Seven Months Later, What We Know About Covid-19 (and Don’t)

Our president announced that New Zealand suffered a major surge of Covid-19 on Monday (“big surge in New Zealand, you know it’s terrible, we don’t want that”). They had nine new cases. The U.S. had 42,000. 

For somewhat more reliable information, see this informative summary from StatNews (the article has more about each item):

. . . In the time since Chinese scientists confirmed the rapidly spreading disease in Wuhan . . . an extraordinary amount has been learned about the virus, SARS-CoV-2, the disease it causes, Covid-19, and how they affect us.

Here are some of the things we have learned, and some of the pressing questions we still need answered.

What we know

Covid and kids: It’s complicated 

. . . Everything Covid is complex, and kids are no exception. While deaths among children and teens remain low, they are not invulnerable. And they probably contribute to transmission of SARS-CoV-2, though how much remains unclear. . . 

There are safer settings, and more dangerous settings

Research has coalesced on a few key points about what types of setting increase the risk that an infectious person will pass the virus to others. . . . 

People can test positive for a long time after they recover. It doesn’t matter 

There was a lot of angst a few months ago about some people who had seemingly recovered from Covid-19 infections continuing to test positive for the virus for weeks. Were they infectious? Should recommendations be changed for how long infected people should be isolated? It turns out it is an issue of testing. . . .

After the storm, there are often lingering effects 

Name a body part or system and Covid-19 has left its fingerprints there. . . . There are growing worries that these and other health effects will be long-lasting. . . .

‘Long-haulers’ don’t feel like they’ve recovered

We know they’re out there, but we don’t know how many, why their symptoms persist, and what happens next. . . . 

Vaccine development can be accelerated. A lot

An extraordinary amount of progress toward Covid-19 vaccines has been made, in record time. . . . 

People without symptoms can spread the virus

Whatever group you’re talking about, there are some key implications for the pandemic, and trying to rein it in. . . .

Mutations to the virus haven’t been consequential 

Coronaviruses in general do not mutate very quickly compared to other viral families. This is a good thing . . .  .

Viruses on surfaces probably aren’t the major transmission route

The general consensus now is that “fomites” — germs on surfaces — aren’t the major transmission route for Covid-19. . . .But it’s clear from lots of studies that surfaces around infected people can be contaminated with viruses and the viruses can linger. . . . 

What we don’t know

People seem to be protected from reinfection, but for how long? 

The thinking is that a case of Covid-19, like other infections, will confer some immunity against reinfection for some amount of time. But researchers won’t know exactly how long that protection lasts until people start getting Covid-19 again. So far, despite some anecdotal reports, scientists have not confirmed any repeat Covid-19 cases. . . .

What happens if or when people start having subsequent infections? 

Given that most respiratory viruses are not “one-and-done” infections — they don’t induce life-long immunity in the way a virus like measles does — there is a reasonable chance that people could have more than one infection with Covid-19. . . .

How much virus does it take to get infected? 

Whether you become infected or not when you encounter a pathogen isn’t just a question of whether you’re susceptible or immune. It depends on how much of the virus (or bacterium) you encounter. . . .

How many people have been infected?

There have been 21 million confirmed cases of Covid-19 around the world, and 5.3 million in the United States. Far more people than that have actually had the virus. . . .

It’s not clear why some people get really sick, and some don’t 

The sheer range of outcomes for people who get Covid-19 — from a truly asymptomatic case, to mild symptoms, to moderate disease leading to months-long complications, to death — has befuddled infectious disease researchers. . . .

Winter Is Coming. For Real This Time.

From Helen Branswell, a reporter for Stat who focuses on infectious disease:

The good news: The United States has a window of opportunity to beat back Covid-19 before things get much, much worse.

The bad news: That window is rapidly closing. And the country seems unwilling or unable to seize the moment.

Winter is coming. Winter means cold and flu season, which is all but sure to complicate the task of figuring out who is sick with Covid-19 and who is suffering from a less threatening respiratory tract infection. It also means that cherished outdoor freedoms that link us to pre-Covid life — pop-up restaurant patios, picnics in parks, trips to the beach — will soon be out of reach, at least in northern parts of the country.

