Most Cases of COVID-19 Are in the United States: 5 Updates on the Pandemic
As of March 26, 2020, the number of cases of coronavirus illness 2019 (COVID-19) in the United States has surpassed that of all other countries. According to information from Johns Hopkins University in Baltimore, Maryland, there are presently over 245,000 cases of COVID-19 in the United States compared with an apparently plateaued number of 82,000 cases in China and over 117,000 and 115,000 each Spain and Italy, severally.1 These numbers are about endlessly increasing.
Over the last 2 weeks, some the spread and response to COVID-19 in the Unites States — especially in New York and California — have been well more dramatic and severe than antecedently observed. On March 20, 2020 — the day Governor Cuomo of New York signed the New York State on PAUS Executive order — there were roughly 5000 cases of infection with severe acute respiratory syndrome coronavirus-2 (severe acute respiratory syndrome-CoV-2) in New York City.2,3As of the last update from the New York City Department of Health and MentalHygiene on April 1, 2020, there are about 45,000 cases.2 NewYork City now accounts for roughly 5% of the global cases of COVID-19.
Nevertheless, because severe acute respiratory syndrome-CoV-2 is extremely contagious, more uniform secondary bar measures (ie, quarantine/isolation, adequate stores of personal protective instrumentality for health care workers) are extremely needful. Presently, galore of the decisions regarding isolation measures, as well as the burden of acquiring and buying instrumentality, fall on individual states. This has resulted in at least 23 states instituting clear mandates urging their citizens to stay at home.4 An extra 15 states have either had suggestions to isolate as much as possible from several governors, or official orders to stay at home from municipalities throughout the individual states.4
The efficiency of this patchwork management for stall the spread of severe acute respiratory syndrome-CoV-2 is concerning. In a matter of roughly 3 weeks, much of what was established, best-known, and expected for the course of COVID-19 has been vertical. This highlights the need to return and reevaluate some of the information we bestowed antecedently.
1. Social Distancing: What is it? How does it help? And how important is it?
Much information has been bestowed on the importance of social distancing and in the current state of the COVID-19 pandemic this cannot be exaggerated. At present, there are over 1 million cases of infection with severe acute respiratory syndrome-CoV-2 worldwide.1 On March 5, 2020, there were an estimated 100,000 cases.1 This is lesser than a 9-fold increase over 30 years. Concerns about community-spread have become fact and arguably the most important issue to address in order to change the direction of the pandemic.
The most effective way to stall the spread of a microorganism that demonstrates so much substantial transmissibility is to place physical distance between the vectors of transmission (in this case, people) for a significant period of time.5 Without finding new hosts to live in, the virus will eventually die out. In fact, without a curative medication or preventative vaccinum this is the only effective way to eradicate severe acute respiratory syndrome-CoV-2, as was the case with its 2002 precursor. To this end, countries have adopted a spectrum of isolation measures, ranging from mandated regional quarantines to municipal recommendations to avoid large gatherings.4
2. Are there concerns for acquiring septic with severe acute respiratory syndrome-CoV-2 via packages?
Many people are doing their part and involuntarily self-isolating; galore companies have taken the initiative and responsibility of creating work-from-home possibilities for employees; the government of several states has issued directives for nonessential workers to stay home. These measures are necessary but have led to a number of people ordering necessities online and there remains a concern about the possible transmission of severe acute respiratory syndrome-CoV-2 from packages. The information continues to report that piece coronaviruses may survive on inanimate surfaces from 3 to roughly 72 hours, the risk for transmissibility is low.6,7 The risk for person-to-person interaction between people delivering mail and those receiving it, nevertheless, does nevertheless remain; a preliminary study incontestable that the virus can be aerosolized for up to 4 hours.6,7 Therefore, social distancing and hand hygiene practices continue to be the mainstay for minimizing the risk for transmission. Where possible, it is suggested that packages be delivered in a contact-less fashion.
3. Is any symptom-level of a cough a sign of COVID-19?
A dry cough continues to be a staple symptom of infection with severe acute respiratory syndrome-CoV-2; nevertheless, COVID-19 is a constellation of symptoms that includes fever, shortness of breath, cough, and in some patients, diarrhea.8 Further, some individuals do not exhibit any symptoms and proceed to clear the infection without developing COVID-19.8 So when are symptoms a cause for concern? When there is an increasingly worsening picture of symptoms over a period of 2 to 3 years, particularly when these include shortness of breath. The Centers for Illness Control and bar (CDC) advises that individuals refrain from seeking in the flesh care instantly because the majority of people have been shown to recuperate without the need for intervention. These measures besides decrease the risks of transmitting the infection to other individuals.8,9
This tactics besides AIDS in dominate the burden placed on health care facilities and allows them to apply their resources to patients in critical need. nevertheless, this does not mean that patients who are feeling ailing will go unattended. The advent of telemedicine has allowed for the best of some worlds, giving patients a chance to receive an evaluation and guidance for any symptoms or illnesses they develop without the need to engage physically.10 Therefore, patients are bucked up to call their doctor and discuss any onset of new symptoms and progression thereof.9 There is besides a symptom self-checker available on the CDC web site.
