Thursday, March 26, 2020

Bright spot seen in Italian trend

New York's infection rate nosedives

The rate of new infections in New York State has taken a sudden plunge after New York Gov. Andrew Cuomo issued an emergency decree imposing social distancing restrictions statewide.

Nicole B. Saphier, MD, a radiologist who has been giving broadcast advice on the Covid-19 epidemic, says that numbers released by health officials show that between Sunday and Tuesday, the rate of infection declined rapidly. On Sunday, the day of Cuomo's freeze-in-place order, the number of people testing positive was doubling every two days. On Monday, the doubling was slowed to an average of 3.4 days and by Tuesday night infections were taking an average of 4.7 days to double.

Saphier said that though the caseload is still accelerating -- as shown by 13 deaths in a 24-hour span at a New York City hospital packed with Covid-19 patients -- "we may be reaching an equilibrium sooner than we think."

Saphier, who works for Memorial Sloan-Kettering cancer centers in New York and New Jersey, called these numbers "very encouraging."

The doctor said the rest of the country is "a few days behind New York," but that if Americans maintain social distancing, the national rate should also begin to plateau. Yet, when a rate of climb slows, the numbers still climb -- as when a decelerating car continues to move forward for a while before reaching a stopping point.

Cuomo said yesterday that new evidence suggests social distancing is slowing down the virus, with the rate of hospitalizations slowing every day this week. But, he said, New Yorkers were "still on our way up the mountain."

Cuomo's "New York State on PAUSE" order limits outdoor activity to the essentials, like grocery shopping and getting medication, and requires New Yorkers to cancel all non-essential gatherings and stay at least six feet away from others when out in public.

Remarkably, the New York figures, which were released last night, dovetail with a calculation by a Nobel laureate, Michael Levitt, that his figures showed that the epidemic would be brought under control much sooner than many experts were thinking.

In a previous prediction, Levitt, a Nobel laureate and Stanford biophysicist, after analyzing Chinese and global Covid-19 numbers, in January correctly calculated that China would get through the worst of its outbreak long before many health experts had predicted. The Los Angeles Times reported yesterday that the numbers convinced him the same would happen in America.

There are now 30,000 cases of coronavirus in New York State, including 17,000 in New York City. Across the state, there have been 285 coronavirus deaths, including at least 192 in New York City.

The current hospitalization rate is 12 percent -- a worrying figure especially given the looming peak of cases which is expected to inundate hospitals in just three weeks, though that forecast may change with the infection slowdown. Three percent of cases require intensive care.

That means there are now about 890 people in the state needing intensive care and experts say the city's hospitals are already close to capacity.

'Encouraging signs' in Italy
In a related development, the World Health Organization’s European office said today that it saw “encouraging signs” in Italy reporting a lowered infection rate, though the UN agency cautioned that it was too soon to say whether the worst had passed.

Also, WHO said, many European countries have implemented or plan to implement changes in testing strategies to focus on severe cases and on hot zones in order to improve the quality of data used by epidemiologists.

A very similar approach has been recommended by Marc Siegel, MD, who has written about epidemics and is a media personality.

Generally, the focused approach means to have health authorities spot people who have the disease, track their contacts and apply medication and quarantines. That is the approach generally used for other contagions, so that society need not grind to a halt. But authorities cannot implement that policy when their data are insufficient. In various locales across the United States, there have been complaints of underreporting of Covid-19 infections and deaths due, in part, to shortage of tests and lab equipment.

“While the situation remains very serious, we are starting to see some encouraging signs,” declared Jan Kluge, WHO's regional director for Europe.

“Italy, which has the highest number of cases in the region, has just seen a slightly lower rate of increase, though it is still too early to say that the pandemic is peaking in that country,” he added.

WHO's European office said that to date more than 220,000 cases of Covid-19 had been reported on the continent, along with 11,987 deaths.

That means that globally, roughly 6 out of every 10 cases and 7 out of 10 deaths have been reported in Europe, with the number of confirmed infections worldwide now topping 400,000.

As the virus has spread across the continent, many European countries have adopted severe measures to curb the outbreak, including shelter-in-place lockdowns, the shuttering of nonessential businesses and the closing of borders, as well as the limiting of public gatherings.

Kluge said it will soon be evident whether these social mobility clampdowns have had an impact on curbing the rate of contagion.

WHO reports that
¶ The number of cases reported in Europe has doubled since last week
¶ 61% of the cases and 90% of the deaths have been reported from Italy, Spain and France
¶ 96% of deaths were in persons aged 60 years and older
¶ 87% of infected persons with outcome data available recovered
¶ 10% of reported infections with information available was a health care worker
European nations believe that targeted virus surveillance -- known as "sentinel surveillance" -- will provide better data on the most efficient ways to break the back of the epidemic. WHO says that:
A sentinel surveillance system is used when high-quality data are needed about a particular disease that cannot be obtained through a passive system.

Selected reporting units, with a high probability of seeing cases of the disease in question, good laboratory facilities and experienced, well-qualified staff, identify and notify on certain diseases.

Whereas most passive surveillance systems receive data from as many health workers or health facilities as possible, a sentinel system deliberately involves only a limited network of carefully selected reporting sites.

For example, a network of large hospitals might be used to collect high-quality data on various diseases and their causative organisms, such as invasive bacterial disease caused by Haemophilus influenzae type b, meningococcus or pneumococcus.

Elements of this story came from Al Manar TV (Lebanon), Fox News, the World Health Organization, and wire services.

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