August 10, 2020

 Latest numbers show that North Carolina has not seen a spike in deaths. There have been similar daily deaths over the past few months despite the significantly higher number of cases. The Northeast continues to be stable and there are a few areas seeing mild increases. The hot spots in the South are cooling down. North Carolina peaked on July 23rd. As with the first newsletter on this topic, keep solace with the fact that there is a 99+% chance of survival for all of us.

NC death cases


 1) A very interesting and truly dispassionate article written in the Daily Mail raises very important questions regarding the overall reaction to this pandemic and death in general. We know that the vast majority of deaths related to COVID19 were in significantly compromised individuals who may or may not have died in the coming weeks to years. Did we really just see accelerated deaths in these at risk individuals and thus now are seeing less deaths as these individuals that contracted the disease are now deceased and out of the risk pool? This is a highly plausible argument and is rooted in Darwinian science. As time progresses, those at highest risk will become less and less in number and thus death overall related to COVID19 will absolutely decline. Time will continue to prove this true or false, however, it is likely to be true. Always remember that to discuss these issues in a dispassionate way is with the knowledge that we all mourn the loss of those that are no longer with us. We never want to lose sight of life and love.


2) Repeat from last week as this is important: The American College of Cardiology has written a nice algorithm for a post COVID19 return to sports plan. Their thoughts are:
a) one must be symptom free for 14 days
b) for teenagers and college students that had moderate disease (prolonged fever and bedrest), they should consider getting an EKG, echocardiogram and troponin I. These tests can rule out COVID damage that could result in a negative outcome with an acute change in metabolic demand that follows a return to competitive sports. Younger children need not have any intervention unless they had multi inflammatory syndrome.
c) for anyone with severe disease (hospitalized, abnormal cardiac testing) they should not proceed until cleared by a specialist (Dean et. al. 2020)


3) It is becoming more and more apparent from the literature that many many more people have been exposed to this virus and while they may or may not have detectable antibodies they are almost certainly living with T cells and memory B cells specific to SARS2. (Le Bert et. al. 2020) SARS-CoV-2-specific T cells were detectable in antibody-seronegative family members and individuals with a history of asymptomatic or mild COVID-19. (Sekine et. al. 2020) This is going to be a second major reason moving forward as to why we will continue to see less cases but specifically, less deaths. Understanding the immunology of SARS2 will provide us with a clearer and clearer picture of how to move forward as a society. It will also help us all stay focused on the reality and not the ridiculous sensationalized mainstream media coverage. As long as this virus continues to keep a relatively low infection fatality rate of 0.26% or likely even less as the data trends continue and slants towards the metabolically ill, we will likely be able to get the population exposed and relatively immune in a year or so with less death. This is all hypothetical ifs.


4) In an opinion piece in The Atlantic magazine, Kristen McConnell wrote what I have been thinking all along: title - "I'm a Nurse in New York. Teachers Should Do Their Jobs, Just Like I Did." She writes, "Instead of taking the summer to hone arguments against returning to the classroom, administrators and teachers should be thinking about how they can best support children and their families through a turbulent time. Schools are essential to the functioning of our society, and that makes teachers essential workers. They should rise to the occasion even if it makes them nervous, just like health-care workers have."

Societies of the past, during World War II for example, sacrificed much to make the country strong and survive for the next generation. Whether you agree with this opinion piece or not, we have to find a way to teach the children. That has to be the primary goal or we will sacrifice them and their future for our own personal safety.

 5) Further work on school risk.

 a) Kids in an overnight Georgia camp effectively spread the virus between each other. There was no effective masking rules and children were cheering and singing which is a potent spreading activity. 260 of the 610 children and adults tested positive with no bad outcomes. (NBCnews article )

b) In an Australian school study, published in the Lancet, there was a decidedly low transmission rate. From the article, "15 schools and ten ECEC settings had children (n=12) or adults (n=15) attend while infectious, with 1448 contacts monitored. Of these, 633 (43·7%) of 1448 had nucleic acid testing, or antibody testing, or both, with 18 secondary cases identified (attack rate 1·2%). Five secondary cases (three children; two adults) were identified (attack rate 0·5%; 5/914) in three schools. No secondary transmission occurred in nine of ten ECEC settings among 497 contacts. However, one outbreak in an ECEC setting involved transmission to six adults and seven children (attack rate 35·1%; 13/37). Across all settings, five (28·0%) of 18 secondary infections were asymptomatic (three infants [all aged 1 year], one adolescent [age 15 years], and one adult). (Macartney et. al. 2020)

c) The data to date speaks to very low transmission rates in school settings. Large crowds, overnight camps, singing events and other high risk spread situations should be curtailed.

d) The data shows that standing in the front of the classroom, wearing a mask and limiting exposure to any one child for a prolonged time can significantly reduce the risk of a COVID infection. Viral load and time of exposure appear to be a big part of the illness risk and severity. For example, the first ill person in a household usually recovers quickly and without significant issues. The individuals that quarantined with the index case are more likely to fair less well as they presumably had more exposure over a longer period of time. Age has a lot to do with risk of getting sick and how sick. The young continue to have little risk overall. (Jing et. al. 2020)(Li et. al. 2020)

e) The other elephant in the room that has been talked about for years as it relates to academic ability is the poor ventilation of the older school buildings. Francis Koster and the Pollution Detectives (site) have been looking at the CO2 levels in poorly ventilated schools and the results are not good. When the schools are poorly designed, maintained or both, the CO2 levels and other pollutants rise throughout the day affecting thinking and health. I bring up this point because this is a known issue that has implications for COVID and teaching. Poorly ventilated schools, in theory, are more likely to hold virus for longer and could be part of a transmission scenario whereas a well ventilated school would be more likely to expel the virus faster. A solution until the school system fixes the ventilatory system is to open windows and hold more classes outside.

6) Sweden continues to look good. Article. No masks and no lockdown. Is it luck or are we missing something here?

7) Why are COVID19 patients losing their sense of smell? A group of scientists have figured this issue out. Read here.

8) An excellent 18 minute podcast by Docsmo on the SARS2 vaccines is available here.

For now, using a mask of the surgical type appears to be a great idea to prevent spread. The best idea for survival is still rooted in caring for yourself through healthy eating, adequate rest, exercise and stress reduction.

Knowledge is power,

Dr. M

Dean American College of Cardiology
Le Bert Nature
Sekine BioRxIV
McConnell Atlantic
Macartney Lancet
Jing Lancet Infectious Disease
Li Clinical Infectious Diseases
CDC Death Statistics
Jiang Harvard Medical School