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United States: New Cases of COVID-19 Reported Daily Records in Florida, Texas, Arizona, California; Gilead to charge $3,120 for a course of remdesivir

2020-06-29

Electron micrograph of SARS-COV-2 virions in vitro

According to worldometer, there were 40,540 new cases of COVID-19 reported yesterday (June 28) in the United States.  The total number of cases reported is 2,637,077 and 128,437 deaths.  According to Johns Hopkins, there have been 2,562,921 total  cases and 125,927 deaths reported in the United States as of 9:00 AM on June 29.  The global number of cases reported, according to Johns Hopkins, is 10,195,680, with 502,802 deaths.  WHO’s webpage says that there have been 10,021,401 confirmed cases of COVID-19, including 499,913 deaths reported to them.  WHO also says that, in the US, there were 44,580 new cases reported yesterday, with a total of 2,496,628 reported cases and 125,318 deaths.

The CDC reports 2,545,250 total cases in the US and 126,369 total deaths, with 41,075 new case reports and 885 new deaths.  On April 6, there were 43,438 new cases reported, with rates dropping to below 15,000 reports a day by June 1; last weekend, there were two days of over 44,000 new cases reported.  CDC also reports 87,696 cases among healthcare providers and 478 deaths.  They report a total of 32,297,688 tests performed, with 3,039,503 of them positive, although this is not broken down into antibody vs. antigen tests nor stated whether some people were tested more than once.  Since the total of positive tests is larger than the number of people said to be infected, clearly some are antibody tests and some people had more than one test.  The page says that 9% of tests were positive.

The New York Times also keeps a database; it reports that “more than 2,564,600 [reported] people in the United States have been infected with the coronavirus and at least 125,800 [are reported to] have died.”   Google itself has figures if you search “covid usa tracker” (showing “2.59 M” total reports) and even Bing has a covid page with numbers for the US (2,593,169 total reports) and the world.

There’s no single explanation as to why WHO would report 140,000 fewer total cases than worldometer.  Clearly, the data comes from different sources and may be confirmed in different ways.

All  the databases show a peak in new cases in early April with a trough at the beginning of June; the graph appears to start rising again in the middle of June.  The death rate peaked early in April and stayed high until mid-May.  The death rate has not started to rise again as of the end of June.  The totals were skewed by the large number of cases in New York and the Northeast; their rates dropped dramatically and are now no longer hiding the fact that the rest of the country is experiencing an uncontrolled increase in cases (though not yet in deaths.)

Death rates have been significantly undercounted in the US and elsewhere, first due to poor availability of tests (especially at first) and second, because of people who died at home without being tested.  Tests have increased to about half a million every day in the US, but there are several areas where it is still very hard to get tested.  Some locations that offer tests to the public are swamped, with several-hour waiting times; some have closed early after running out of testing materials for the day.  Because of incomplete testing, I have used the qualifier “reported” with every statement of the number of cases.

There is not adequate information about who has symptoms and who does not when getting tested, so it is unknown how many asymptomatic people have tested positive.  Widespread antibody testing has recently revealed that at least ten times as many people have antibodies as have tested positive for the antigen, suggesting that something like 20 million Americans have had COVID-19.  The rate of asymptomatic COVID-19 has been guesstimated at from 30% to as high as 80% (the higher number is based on tests of the guests and staff on a cruise ship.)  The rate of “paucisymptomatic” (meaning with minimal symptoms) disease is unknown as well.

Most importantly, the level of contagiousness that people with no symptoms present is unknown but probably significant.  This issue is why mask-wearing is so important for the general public– if you have no symptoms yet are contagious for COVID-19, shouldn’t you be wearing a mask to prevent other people from being exposed to your breath and its thousands of microscopic particles full of viruses?

In other news, CBS News (and other sites) are saying that Gilead plans to charge $3,120 to private insurers for a course of remdesivir.  For Medicaid, the price will be $2,340; overseas, some generic makers will offer the drug for $600 a course.  The company has come under criticism for its pricing policy, in part because (as Public Citizen complained in a tweet) $70 million in taxpayer money was used to help in its development.  The drug was originally to be used for Ebola; it was orphaned after a better drug combination was found.

Remdesivir was shown in an early randomized, placebo-controlled study to reduce recovery time significantly, by 31%; the reduction in death rate, while substantial, did not reach statistical significance at two weeks.  Dexamethasone was shown to reduce death rates in severe or critical COVID-19 infections significantly, even at a relatively low dose.  Dexamethasone is a cheap generic steroid that has been highly useful in other conditions to reduce inflammation.

Treatment with remdesivir and dexamethasone will help reduce the death rate from COVID-19, but only if hospitals are not overwhelmed with a surge in patients brought on by the dramatic increases in new cases.

Another development that will reduce death rates is that the age of people presenting with new infections has dropped significantly.  More young people (almost all over 21) have been tested and are positive for acute infection; the reasons for this are not known with any certainty.  It is possible that as testing has been expanded, more young people have been included.  Florida’s governor blames young people going out to bars for this new surge in his state; he has ordered the bars closed as well as the beaches in Miami-Dade County.

Even if you don’t die from COVID-19, it has increasingly become apparent that you can have a prolonged, debilitating illness very different from the flu.  Patients have been reporting prolonged fevers, lassitude, weakness, and shortness of breath with exertion.  Some people have permanent lung damage or weakened hearts, even kidney failure.  We don’t know how common this extended illness is, but with so many people getting the virus, even a small proportion of debilitated people will have a profound effect on our medical system.

The worst problem and the reason we have uncontrolled spread is that we have a failure of leadership.  The man nominally in charge refuses to model good behavior and has never been photographed wearing a mask in public.  Instead, he encourages resistance to mask-wearing mandates and retweets hostile, anti-scientific, and sometimes racist material multiple times every day.

If he were to lead by example, we might have the pandemic under control in this country.  If he had invoked the Defense Production Act to get testing supplies manufactured, we wouldn’t have spotty availability of tests.  If he had encouraged people to follow sensible protective guidelines, we wouldn’t have so many public health officials resigning due to death threats.

 

 

 

 

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