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COVID Crisis Post 67: Additional Updates on the COVID Front.

Updated: Aug 31, 2020

New York City may be coming back to life. Sorta. Kinda.

There is optimism that NYC could start phase 1 of reopening - retail merchants with distancing guidelines and construction work - by mid-June. There are various metrics that must be met for 10-14 days consecutively to allow for reopening:

1. Total number of patients being admitted to hospitals daily must be less than 200. 2. Total number of ALL patients in the ICU, not just COVID-19, must be less than 375. 3. Total percentage of patients testing positive for COVID-19 daily must be less than 15%.

Number 2 at the moment is the biggest hold up due to the large number of COVID-19 patients still filling up a large number of beds.

Given NYC was the epicenter of the breakout, I am allowing myself to be cautiously optimistic. Because it is up to ALL of us to keep being socially responsible so we can have some semblance of a summer in the city.

But there WILL be a second wave - bet on it. Let us just hope we can mitigate it by not doing anything stupid, especially avoiding unnecessary large gatherings, social distancing, masks, and hygiene.

Per usual.

And in the meantime: keep supporting your local businesses! NYC has a number of restaurants that allow for walk-up food and booze, and seeing people walking down streets with alcohol flowing is kinda fun and unique we never get to do here otherwise!

Multiple city streets have also been closed to through traffic with the goal to allow pedestrians greater ability to social distance and more space to hang outdoors.

I wish things were normal, but honestly, the city has felt kinda special and unique as a result of the closures. It is definitely a different NYC, but still so much the same as I have said.

A few quick and dirty updates on the science front:

1. Researchers have discovered SARS-CoV-2 acts differently than SARS and other viruses in the way it works to modulate the immune response. It is a two-pronged system in its most basic form: release of interferons and cytokines.

Typically, interferons are produced once a virus begins replicating, and these interferons help slow down viral replication UNTIL our chemokine/cytokine response kicks in. SARS works by impeding BOTH responses.

HOWEVER, it seems the virus works by only impeding the interferon response and NOT the cytokine response.

This is significant in terms of explaining and understanding the patients we are seeing who are most at risk for developing severe disease.

As we get older and along with some chronic diseases, our interferon response dampens and therefore the virus has less resistance in terms of replicating. This may be the reason for the uncontrolled chemokine response leading to "cytokine storm" because uncontrolled viral replication may lead to the immune system being totally overwhelmed and attempting to churn out enough cytokines to deal with the huge amount of virus floating around.

Interferon responses are more robust in the young and healthy, so this may be the reason for the smaller number of children and young healthy adults in our ICUs in comparison.

2. As I have said in the past, children with Kawasaki disease in some studies have demonstrated high levels of BOTH interferons and certain cytokines like IL-6. So curious to know if in cases of MIS-C, if the interferon response is still high but not enough to stave off the cytokine storm as a result.

The delayed response in children may mimic the second "wave" of illness that many COVID-19 patients seem to experience, where they feel crummy, then better, and feel even worse.

Because Kawasaki disease is more common in the winter months, this is likely the reason these cases were missed earlier. So once cases started popping up in April, along with children MUCH older than what would be expected with good ole regular Kawasaki, this raised suspicion it may be related to COVID-19 instead.

So there is an attempt to antibody test all children in some hospitals who presented with Kawasaki during the winter months and see if they are positive. And fortunately, MIS-C has been much more treatable than not.

3. There has been no evidence THUS FAR that COVID-19 will be like Dengue, where antibody-dependent enhancement makes a subsequent infection with a different strain worse. This is good news.

4. Do NOT freak out about the apparent "change" from the CDC regarding surface contamination and spread of the virus. Nothing changed.

It was NEVER considered a major cause of spread of the virus, as it has always been droplets. The risk is very low and spread via touching contaminated surfaces was never thought to be a major threat. So I never wiped down anything besides my cell phone. Which people should do anyway.

And until they could confirm HOW low the risk would be, informing the public to practice proper hygiene was a good move.

Good old fashioned hygiene does the trick usually to prevent illness. People just really suck at it, which is why the CDC needed to tell people to wash their hands. Because so many people are gross. And may be contaminated by butt juice 🤮🤮🤮🤣.

5. Even though asthma can flare with any respiratory illness, there are a multitude of studies that have come out with results demonstrating asthma does NOT appear to be a risk factor for contracting COVID-19. For this, I am very grateful as an asthmatic myself.

6. Do not host COVID-19 parties. For the sake of everything good in this world, just don't.

7. The CDC has never been a perfect entity. But this level of incompetence is absurd, and there is something driving this incompetence.

The idea of incorporating the number of COVID-19 viral tests and antibody tests into one pool to determine the "total number of people tested" for COVID-19 is totally asinine.

This has huge implications in regards to opening and monitoring ACTIVE disease. This is something no normal person would ever have suspected was happening. Fortunately, it seems many states are reversing it and will be releasing modified numbers which more accurately reflect the amount of COVID-19 viral tests being completed.

Just felt like a straightforward post today. Enjoy the graphic 💦🌬💩☠😘🤣.

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