Coronavirus at Yale Hospitals

A story inside the April 22 edition of the CT Post bore the following headline: "More than 600 Yale New Haven Hospital workers have virus." The story quoted a senior vice president for public affairs who “said that about 1000 employees, at a peak time, were out of work because of the coronavirus since the beginning of the pandemic, with 603 having tested positive.” Yale New Haven Hospital has about 27000 employees. 

So far about 1000 coronavirus cases have been treated at the five hospitals that make up the Yale system. The majority have gotten well enough to be sent home or to another facility. A total of 185 have died. However, the story failed to mention if any of the 603 staff members who tested positive have died. 

Since the story did not mention it, I assume that none of the 603 staff members have died. Apparently, the great majority had symptoms and just stayed at home until they got better and returned to work. Although the news story did not mention what happened to these staffers, I guess when they returned to work, they would no longer have been able to infect anyone. 

Why not follow Yale’s example? The hospital was as contagious a work place as can be imagined and 603 staffers became infected, but none died. Isn’t it time to let other workers return to jobs where there is much less risk of infection?

What good will more testing do? By the time most people get the results of the tests, they will already have recovered from the symptoms. A Yale official stated that they are testing less because there are fewer people with symptoms. All five of their hospitals now have beds available.

Of course, we know that Senior citizens and those with high risk conditions like hypertension, diabetes and immune system disorders are particularly vulnerable in the same way that they are to the flu. I am age 80 and although in reasonably good health, I can understand the need for people like me to stay at home and avoid unnecessary contact. 

For the others, the young and the healthy, it is time to let them go and resume their normal lives. Doctors have pointed out that the have found ways to mitigate the effects of the Coronavirus. For most people staying in bed for a couple of days and letting their immune system do its job will be enough. For more severe cases, doctors in the field have been using the combination of Plaquinil and Z-Pac and it seems to be working. Some doctors even take it themselves as a precaution. Another article in the Ct Post indicated that it is now the protocol in Bridgeport Hospital.

Governor Lamont, let your people go! Let them go back to work. Let them go back to school. Let them go back to church. Let them go to the barber shop and beauty salon. Let them go the parks and beaches and get the much needed sunlight that not only strengthens their immune system, but also creates a very hostile environment for the coronavirus itself. 

Speaking of sunlight, The Weekly Bystander reported on its importance a month ago. Back then my scientific advisor claimed that as the days grew longer, elements in sunlight would impede the spread of the virus.* Just last week Bill Bryan, an official with the Homeland Security Agency, made a presentation at President Trump’s press conference that offered startling proof. The study indicated that the combination of sunlight, increased temperatures, and higher humidity would be lethal to the virus. He argued that it was vitally important for people to take their activities outside. Here is a link to these very important findings, or just view the short video below.**

k

* In the last seven days the percentage increase in the number of cases and deaths has declined dramatically in the USA. In the week ending on March 31, the number of cases increased by 198% and deaths by 305%. In the week ending April 28, the number of cases increased by 20%, and deaths by 25%.

** I think that President Trump in his immediate remarks failed to properly address the main points of Mr. Bryan's presentation, and that his ill-conceived questions created an unnecessary furor that should not detract from the findings of the Homeland Security study.

###

Coronavirus FAQs

I have been using a spread sheet to track the progress of the coronavirus for over a month. Most of my information has come from the daily updates from Johns Hopkins University. Here is my own list of questions and answers. 


Q. How many people have been tested for the coronavirus in the US?

A. 4026000.

Q. How many of those tested had symptoms?

A. Practically all according to Dr. Deborah Birx.

Q. How many of the over 4 Million tested positive?

A. 787960 or 19.7%. The symptoms of the remaining 81.3% were caused by something else.

Q. How many of those tested positive have died as of April 21?

A. 42814 or 5.4%.

Q. Were there any other health issues among those who have died?

A. We do know that the great majority were elderly with other medical conditions. A New York study showed that a majority suffered from hypertension (high blood pressure). Other conditions were diabetes and dementia. 

