Dear friends and neighbors:
Happy Easter! Here is my weekly e-mail with some updates on COVID-19 in Boone County and Missouri:
(1) According to the latest data that I can access, we currently have 99 positive COVID-19 patients in Boone County (with 1 death) and 4024 positive patients in Missouri (with 109 deaths).
(2) My commentary is that the pace of new cases appear to be slowing down in Boone County, but we can all still see the storm coming. Hopefully, we have instituted social distancing just when it mattered the most. Please don’t think we’re “safe” because the virus will somehow respect state or county borders. We should continue to comply with recommendations for good hygiene, and social and physical distancing.
(3) While it continues to be incredibly difficult to make projections in this time of uncertainty, one source suggests that our peak death rate will hit on 4/25/20, with 36 deaths that day in Missouri: https://covid19.healthdata.org/united-states-of-america/missouri
(4) Below are my notes from a pair of updates that Dr. Randall Williams (our state health commissioner) gave to physicians in Missouri over the past week. Any errors or typos are strictly my own:
– “We have started posting data on health.mo.gov/coronavirus, based on data from the Missouri Hospital Association: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/pdf/gov-dashboard.pdf
=> note: based on the last update (on 4/10/20), there are 672 total ICU beds still available (out of 2129 total). There are 982 ventilators available (out of 2115 total). Out of a total of 3799 COVID-19 positive patients in Missouri, 506 of them are hospitalized.
– “We have also performed about 22,000 tests, with 11 labs doing that now.”
– “We continue to see 80% of patients with COVID-19 to be mildly symptomatic, 10-12% needing oxygen, and perhaps 6-8% needing ventilation and/or ICU care.”
– “For the 20% who get hospitalized on oxygen support, the recovery time is generally 4-12 days; if you end up on a ventilator, recovery time can be 9-15 days. You have a protracted course if you end up on a ventilator. Many patients go on dialysis for unknown reasons.”
– “This does not appear to be a disease that is more virulent in pregnant women; to date, we also have had no evidence of fetal transmission and fetal harm.”
– “We are doing 2000 tests/day throughout the state; approximately 7-10% of symptomatic patients are having positive tests for COVID-19.”
– “We are continuing testing, case identification and isolation.”
– “In Missouri, this is largely a metropolitan disease that is following urban clusters. Approximately half of our positive tests are occurring in St. Louis City and St. Louis County.”
– “About 50% of all cases are in St. Louis City and St. Louis County.”
– “We continue to increase testing capacity. Abbott has a new 5-15 minute test; we will be getting 10 machines to do that. Those machines can only run 1 test at a time. We will be distributing those machines to hotspots around the state.”
– “We get a daily update on surge capacity, especially ventilators and ICU beds. The state currently has 123 ventilators, and we have 220 more on order.”
– “In New York, we have all seen that they have re-purposed the Javits convention center as a field hospital. While we don’t think we need to do that, we are also preparing for the worst, and we have identified 7 possible sites in Missouri, as needed.”
– “We are now looking at surge capacity, particularly in St. Louis City, St. Louis County, and Jefferson County. We have opened up two testing sites in North St. Louis, and we appreciate that Barnes-Jewish, SSM, St. Lukes, St. Mary’s, and Mercy are all working closely together. We understand that that is going to be the focus of our surge.”
– “Our first case was on 3/7 in St. Louis County. Statewide, about 3 million Missourians have been on a stay-at-home ordinance through their local municipalities. The whole state has been on social distancing, where we should have <10 people gathered in any one place, and everyone should stay at least 6 feet apart.”
– “Our Missouri stay-at-home order (with the list of exemptions) is on our website at health.mo.gov, at: https://content.govdelivery.com/attachments/MOGOV/2020/04/03/file_attachments/1419322/Stay%20at%20Home%20Missouri%20Order.pdf
– “It is a misdemeanor to violate this order, enforced through local health departments. This is consistent with our message, that it’s really important to avoid people to the best of your ability.”
– “We continue to strongly encourage social distancing across the state.”
– “We are working closely with epidemiologists and the Missouri Hospital Association on modelling. We are using our data, our mortality data, and our testing data (together with DHHS, HHS Region 7, and the Missouri Hospital Association) to look at our surge capacity, to see where we might need to use our 123 state ventilators, with the two main hotspots being the St Louis area, or possibly Springfield.”
– “We continue to look at capacity. People always want to know how we think things are going to develop. We are doing modelling based on our 22,000 tests and 10% positivity rate overall. Our hope is that the stay-at-home order goes through April 24th, and then we hope to see some daylight after.