Unless Americans use the dwindling weeks between now and the onset of “indoor weather” to tamp down transmission in the country, this winter could be Dickensianly bleak, public health experts warn.

“I think November, December, January, February are going to be tough months in this country without a vaccine,” said Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

It is possible, of course, that some vaccines could be approved by then, thanks to historically rapid scientific work. But there is little prospect that vast numbers of Americans will be vaccinated in time to forestall the grim winter Osterholm and others foresee.

Human coronaviruses, the distant cold-causing cousins of the virus that causes Covid-19, circulate year-round. Now is typically the low season for transmission. But in this summer of America’s failed Covid-19 response, the SARS-CoV-2 virus is widespread across the country, and pandemic-weary Americans seem more interested in resuming pre-Covid lifestyles than in suppressing the virus to the point where schools can be reopened, and stay open, and restaurants, movie theaters, and gyms can function with some restrictions.

“We should be aiming for no transmission before we open the schools and we put kids in harm’s way — kids and teachers and their caregivers. And so, if that means no gym, no movie theaters, so be it,” said Caroline Buckee, associate director of the Center for Communicable Disease Dynamics at Harvard . . .

“We seem to be choosing leisure activities now over children’s safety in a month’s time. And I cannot understand that tradeoff.”

While many countries managed to suppress spread of SARS-CoV-2, the United States has failed miserably. Countries in Europe and Asia are worrying about a second wave. Here, the first wave rages on, engulfing rural as well as urban parts of the country. Though there’s been a slight decline in cases in the past couple of weeks, more than 50,000 Americans a day are being diagnosed with Covid-19. And those are just the confirmed cases.

To put that in perspective, at this rate the U.S. is racking up more cases in a week than Britain has accumulated since the start of the pandemic.

Public health officials had hoped transmission of the virus would abate with the warm temperatures of summer and the tendency — heightened this year — of people to take their recreational activities outdoors. Experts do believe people are less likely to transmit the virus outside, especially if they are wearing face coverings and keeping a safe distance apart.

But in some places, people have been throwing Covid cautions to the wind, flouting public health orders in the process. Kristen Ehresmann [of the] Minnesota Department of Health, points to a large, three-day rodeo that was held recently in her state. Organizers knew they were supposed to limit the number of attendees to 250 but refused; thousands attended. In Sturgis, S.D., an estimated quarter of a million motorcyclists were expected to descend on the city this past weekend for an annual rally that spans 10 days.

Even on smaller scales, public health authorities know some people are letting down their guard. Others have never embraced the need to try to prevent spread of the virus. Ehresmann’s father was recently invited to visit some friends; he went, she said, but wore his mask, elbow bumping instead of shaking proffered hands. “And the people kind of acted like, … ‘Oh, you drank that Kool-Aid,’ rather than, ‘We all need to be doing this.’”

Ehresmann and others in public health are flummoxed by the phenomenon of people refusing to acknowledge the risk the virus poses. . . .

Epidemiologist Michael Mina despairs that an important chance to wrestle the virus under control is being lost, as Americans ignore the realities of the pandemic in favor of trying to resume pre-Covid life.

“We just continue to squander every bit of opportunity we get with this epidemic to get it under control,’’ said Mina, an assistant professor [at Harvard] and associate medical director . . . at Boston’s Brigham and Women’s Hospital.

“The best time to squash a pandemic is when the environmental characteristics slow transmission. It’s your one opportunity in the year, really, to leverage that extra assistance and get transmission under control,” he said, his frustration audible.

Driving back transmission would require people to continue to make sacrifices, to accept the fact that life post-Covid cannot proceed as normal, not while so many people remain vulnerable to the virus. Instead, people are giddily throwing off the shackles of coronavirus suppression efforts, seemingly convinced that a few weeks of sacrifice during the spring was a one-time solution. . . .

Osterholm said with the K-12 school year resuming in some parts of the country or set to start — along with universities — in a few weeks, transmission will take off and cases will start to climb again. He predicted the next peaks will “exceed by far the peak we have just experienced. Winter is only going to reinforce that. Indoor air,” he said.

