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New cases of COVID-19 in the US continue to set records, despite a bottleneck in testing. Death rates have not yet risen to match but chronic symptoms are appearing more often.

2020-07-03

Electron micrograph of SARS-COV-2 virions in vitro

Worldometer reports 46,042 new cases of COVID-19 in the US on July 2; WHO reports 54,271 new cases.  For California, Johns Hopkins reported 6,491 new cases on July 2; for Florida, it reported 7,480.  Arizona reported 3,452 new cases and Texas reported 6,368.  All these reports represent new records and an uncontrolled rate of increase.  Oklahoma’s rate of new cases appears to have leveled off since June 24 (the notorious rally in Tulsa occurred on June 20.)  The new case rate in northeastern states has dropped dramatically from two months ago; rates in southern and western states are increasing rapidly.

According to the New York Times, “most of the biggest known clusters have been in nursing homes, food processing plants and correctional facilities…”  Their web pages have detailed lists and case counts for the bigger clusters, as well as county-by-county case reports for the whole US.  They also have data for world-wide cases.  Their US data is based on reports from local, county, and state governments.

The CDC has a web site reporting totals for each state and county-level statistics with links to the web sites for state health departments.  Their data comes from USAfacts.org, which appears to be a non-governmental organization based in the University of Pennsylvania; it reports all kinds of statistics and data gathered from governmental sources and analyzed.  According to their website, they are funded by Steve Ballmer, the former CEO of Microsoft, and they source all their data from various government agencies.  Their FAQ page states, “we do not advocate for any views of Steve or Connie Ballmer except for one: that facts matter and public data should be available and understandable.”

The good news is that daily death counts have been gradually and consistently dropping since a peak in mid-April; despite rapid increases in daily cases since early June, death rates have continued to trend down all month.  Unless death rates start to increase again soon, it appears that the case rate reflects less serious infections or else better treatment of serious cases.

The bad news is that, as deaths drop, the number of unresolved cases rises.  More and more reports are coming out about people who still have symptoms months after coming down with the virus.  Fatigue and weakness with poor exercise tolerance are the most common persistent symptoms, but some patients still have intermittent fever, cough, and shortness of breath.  These symptoms are similar to those of “post-viral asthenia” and “chronic fatigue syndrome (CFS).”

News accounts about chronic symptoms have begun to appear more often: here is an NBC report with a patient who has had a low-grade fever for over 100 days.  Here is a report in “The Conversation” from June 24 written by an infectious disease physician regarding “what we know” about chronic symptoms.  Here is an article in the Washington Post from June 11 stating “doctors aren’t sure why” some patients don’t recover.

Here is an article from the Vaccine Alliance (GAVI.org) posted June 19 about chronic post-viral symptoms that references the SARS outbreak, which left half of its survivors with long-term weakness two years later.  Here is an article in the Atlantic from June 4  that details the connections to “myalgic encephalitis” and CFS and suggests more diagnoses will be made as our experience with the virus continues.

Those who had the most serious illness and were on mechanical ventilation in the intensive care unit (ICU) have muscle weakness and atrophy due to prolonged immobility.  They have post-ICU delirium that resolves slowly.  They may have permanent memory loss or cognitive deficits (reduced thinking ability.)  Some had renal failure (kidney shutdown) that may only partially resolve.

Even those who had relatively mild illnesses may persist with symptoms of fatigue and weakness, cognitive deficits, and depression.  These chronic symptoms may be more common than we know and this has not been carefully studied because we are still fighting the acute disease.

These patients probably do not have persistent infection but rather, end-organ (lung, kidney, brain, muscle, etc.) damage that has not resolved and may be permanent in some cases.  Since the oldest infections occurred no more than six months ago, the diagnosis “chronic fatigue syndrome” caused by the virus is only just beginning to be made (CFS requires symptoms to last more than six months to fit the case definition.)  If there is a significant number of chronically disabled patients, this may become an issue of permanent productivity loss with serious consequences for society.

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