Q. How many people have survived the coronavirus infection?

A. If we subtract the number of deaths (42518) from the number of positive cases (787960), we get about 745000 survivors so far. Published recovery rates obviously lag behind. However, medical researchers tell us that we must conclude that there are many more cases that have not been recorded. One model suggests that we should multiply actual cases by 3 which would mean that about 2.3 Million have survived. One health official stated that we should multiply actual cases by 100, a figure sometimes uses in estimating the number of people infected by the flu each year. If we multiply positive cases by 100, then over 78 Million people have been infected in the US, but only 42814 have died.  

Q. How does the death rate in the US compare with other countries?

A. in the United Kingdom 125856 people have tested positive and 16509 have died. 13% of those who tested positive have died. In Italy 181228 people have tested positive and 24114 or 13% have died.

Q. What are the leading causes of death in the USA.

A. We don’t have figures for 2020 but in 2019, heart disease (670000) and cancer (600000) were the leading causes of death. Chronic lower respiratory diseases took 160000 lives, and146000 died of strokes. Rounding out the top ten killers were accidents (170000), Alzheimers (121000), Diabetes (84000), Nephritis (50600), Flu and Pneumonia (55000), and Suicide (47000). 

Q. How rapidly is the coronavirus spreading in the US.

A. Over the past five weeks,  although cases and deaths continue to rise, the rate of increase has been dramatically slowing. Here are the figures.

March 18-24: Deaths increased by 958% and cases by 615%
March 25-31: Deaths increased by 305% and cases by 198%
April 1-7: Deaths increased by 169% and cases by 94%
April 8-15: Deaths increased by 84% and cases by 46%
April 16-24: Deaths increased by 63% and cases by 29%.

Q. What states lead the Nation in cases and deaths?

A. New York State leads the nation with over 242000 reported cases and 13869 deaths. New Jersey is in second place with 89000 cases and 4377 deaths followed by Massachusetts (40000 cases and 1809 deaths), and Pennsylvania with 34000 cases and 2348 deaths. California, the most populous state in the country, is only in fifth place with 34000 cases and only 1227 deaths. Interestingly, Florida (27000 cases and 823 deaths) and Texas (20000 cases and 820 deaths) seem to have been largely spared.

Q. Why are California and Florida, two of the most populous states with large proportions of senior citizens, doing relatively well?

A. I don’t know. Is it the sunshine? Ask Dr. Birx.

###

Covid-19: Asymptomatic Carriers

Why do so many people believe that they could be secret carriers of the coronavirus? Why, when I go on my daily walk, do my neighbors cross the street to avoid me, even though I have no symptoms, and have been virtually quarantined in my home for a month?  

Most of them are younger than me and I think they fear that they might infect me, an obvious senior citizen. Even though they have no symptoms, I believe that there is a widespread fear that many people are asymptomatic and infectious without knowing it.

Reading the newspapers or watching TV gives the impression that many people have in their minds the image of Typhoid Mary, the legendary woman who infected people with a dreaded disease even though she herself was not harmed. She was a secret carrier. 

However, it does not appear as if the coronavirus or any virus works that way. It is true that once infected, we may not show the familiar symptoms for a day or two, but then the symptoms: cough, fever, and fatigue must appear. Here is a timeline of the infection.

Typical Time Line of Viral Infection

Day 0 - you have been infected with a virus and have no symptoms but you are contagious.

Day 1-4  -  typical symptoms appear, fever up to 102 F, coughing, tired due to onset of the Immune response.  The Innate Immune system has already been initiated and the Adaptive Immune system is at work performing both the Humoral and Cell Mediated Responses.  You are most contagious now as you are coughing and sneezing out virus laden droplets.

Day 5-7 - you are feeling better fever still present but going down.  Less contagious but the recommendation is that you wait 24 hours after body temperature is back to normal before interacting with others.  

Day 7-10 - the virus has been neutralized but there are still many immune actions being taken by the body.   Different classes of antibodies are being produced with a maximum of these present at about 14 days after Day 0.  These will persist for months in the blood plasma.  The inflammation is being attended to so you may still be coughing up mucus.

Just today I saw a brief video from a Fairfield town health official who confirmed that we can only be asymptomatic for two days. We are not secret carriers of the disease for weeks, or months. When the virus enters our bodies, the immune system must immediately respond and cause symptoms of varying degrees to appear.  

