoping to have a good candidate by end of year. Development of a vaccine in 18 months would still be incredibly fast. It's important to remember that there are two sides to the coin. We want a vaccine quickly, but we need to make sure it's safe. This is a totally new form of vaccination and introducing that to a large population. It is very likely to be safe, but we don't know yet.
I’ve seen media reports that asthma is not a significant risk factor after all. What does the medical evidence suggest about this? I think that's true. We had thought that it was true because of the effect of asthma on other diseases, but for well-controlled asthma, that does not seem to be the case. T biggest risk factors are: body weight, age, diabetes, hypertension, and metbaolic disease. Someone with asthma is likely more at risk than someone without asthma, but that's my best guess as a medical professional.
Is celiac disease a significant underlying condition for this virus? Celiac is probably not putting you at higher risk. In fact, people with Celiac tend to be healthier eaters, and may be lower risk as long as they are at a healthy weight. But, it may be safe to say that anoyone with any medical condition is more at risk than someone with none.
Do autoimmune disorders render people more susceptible to cytokine storms? I don't know that we know the answer to that either way. It partly depends on the type of auto-immune disorder. They are all so different and affect your body in different ways. There's no good data at this time showing that people with auto immune disorders are more susceptible to cytokine storms.
What are you thoughts on neighborhood pools opening? Most pools are going to follow the governor's guidelines closely and limit the number of people at the pools. This is wise until we see the number of hospitalizations go down. We need to balance getting back to normal with being cautious.
I’m seeing. Facebook advertisements for 3M N95 masks. Are these now sufficiently available that they should no longer be reserved for medical providers? Although the supply chain is much better, I would encourage you to investigate if these ads are real. PartnerMD is still having trouble getting medical equipment, so be cautious that these masks are what they claim to be. If it is real and you feel like you need it for your protection, you can wear them, but beware of scams. Most of the legitimate supplies have the taken by the medical field and government.
Do you think that people that are otherwise healthy and take no daily meditations other than for seasonal allergies or seasonal asthma are at a higher risk than those that do not have asthma during this time? Seasonal allergies and asthma are at higher risk than someone without these. Are they are much higher risk? No.
Can I have a party, of fewer than 10 people, outside? You're allowed to, but consider the risk in having any kind of gathering. If everyone is feeling well, not sick, and not high risk, the risk is low. Just be cautious and expand your social circle carefully.