– “Italy’s cases are now plateauing, and we consider Italy as a worst-case scenario. NYC cases are doubling every 6 days right now.”
– “We are hoping that our social distancing will make us be like Singapore, and while we will have continued cases, we hope that toward the end of this stay-at-home order, we will be getting through a surge situation. This is a best-case scenario.”
– “We hope that this will dissipate in the summer, with warm weather and more social distancing.”
– “There is always a concern in the winter that (similar to the 1917-1918 flu pandemic), we could have a rebound in November before we have a vaccine.”
– We continue to talk daily about how we make decisions. We listen to thought leaders, we listen to Dr. Fauci, we talk to the CDC daily. We are working with HHS Region 7. We continue to gather input weekly from infectious disease, from the hospital association, and from others. WE talk to mayors every week, and we talk to local health departments.”
– “We have a hotline with 2000 calls every day, we have lots of employees working 24/7 (not just 9-5) and nurses (who are not doing as many inspections as before, per CMS) who are manning that state hotline: 1-877-435-8411.
– “PPE remains a huge priority for us. We are doing everything to get that. On the open market, we continue to purchase PPE, we also continue to try to purchase swabs to do more testing.”
– “We have the capacity to do 5000 tests per day (currently doing 2500-2800 tests per day) with a good strategy of doing testing. Some other states are only testing high-risk groups; some other states have given up on testing, and are just doing community mitigation now. We do not do that here. We think our data helps us, that the public appreciates it, and it also helps anxious patients.
– “For every symptomatic patient that we check, 90% are negative. As we get out of flu season, we will hopefully have less symptomatic COVID-negative patients.”
– “To review numbers, we have had 450-500 COVID-19 admissions, with many NOT on ventilators.
– “PUI (Persons Under Investigation): one might think that if a patient is hospitalized, there would be a higher rate of positive COVID-19 confirmations, but we actually only see 6% of these individuals test positive for COVID-19. For PUI in Missouri, the vast majority will be negative.”
– “We are focused on the long-term: the pathogenesis of the disease leads to protracted time on ventilators. When patients get sick, they can get very sick, and we need to be very sensitive to that.”
– “We are very concerned about community transmission in nursing homes. We have had 7 outbreaks in nursing homes, in Springfield and St. Charles and St Louis County. We remain very vigilant there.”
– “We know that there is more community transmission, even though those facilities instituted no visitors and are checking fevers. Even doing that, we still have outbreaks in nursing homes and we will watch those carefully.”
– “We have also heard that some long-term care facilities are not taking patients back after hospitalization, which creates a bottleneck while trying to create bedspace in hospitals. We have issued guidance on this, in the hope that patients can go back to these long-term care facilities and free up hospital beds. Per the CDC, hospitals can clear a patient to go back at 7 days after symptom onset *or* 3 days after being asymptomatic *or* with two negative COVID-19 tests, 24 hours apart.”
– “There has been a lot of discussion about face masks, with recommendations from Surgeon General Jerome Adams.”
– “Earlier, we were adamant that it did not appear that face masks can decrease the risk of catching the disease. However, there is some new evidence that patients *can* possibly transmit SARS-CoV-2 through talking (and not just sneezing and coughing). Importantly, there is also some evidence that patients can have high viral loads and be contagious, 2-3 days before becoming symptomatic.”
– “There is some guidance from the CDC, that the general public may want to use cloth masks, to protect themselves and each other. “For those who cannot implement social distancing, it may be helpful to use your own cloth masks.”
– “I cannot tell you how much we appreciate you. In Italy and others, healthcare workers have 3 times the infection rate of others, and so we are very sensitive that first-line responders including fire, law enforcement, doctors, nurses, and PAs are all protected.”
– “We are continuing to send personal protective equipment out to hospitals, emergency medical services, and long-term care facilities, as soon as we get it.”
– “We are eager to see us Flatten the Curve, and we hope mitigation efforts will have paid off.”
– “I want to close by thanking you again. I have been in healthcare for 30 years, the Governor was a Sheriff, and Sandy was in law enforcement. We have great appreciation for those of you exposing yourselves to some risk.”.
I invite all of you to forward this e-mail judiciously, if you wish.
Stay safe, well, and panic-free,
– Albert Hsu
PS: for the most up-to-date information, please visit <https://www.cdc.gov/>, <https://health.mo.gov/>, and <https://www.como.gov/>