The German study that caused Dr. Anthony Fauci back on January 31 to change his mind about the seriousness of the disease cited the case of a young woman from Shanghai, who after a visit from her parents in Wuhan, the apparent place of origination in China, flew to Germany for a conference. 

She had no symptoms but now we know that she infected some of the other participants in the conference. But shortly after, on the plane ride back home, she got sick. She was only asymptomatic at the outset. The lady from Shanghai eventually recovered.

This scenario was repeated in a story that recently appeared in my local newspaper that had the following alarming headline:

Yale doc: Asymptomatic Carriers spread half of virus cases.

A careful reading of the story indicated that the infected parties were only asymptomatic for a day or two. A man showed symptoms on Thursday, March 12. On Sunday, March 8 he had attended a large party in the town of Westport. a hot spot for the virus in Connecticut. The next day, March 9, he attended a basketball game in a crowded gym. He worked that week until the day his symptoms appeared on March 12.

It is most likely that he got infected at work especially considering that his nephew, who also worked at the same place, came down with the symptoms shortly after. The nephew worked until March 19 and showed symptoms on March 22. Neither uncle nor nephew were asymptomatic for more than a couple of days. Their symptoms were severe but did not require hospitalization, and they have both recovered.

Speaking of symptoms, so far in the USA more than 3 Million people have been tested for the coronavirus. At a recent news conference Dr. Birx of the CDC asserted that only 20% had tested positive for the coronavirus even though practically all of the tests had been done on people with symptoms. Only 24% of seniors between 65 and 85, the most vulnerable group, tested positive. 

The other 80% had some other reason for their symptoms, most likely the flu which so far this year has caused more deaths than the dreaded coronavirus. So far, of the 20% (about 600000) who did test positive only 26064 have died. 

About 96% of those who tested positive have not died, and the great majority have not required hospitalization. Most infected people just stay home and take to bed for a couple of days. For most of us the cure for the coronavirus is already in our bodies. Our immune system immediately attacks and destroys microscopic foreign invaders. Once infected a veritable war breaks out in our bodies that actually causes most of the symptoms like fatigue, cough, and fever.

Of course, we know that Senior citizens or those with high risk conditions like diabetes or immune system disorders are particularly vulnerable in the same way that they are to the flu. The immune reaction in their bodies is so strong that it causes inflammation and congestion that can result in deadly pneumonia. These vulnerable people are well advised to stay home.

At the beginning of the year the World Health Organization (WHO) decided to call the corona virus that originated in China in November of 2019 COVID-19. The acronym derived from the first two letters of each word plus the year of origination. Actually, a corona virus is similar to the virus that causes the common cold. Nevertheless, the ominous name made COVID-19 seem like an irresistible, unstoppable alien invader that could destroy the entire planet.

This virus like all others is no alien. It is as much a part of nature as we are. In fact, viruses existed before humans and may always have played a role in the existence of human life as we know it. COVID-19 is no different. When it enters or infects a human body, the immune system of most humans immediately attacks and ultimately destroys it. 

###

Tracking the Coronavirus

                                                

I’ve been tracking the coronavirus statistics compiled by The Center for Systems Science and Engineering (CSSE) at Johns Hopkins University for the past three weeks. As of April 7 the CSSE has reported that there are 1359398 known cases worldwide resulting in 75945 deaths so far. 289109 of those cases have recovered although it would appear that recovery statistics lag behind. 

Worldwide, over the past three weeks the number of confirmed cases has grown by over a million, and the number of deaths has grown from about 6500 to 75000. But the rate of increase has declined dramatically in the past week. From March 23 to March 30 the number of reported cases jumped by 95% but in the last week the rate of increase was 65%. In the same two weeks the number of deaths continued to grow but at a slower pace. From March 23 to March 30 the number of deaths increased by 108% but in the past week the death rate increased by 88%.

It is difficult to draw conclusions from the worldwide numbers since not only do different countries have different reporting standards, but also some may even be suppressing information. It is hard to believe that the number of cases and deaths in China leveled off so rapidly a few weeks ago. 

However, the figures in the USA are also, despite alarmist headlines, somewhat hopeful. In the past three weeks the number of reported cases has grown from about 6500 to 368000, and the number of deaths has grown from about 500 to 10937. However, from March 18 to March 24 the number of confirmed cases increased by 615%, and deaths by 958%. From March 25 to March 31 confirmed cases increased by 198% and deaths by 304%. From April 1 to April 7 the number of cases increased by 94% and the death rate by 169%. While the numbers are obviously growing, the rate of increase is slowing.

