USA Today article by Susan Miller, posted April 26, 2020.
For months we have known that a larger list of symptoms should be considered when characterizing this new infection. The CDC has however been slow to move past the original three symptoms: fever, dry cough and shortness of breath. Finally, an additional 6 symptoms have been added. All have been on my symptom checklist since early March. This change comes on the heals of a major JAMA report showing that only a third of patients hospitalized for COVID-19 had a fever on admission.
Today’s bite-sized, handpicked selection of important news, information or science for all who want to know where this epidemic is going and what we should do.
Based on previous research, stopping social distancing before Easter could result in more death and suffering Today’s top pick is an article in Vox about why easing social distance measures too soon risks causing a spike in cases and deaths. The article reports on a study published in JAMA in 2007 that looked at epidemic curves from the 1918 Spanish flu pandemic in various U.S. cities. The figure below comes from that paper. I added some annotations in blue to explain things. It shows that when St. Louis MO reopened schools and stopped banning public gatherings in late November, cases doubled in December, forcing officials to re-instate control measures. It wasn’t just St. Louis, they studied 43 cities and found that places that instituted social distancing measures early had fewer deaths. Cities that stuck with it longer also had fewer deaths. Why this matters? President Trump has told the nation that he wants America to be open for business and back in church by Easter. I have not heard a single public health expert say that this is a good idea. We are not yet near the peak of cases in the U.S.. Easing social distancing measures will cause death and suffering. This epidemic is being driven by covert cases. Therefore, sending people back to work, school and church will do nothing but reignite the epidemic just as these important measures are starting to work.
U.S. cases rise by 23% on Wednesday, while deaths are doubling every two days Despite some evidence of a slowing pace of epidemic spread in Tuesday’s data, the Wednesday numbers show 12,209 new cases (another new high) and 225 deaths. I don’t tally today’s numbers until mid-night, but it’s clear that Thursday will be as bad or worse. Regionally, 62% of cases are now in the Northeast, due to the fact that New York has been so badly impacted, but fast moving brushfires are arising all over the country. Significant hot-spots were seen (in hot places by the way) including Texas, which added 564 new cases overnight (a rise of 138%). Texas has already added over 400 cases on Thursday, so this is no fluke. Other hard hit states include Louisiana (+407), Massachusetts (+679), Florida (+565), and Michigan (+501). What does this mean? Hopes we were nearing peak were misplaced. What looked like a slow down in new cases is most likely a back-log of testing as the nation’s labratory bandwidth starts to get stretched.
Many COVID-19 patients don’t fit the symptom profile I have returned to this topic on several occasions, but I remain very concerned about a disconnect between our case definition of COVID-19 and the reality that is being seen in hospitals. For a powerful example, read the account of a 38 year-old history professor who was infected with COVID-19 but did not self-isolate because he had symptoms that didn’t match what he had heard (VICE, March 25, by Jordan Davidson). Craig Hollandar had no cough and no breathing or respiratory issues. What he had was fatigue, a loss of appetite and diarrhea. His doctor’s told him he didn’t have the right symptoms and had not traveled so he didn’t have COVID-19. But he did. A new study online at the American Journal of Gastroenterology tracked 200+ patients treated at Wuhan hospitals and found that nearly showed up with digestive problems like loss of appetite or diarrhea as the main problem, not respiratory symptoms. Why this matters? Until we know more, everyone must recognize that this disease shows up in different forms in different places. Those who experience stomach problems, tiredness and loss of appetite may have COVID-19, even if they don’t have a cough, and should consider themselves a presumptive case. If this sounds like you, stay home and call your doctor.