Buckee thinks that if the country doesn’t alter the trajectory it is on, more shutdowns are inevitable. “I can’t see a way that we’re going to have restaurants and bars open in the winter, frankly. We’ll have resurgence. Everything will get shut down again.”

[Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases] favors . . . a strong messaging component aimed at explaining to people why driving down transmission now will pay off later. Young people in particular need to understand that even if they are less likely to die from Covid-19, statistically speaking, transmission among 20-somethings will eventually lead to infections among their parents and grandparents, where the risk of severe infections and fatal outcomes is higher. (Young people can also develop long-term health problems as a result of the virus.)

“It’s not them alone in a vacuum,” Fauci said. “They are spreading it to the people who are going to wind up in the hospital.”

Everyone has to work together to get cases down to more manageable levels, if the country hopes to avoid “a disastrous winter,” he said.

“I think we can get it under much better control, between now and the mid-to-late fall when we get influenza or we get whatever it is we get in the fall and the winter. I’m not giving up,” said Fauci.

But without an all-in effort “the cases are not going to come down,” he warned. “They’re not. They’re just not.”

How It Beat Us

If you want a deep analysis of how this country screwed up its response to Covid-19 and what we need to do better next time, read this long article by Ed Yong for The Atlantic Monthly. It’s been recommended by intelligent people. I don’t intend to read the whole thing. The first 700 words were enough (by the way, Dr. Fauci says we need to get new cases down to 10,000 a day from the current 50 or 60 thousand or else the fall is going to be very bad):

America has failed to protect its people, leaving them with illness and financial ruin. It has lost its status as a global leader. It has careened between inaction and ineptitude. The breadth and magnitude of its errors are difficult, in the moment, to truly fathom.

In the first half of 2020, SARS CoV 2—the new coronavirus behind the disease COVID 19—infected 10 million people around the world and killed about half a million. But few countries have been as severely hit as the United States, which has just 4 percent of the world’s population but a quarter of its confirmed COVID 19 cases and deaths. These numbers are estimates. The actual toll, though undoubtedly higher, is unknown, because the richest country in the world still lacks sufficient testing to accurately count its sick citizens.

Despite ample warning, the U.S. squandered every possible opportunity to control the coronavirus. And despite its considerable advantages—immense resources, biomedical might, scientific expertise—it floundered. While countries as different as South Korea, Thailand, Iceland, Slovakia, and Australia acted decisively to bend the curve of infections downward, the U.S. achieved merely a plateau in the spring, which changed to an appalling upward slope in the summer. “The U.S. fundamentally failed in ways that were worse than I ever could have imagined,” Julia Marcus, an infectious-disease epidemiologist at Harvard Medical School, told me.

Since the pandemic began, I have spoken with more than 100 experts in a variety of fields. I’ve learned that almost everything that went wrong with America’s response to the pandemic was predictable and preventable.

A sluggish response by a government denuded of expertise allowed the coronavirus to gain a foothold. Chronic underfunding of public health neutered the nation’s ability to prevent the pathogen’s spread. A bloated, inefficient health-care system left hospitals ill-prepared for the ensuing wave of sickness. Racist policies that have endured since the days of colonization and slavery left Indigenous and Black Americans especially vulnerable to COVID 19. The decades-long process of shredding the nation’s social safety net forced millions of essential workers in low-paying jobs to risk their life for their livelihood. The same social-media platforms that sowed partisanship and misinformation during the 2014 Ebola outbreak in Africa and the 2016 U.S. election became vectors for conspiracy theories during the 2020 pandemic.

The U.S. has little excuse for its inattention. In recent decades, epidemics of SARS, MERS, Ebola, H1N1 flu, Zika, and monkeypox showed the havoc that new and reemergent pathogens could wreak. Health experts, business leaders, and even middle schoolers ran simulated exercises to game out the spread of new diseases. . . . [They showed that] the U.S. was not ready for a pandemic, [sounding] warnings about the fragility of the nation’s health-care system and the slow process of creating a vaccine. But the COVID 19 debacle has also touched—and implicated—nearly every other facet of American society: its shortsighted leadership, its disregard for expertise, its racial inequities, its social-media culture, and its fealty to a dangerous strain of individualism.