Even though the number of deaths in the USA as of this morning is 14797, we hear predictions that the eventual number of deaths in the USA will be anywhere from 100000 to 1.2 million before the epidemic is over. What are these predictions based on?

A couple of weeks ago, an alarming banner headline in my local newspaper reported that there were 6800 people in Connecticut infected with the virus despite the fact that at the time there were only 68 tested positive in the state. A medical official with the State of Connecticut explained that although there was no way to estimate the effect of the coronavirus as yet, past experience with the flu would indicate that you must multiply by 100 the number of reported cases to get the true extent of the epidemic. In other words, 68 actual cases mean that at least 6800 people have been infected.

However, a couple of weeks later the same paper reported that two Yale researchers projected that the number of reported cases should only be multiplied by 3 to get an accurate estimate of the extent of the virus contagion. These researchers admitted that there were a number of variables and unknown factors that might cause them to revise their projections. 

The gap between these two estimates is huge and that is why we should be very careful when reading alarming headlines either in print or online. I prefer to look at what has actually happened and see what conclusions can be drawn from what we actually have experienced.

It is still too early to tell but it could be that the curve is flattening due to the widely practiced social distancing measures. Some also believe that as the days grow longer in the Spring the ultraviolet light of the Sun plays a significant role. It replenishes the Vitamin D in our bodies, an important element in a strong immune system. 

Also, it is important to note that as of April 8, 400000 cases of coronavirus have been reported in the USA. Of these cases, 12857 or 3.2% have died. Of these, the great majority of the fatalities were elderly with existing medical problems like hypertension and diabetes. But what about the remaining 96.8 percent? Recovery statistics lag behind for various reasons but even if we double the death rate, the great majority of those infected will survive, and even develop immunity. 

Finally, it is interesting to compare the statistics of the USA with other countries. Both the United Kingdom and Italy also show a flattening curve but as of April 8, there have been 55987 cases in the UK resulting in 6157 deaths, a death rate of 11%. In Italy, there have been 135586 cases (although some claim the Italians are not fully reporting) with 17127 deaths, a death rate of 12.65%. Even though the USA now has the largest number of reported cases in the world, the number of those cases resulting in death (3.2%) is significantly lower.

So far, these statistics seem to indicate that the USA health care system is doing a very good job of dealing with the crisis. Hopefully, when things calm down, studies will explain the disparities in the results. These studies might also help to put the whole pandemic into perspective.  The CDC has reported that last year in the USA there were anywhere between 35 Million to 50 Million cases of the flu, resulting in 500000 to 600000 hospitalizations, and 38000 deaths. 

###

Coronavirus Immunity

In the past three weeks I have put up three posts on the coronavirus largely with the help and advice of my brother, Robert DeStefano, a retired high school master biology teacher with an intense interest in the workings of nature.  It would appear to me that the cure for the virus for most of us already already exists within our bodies. Please note the brief video at the end of the piece that actually shows killer cells hunting down unwelcome invaders.

***

The staggering complexity of the human Immune system reveals a constant struggle against all sorts of infectious agents such as: bacteria, virus, fungus, and parasites.  I will break this essay into four parts:

A.  How do humans prevent infection from happening?

B.  Once infected what is the body’s first response (Innate Response)?

C.  How do humans rid themselves of the infectious agent (Adaptive Immune Response)?

D.  How does the immune system memory function?

A:      The skin, nose hairs (both visible and microscopic), mucus, tears, and cilia lining the respiratory tract all work to prevent infectious agents from entering the body.  Our skin is covered with harmless bacteria approximately 50 million to 5000 million per square inch.  The nose traps and surrounds infectious agents with mucus, chemicals in tears prevent infection, and the cilia beating upward in the respiratory tract cleanse the lungs.  A break in the skin, touching the nose, mouth or eyes with a hand which has touched virus, approximately 15, 000 of which could fit end to end on a pin head,  can overwhelm the body.  Inhaling virus infected droplets either coughed or sneezed out by an infected person could also overwhelm the body’s first line of defense.

