With todays announcement of 101 more CV-19 deaths, most of which did not occur this week, Minnesota is at 610 deaths per million. Sweden, which has experienced a modest case search and a few deaths, is at 660. We are gaining even faster than I imagined possible. Florida, which has had few restrictions and obviously has an older and much more heavily minority population than Minnesota is at 850.
And two-thirds of Minnesota’s deaths continue to be in long-term care facilities and the majority are people over the age of 80. Yet we keep acting like the general population has some risk. And at this point, can we all just agree that the response to the long-term care situation has been completely ineffective, no excuses. And I would actually welcome an honest explanation that likely is true, such as: “There is nothing we can really do to completely keep the virus out of these facilities. Many of the residents are extremely frail and susceptible to any additional health problem. Once there is an infection in a facility there is little that can be done to prevent further spread. So it is unfortunate, but we are almost certainly going to see a large number of deaths among these residents.” And if the state just said that, then they could stop issuing draconian and unnecessary orders affecting the general population, where there is minimal risk.
The CDC has published a paper with a new estimate of likely true infections during the epidemic. (CDC Paper) The authors tackled the problem of undetected infections by applying a multiplier based on testing strategies and other factors. They applied their method to both inpatient and outpatient testing, and estimated that less than half of hospitalized cases were identified. The researchers ultimately found that there were an estimated 53 million cases in the US by September 30, or 7 times the reported number. This is similar to the 6 times multiplier suggested by the recent national lab antibody prevalence study. The finding of underreporting among hospitalized cases seems extremely unlikely however. If the 6 or 7 multiplier is accurate, based on about 13.5 million reported cases in the US as of today, there really would be, hold on, 80 to 90 million infections, or well over 25% of the population. This thing isn’t going to run much more, because based on the age scatter of the cases and contact levels among age groups, people representing well over half the total contacts have been infected.
Here is another paper on how masks do or or don’t work physically. (Medrxiv Paper) The researchers measured penetration of aerosols in a typical range generated by humans through various mask materials. The tests were conducted using salt aerosols and real humans wore the masks, after being trained. But again, why such a limited duration of exposure, 30 seconds. For God’s sake, do these studies with the face covering worn for an extended time, as in real life. For comparison, an N95 respirator had a protective rating of 166 in regard to inward leakage. The cloth masks had one of less than 2. The surgical masks were at 1.7 to 3.6. And in a separate aerosol penetration test, as much as 90% of aerosols penetrated the mask, depending on material type. Using multiple materials in cloth masks substantially improved performance, but also made it harder to breathe. The authors support mandatory mask wearing even though acknowledging that they likely provide a very low level of protection against infection, which is puzzling, because, again, masks are a virus and other pathogen collection device. The likelihood that once on the mask, someone gets infected would seem pretty high. How about doing a study that takes a large number of people wearing masks regularly and at least two or three times a day does a test of the mask to see what level of pathogens have accumulated in or on the mask?
And yet another study confirming a good adaptive immune response in asymptomatic cases. (Medrxiv Paper) The researchers compared T cell responses in those with no symptoms to those who developed disease. They found that the asymptomatics developed a strong and balanced T cell response which likely aided in clearance of the virus while avoiding immune system over-reaction.