SARS CoV 2 is something of an anti-Goldilocks virus: just bad enough in every way. Its symptoms can be severe enough to kill millions but are often mild enough to allow infections to move undetected through a population. It spreads quickly enough to overload hospitals, but slowly enough that statistics don’t spike until too late. These traits made the virus harder to control, but they also softened the pandemic’s punch. SARS CoV 2 is neither as lethal as some other coronaviruses, such as SARS and MERS, nor as contagious as measles. Deadlier pathogens almost certainly exist. Wild animals harbor an estimated 40,000 unknown viruses, a quarter of which could potentially jump into humans. How will the U.S. fare when “we can’t even deal with a starter pandemic?,” Zeynep Tufekci, a sociologist at the University of North Carolina . . . asked me.

Despite its epochal effects, COVID 19 is merely a harbinger of worse plagues to come. The U.S. cannot prepare for these inevitable crises if it returns to normal, as many of its people ache to do. Normal led to this. Normal was a world ever more prone to a pandemic but ever less ready for one. To avert another catastrophe, the U.S. needs to grapple with all the ways normal failed us. It needs a full accounting of every recent misstep and foundational sin, every unattended weakness and unheeded warning, every festering wound and reopened scar.

“Mild” Is Sometimes Damn Bad

Mildness is relative. From The Guardian:

Conventional wisdom suggests that when a sickness is mild, it’s not too much to worry about. But if you’re taking comfort in World Health Organization reports that over 80% of global Covid-19 cases are mild or asymptomatic, think again. As virologists race to understand the biomechanics of Sars-CoV-2, one thing is becoming increasingly clear: even “mild” cases can be more complicated, dangerous and harder to shake than many first thought.

Throughout the pandemic, a notion has persevered that people who have “mild” cases of Covid-19 and do not require an ICU stay or the use of a ventilator are spared from serious health repercussions. Just last week, . . . the US vice-president claimed it’s “a good thing” that nearly half of the new Covid-19 cases surging in 16 states are young Americans, who are at less risk of becoming severely ill than their older counterparts. This kind of rhetoric would lead you to believe that the ordeal of “mildly infected” patients ends within two weeks of becoming ill, at which point they recover and everything goes back to normal.

While that may be the case for some people who get Covid-19, emerging medical research as well as anecdotal evidence from recovery support groups suggest that many survivors of “mild” Covid-19 are not so lucky. They experience lasting side-effects, and doctors are still trying to understand the ramifications.

Some of these side effects can be fatal. Otherwise healthy people who thought they had recovered from coronavirus are reporting persistent and strange symptoms – including strokes.

According to Dr Christopher Kellner, a professor of neurosurgery at Mount Sinai hospital in New York, “mild” cases of Covid-19 in which the patient was not hospitalized for the virus have been linked to blood clotting and severe strokes in people as young as 30. In May, Kellner told Healthline that Mount Sinai had implemented a plan to give anticoagulant drugs to people with Covid-19 to prevent the strokes they were seeing in “younger patients with no or mild symptoms”.

Doctors now know that Covid-19 not only affects the lungs and blood, but kidneys, liver and brain – the last potentially resulting in chronic fatigue and depression, among other symptoms. Although the virus is not yet old enough for long-term effects on those organs to be well understood, they may manifest regardless of whether a patient ever required hospitalization, hindering their recovery process.

Another troubling phenomenon now coming into focus is that of “long-haul” Covid-19 sufferers – people whose experience of the illness has lasted months. For a Dutch report published earlier this month (an excerpt is translated here) researchers surveyed 1,622 Covid-19 patients with an average age of 53, who reported a number of enduring symptoms, including intense fatigue (88%) persistent shortness of breath (75%) and chest pressure (45%). Ninety-one per cent of the patients weren’t hospitalized, suggesting they suffered these side-effects despite their cases of Covid-19 qualifying as “mild”. While 85% of the surveyed patients considered themselves generally healthy before having Covid-19, only 6% still did so one month or more after getting the virus. . . .