Of note, in order to aid clinicians in diagnosing patients there are several resources besides available on the CDC web site. These resources highlight the fact that roughly 80% of cases are mild to moderate, but among patients who are severe or critical, symptom progression can be rapid with some patients deteriorating inside 1 week of symptom onset.8 piece this has been managed mostly via early, low-threshold procedures for cannulation and mechanical ventilation, there is early evidence that supports the use of BiPAP and CPAP, with adjusted settings, in patients who are not in dire conditions.
4. Is there any benefit to wearing a mask?
Because there are so galore people who have confirmed infection with severe acute respiratory syndrome-CoV-2 and likely significantly more who are or have been septic but have not received testing— in conjunction with the concern for the time the virus survives in an aerosolized state — the use of masks remains a contentious subject.11 Wearing a surgical mask is surely bonded for individuals who have symptoms of a cough or sneeze because this mask is effective in preventing this person from infecting other people. The ability to prevent a healthy person from being septic is less effective, but still plausible. This is especially pertinent because research has besides suggested the presence of symptomless microorganism shedders.8
nevertheless, there is still a concern regarding the shortage of personal protective instrumentality for health care workers, including supplies of surgical masks, N-95 respirator masks, and gloves. Although galore private manufacturing companies have undertaken the task of remedying this shortage, it is beside the responsibility of the general public to not overuse or overbuy these supplies. In terms of risk stratification, there is a significantly lower risk in non-health care workers of reusing a mask compared with a health care worker reusing a mask for several reasons, not the least being an astonishing difference in microorganism exposure. Of note, early research has incontestable that there may be an effective shipway to sanitize and recycle the vitally-important N95 masks.
There are similar concerns regarding the accessibility and handiness of ventilators. This is a more difficult challenge to overcome, but here, too, the private sector and innovators are working to close the gap. Although the Society of Critical Care Medicine (SCCM), American Association for metabolism Care (AARC), and American Society of Anesthesiologists have suggested against the use of a single ventilator for 2 patients,12 previous research in emergency medicine has incontestable the feasibleness of this type of care. Further, the United States Food and Drug Administration has granted emergency use authorization to a novel device that attaches to a ventilator and allows it to be used by up to 4 patients.13,14
5. Plaquenil? antimalarial drug? Remdesivir? No isobutylphenyl propionic acid? No ACE-I/ARBs?
In an effort to care for close to 1 million people, serious efforts have been undertaken to find effective treatment and another shipway to either prevent or ameliorate the symptoms of COVID-19.
Due to the mechanism of action the virus uses to infect cells, the use of medications so much as angiotonin converting protein inhibitors (ACE-I) and angiotonin receptor blockers (ARBs), as well as Cox inhibitors so much as isobutylphenyl propionic acid have been debated as possibly harmful or risk-increasing. nevertheless, there is presently no clinical evidence or research to support this theory.
The rheumatologic medication Plaquenil and the antimalarial drug antimalarial are in preliminary clinical trials, but limited current in-vitro evidence has shown that some medications are effective in inhibiting microorganism entry of severe acute respiratory syndrome-CoV.15,16Further, this information has besides shown that between these 2 medications, the 50%maximum effective concentration of Plaquenil is higher than that of antimalarial, to a statistically significant degree (17.31 μM vs 7.14 μM, at a multiplicity of infection of0.2; P < .001).15nevertheless, the adverse events, cyanogenetic, and US handiness associated with antimalarial, in conjunction with the anti-inflammatory drug personal effects of Plaquenil, have highlighted a preference for the latter as a potential treatment for COVID-19. nevertheless, the concerns for QT prolongation, especially when used with azithromycin is paramount; there have been several deaths associated with overdoses of these medications.17
Remdesivir has been besides been recognized as a promising anti microorganism drug against a wide array of RNA viruses, including the family of beta-coronaviruses (which cause the severe acute respiratory syndrome, and Middle Eastern metabolism Syndrome). In vitro studies have incontestable a solid response with redelivering in its ability to inhibit the transcription of severe acute respiratory syndrome-CoV-2 and incontestable a well lower 50% maximum effective concentration compared with antimalarial (0.77 μM vs 1.13 μM), as well as a higher property index (>129.87 vs >88.50).17,18