B:       Now let us say a person has been infected which we experience more than we realize.  The immune system has two main types of White Blood Cells known as Neutrophils and Macrophages as part of what is called the Innate Immune response.  Neutrophils are thought to be primarily involved with bacterial infections but Neutrophils may also be involved with viral destruction as well; however, Neutrophil response can lead to collateral damage due to activation of an inflammatory response which can be life threatening.  Macrophages detect and engulf infected cells.  Infected cells usually display changes on their surface which Macrophages detect.  Some viruses have evolved a way to avoid having an infected cell display these surface changes, but in doing so lower the normal cell surface architecture which Macrophages can detect and thus destroy the infected cell.  They evolve; we evolve as we face a never ending battle. Destruction of these infected cells limits viral replication since a typical infected respiratory cell could release about 10, 000 new viruses.  Macrophages, once they have engulfed a virus infected cell, will then display viral antigens on their surface which will lead to another type of immune response call the Adaptive Immune Response.

C:      The body being infected must begin a twofold attack on the invaders.  With viruses, those virus particles roaming around the body in fluid such as blood or extracellular fluid must be destroyed. This is referred to as the humoral response.  Also, cells which have been infected with the virus must be destroyed before the virus can replicate and release more viruses into the body fluid in order to infect more cells.  This is referred to the cell mediated response.  Remember that Macrophages displayed on their surface virus antigens once they had engulfed and killed a virus infected cell.  This display of an antigen eventually promotes the production of B cells which start to produce specific antibodies which locate and mark the virus for destruction.  This antibody antigen reaction eventually results in the destruction of the virus.  The virus infected cells are also marked for destruction due to markers on the cell surface and these cells are destroyed thereby stopping further viral replication.  There can be consequences to the battle being waged in the body.  A variety of toxic chemicals can be produced such as histamine which can result in an inflammatory response which can lead to pneumonia.  Also, the levels of the killings cells must be brought back down to a pre-infection level or else these may actually start an attack on healthy cells of the body inducing an auto-immune response where the immune system is attacking what it is there to protect. Fortunately, there are suppressor cells which normally control the level of killer cells after the infection has been controlled.

D:      Once the invading agent has been destroyed, the antibodies which were produced remain in the body for months and therefore can quickly detect the same infectious agent and destroy it.  Also, a variety of long lasting memory cell remain active in the body constantly circulating looking for the same infectious agent. These memory cells can quickly respond to the same infectious agent and stimulate very rapid antibody production.   This is known as active acquired immunity which is what is produced by vaccination.  This usually provides for lifetime immunity to that SPECIFIC virus or bacteria.  Unfortunately, viruses such as the flu and common cold can mutate and require a new round of innate and adaptive immune response.  Scientists have long been looking for some similar aspect of all existing common cold viruses and flu viruses which could be targeted so as to be an effective vaccine for all cold and flu viruses.

Typical Time Line of Viral Infection

Day 0 - you have been infected with a virus and have no symptoms but you are contagious

Day 1-4  -  typical symptoms appear, fever up to 102 F, coughing, tired due to onset of the Immune response.  The Innate Immune system has already been initiated and the Adaptive Immune system is at work performing both the Humoral and Cell Mediated Responses.  You are most contagious now as you are coughing and sneezing out virus laden droplets.

Day 5-7 - you are feeling better fever still present but going down.  Less contagious but the recommendation is that you wait 24 hours after body temperature is back to normal before interacting with others.  

Day 7-10 - the virus has been neutralized but there are still many immune actions being taken by the body.   Different classes of antibodies are being produced with a maximum of these present at about 14 days after Day 0.  These will persist for months in the blood plasma.  The inflammation is being attended to so you may still be coughing up mucus.

Try to think of the face as the deadly Bermuda Triangle.  Imagine a triangle extending from above the eyes down to the chin.  These are areas to be avoided especially the nose through which most viruses gain entry into the body!  

###

Note: Here's a follow up from my brother:

The CDC reported for the 2018-2019 flu season of which they have real data over a period of time from Oct to March, that somewhere between 35 million to 50 million cases of the flu in the US! 500,000 to 600,000 hospitalizations and probably 35,000 deaths with 92% of deaths involving people with diabetes. How come this level of infection doesn't seem to overwhelm the medical profession?