“To me, and I think most people, the definition of ‘mild’, passed down from the WHO and other authorities, meant any case that didn’t require hospitalization at all, that anyone who wasn’t hospitalized was just going to have a small cold and could take care of it at home,” [said ] Hannah Davis, the author of a patient-led survey. “From my point of view, this has been a really harmful narrative and absolutely has misinformed the public. . . .

At this stage, when medical professionals and the public alike are learning about Covid-19 as the pandemic unfolds, it’s important to keep in mind how little we truly know about this vastly complicated [and highly contagious] disease . . . .

Unquote.

Broadway actor Nick Cordero, 41, died yesterday after 90 days in the hospital. According to The Guardian, “Cordero entered the emergency room on 30 March and had a succession of health setbacks including mini-strokes, blood clots, sepsis infections, a tracheostomy and a temporary pacemaker implant. He had been on a ventilator and unconscious and had his right leg amputated. A double lung transplant was being explored”.

But remember, he said we’re getting it under control.

“To reduce the incidence or severity of, especially to innocuous levels”

“We have it totally under control,” President Txxxx said in late January. A month later: “The coronavirus is very much under control in the USA”. . . .

The virus is “getting under control,” he said Wednesday.

As reported tonight by The Washington Post, The New York Times and The Los Angeles Times:

The seven-day average for daily new cases in the United States reached a record high — 49,600 — for the 27th straight day.

Thirteen states reported new highs in their seven-day averages. South Carolina, Texas, Arizona, Nevada and California reported record numbers of current Covid-19 hospitalizations.

After Texas reported another single-day record for new cases over the weekend, Austin Mayor Steve Adler said there won’t be enough medical personnel to keep up with the spike in cases if the rate of increase continued unabated in his city. Intensive care units in the city could be overflowing within 10 days. He currently lacks the authority to impose a shelter-in-place order for the city.

Houston Mayor Sylvester Turner said hospitals in his city face staffing shortages as demand for ICU beds is increasing exponentially. Demand for testing has also outstripped the city’s capacity, he said, and the positivity rate has soared from 10 percent a month ago to 25 percent recently.

Mayor Kate Gallego of Phoenix said that with cases and death counts soaring in Arizona, testing sites in her city and surrounding Maricopa County are overwhelmed, but the Federal Emergency Management Agency has rebuffed her pleas for help. More than 20 percent of tests in Arizona are coming back positive now, Gallego said. “Public health officials tell me that when you’re doing the appropriate amount of testing, it should be around 2 percent,” she said.

Gallego said federal officials had dismissed her requests to conduct community-based testing in the area after people reported waiting in line for six hours at some testing sites. “We were told they’re moving away from that,” she said, “which feels like they are declaring victory while we’re still in crisis mode”. An aide to the mayor said that FEMA had responded to the city’s most recent request by saying the agency was “getting out of the testing business”.

In Florida, new cases exceeded 10,000 in a day on Sunday for the third time in the past week, after the state posted a record high of 11,400 the previous day. The new infections pushed the state’s total caseload past 200,000, a mark passed by just two other states, New York and California.

Miami Mayor Francis X. Suarez said it was “clear that the growth is exponential at this point. . . It’s extremely worrisome”, noting that positivity rates in Miami-Dade County — the share of tests that come back positive — were also now above 20 percent.

Los Angeles County officials reported more than 3,000 cases for Friday — the highest daily total since the pandemic began. The number of hospital patients with confirmed coronavirus infections jumped 41% in the last three weeks. As of Saturday, there were 1,900 people hospitalized in L.A. County with confirmed cases; 28% of those people were in the ICU and 18% were on ventilators. Officials warned last week about “alarming increases in positivity rates and hospitalizations” and projected the possibility of running out of hospital beds in two to three weeks.

The country’s seven-day average of new deaths did fall, but health experts cautioned that the count of infections would soon drive the number back up.

In addition, the death rate does not capture all of the harm caused by the disease. As many as 15 to 20 percent of known Covid-19 patients may require hospitalization, and of the group admitted, 15 to 20 percent are transferred into intensive care, according to some estimates. Many who have recovered are still struggling to regain their pre-disease lives, and may face long-term health issues.

“The virus is getting under control”, he said.