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The Latest on the Coronavirus — November

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11/20/2020:
     Another Shortage of Surgical Gloves as Cases Surge Again — New
     CDC Urges You to Say Home this Thanksgiving, but if you do travel.... — New
     What does emergency approval of a COVID-19 vaccine mean? — New
     Masks Still Needed After You Get the Vaccine — New
     Delirium May Be a Sign of COVID-19 in the Elderly — New
     Patients Dying of COVID-19 Refusing to Believe It — New
     ER Doctor Got Virus and Urges People to Wear Masks — New
     This Week's Statistics
           Florida Department of Health's dashboard — Updated
           Florida's COVID-19 Action dashboard — Updated

11/13/2020:
     COVID-19 Risk Assessment Travel Planning Tool — New
     Study: Almost 2,000 Marines & Asymptomatic Spread — New
     Holiday Celebrations & Small Gatherings — New
     COVID-19 Patients Developed Psychiatric Disorders — New
     Woman Shed the Virus for 70 Days w/out Symptoms — New
     9% of Hospitalized Patients Readmitted w/in 2 Months — New
     This Week's Statistics
           Florida Department of Health's dashboard — Updated
           Florida's COVID-19 Action dashboard — Updated

11/6/2020:
     U.S. Shattered Records for New Cases This Week
     Worst Hit Regions Still Resist Wearing Masks
     The Psychology Behind Not Wearing Masks
     Healthcare Workers the First to Get the Vaccine
     Delaware's Mask & Stay-at-home Orders Suppressed Transmission
     This Week's Statistics
          Florida Department of Health's dashboard
          Florida's COVID-19 Action dashboard

Friday, November 20th

• Another shortage of surgical gloves as COVID-19 cases surge again. The synthetic rubber "nitrile" gloves are a critical barrier to infection for health care workers on the front lines, but experts say the United States is poorly positioned to get ahead of a global shortfall of more than 200 billion. “Gloves are just needed everywhere,” Mary Denigan-Macauley, the Government Accountability Office’s director of health care, said. She said her team recommended the federal government come up with a plan to "mitigate these critical supply needs," but that no such plan materialized. In Florida, a truckload of 6 million medical gloves bought by Medgluv, a Florida based distributor for local hospitals, was brazenly stolen from a warehouse.
   
• The CDC emphatically says to stay home this Thanksgiving, and if you are traveling, wear as mask. And if you are feeling sick, have recently tested positive even if not feeling ill, or have had contact with someone with COVID-19 in the past 14 days, DO NOT travel at all, and do not travel with someone who is sick. If traveling, the CDC provides guidelines for preparing for your trip, during your trip, and breaks it down to your mode of transportation. It also provides tips for being out, using the bathroom or travel stops, getting gas, stopping for food, staying at a hotel or motel, when to get tested afterward, and more.
   
• Pfizer and BioNTech requested emergency authorization from FDA for their Covid vaccine today. If Pfizer’s application is approved, the vaccine will likely be limited and rolled out in phases. But what does emergency use of a COVID-19 vaccine mean? It's when regulators allow shots to be given to certain people while studies of safety and effectiveness are ongoing. During a health crisis, the FDA can loosen its normal scientific standards to allow emergency use of experimental drugs, devices, vaccines and other medical products. Instead of the usual requirement of "substantial evidence" of safety and effectiveness for approval, the FDA can allow products onto the market as long as their benefits are likely to outweigh their risks. Full approval of a vaccine will likely require 6 months of safety follow-up, as well as extensive inspections of company manufacturing sites. The leading vaccine makers are not expected to complete that process until next spring or summer. Only then is the FDA expected to grant full approval, which would allow vaccinations of the general population.
   
• However, even with a vaccine, you will still need to social distance and wear masks. Dr. Anthony Fauci warns "it's not going to be a light switch" back to normalcy, even when a COVID-19 vaccine becomes available to the public. In fact, he recommends people still wear masks and practice social distancing even after getting the vaccine. Even if it is 90% to 95% effective to the general population, it may not be that effective for you and you may still get the virus. "In addition, the protective effect of a vaccine may take at least one month, if not slightly longer." Dr. Bruce Hirsch, another infectious disease specialist, adds that many people have strong feelings about vaccines and may not take them, which may prevent the general population from becoming immune and prolong the threat of the pandemic. It is worth noting that as the trials for both vaccines (Pfizer's & Moderna's) progress, their effectiveness numbers could change. It's also not yet clear how long any immunity would last.
   
• A new study, has found that delirium may be an early warning sign of Covid-19 infection in older adults, and in some cases, it was the only symptom. More than a quarter of older patients in the study arrived in hospital ERs with delirium, and 37% of them had no typical Covid-19 signs. Delirium, confusion, inattention, disorientation, and other cognitive change is a common sign of any infection in older people. A pulmonologist and critical care physician at Vanderbilt University, who was not involved in the study said, "The message to get to the lay public and medical personnel is that if people are confused, pay attention, because right now they could have Covid. When they came to hospital emergency departments, less than half were screened and diagnosed using a test such as the Confusion Assessment Method, a tool developed by a team including Vanderbilt’s Ely and Sharon Inouye of Harvard Medical School, who is a co-author of the current study. The remaining patients’ symptoms were compared to checklists from the Centers for Disease Control and Prevention and the World Health Organization to confirm the delirium diagnosis.
   
• Jodi Doering, an ER nurse in Woonsocket, South Dakota, made news this week as she lamented in tweets and on several network and cable shows the number of Covid patients going to their deaths, refusing to believe they have the virus. "Their last dying words are, 'This can’t be happening. It’s not real.' " She says patients insist they must have pneumonia, even lung cancer, anything but the disease they’ve been persuaded doesn't exist. When they should be spending time on Facetime saying goodbye to their families, they’re filled with anger and hatred. She's overwhelmed, exhausted, frustrated, and infuriated with patients who "scream at you for a magic medicine and that Joe Biden is going to ruin the USA, all while gasping for breath.... They tell you there must be another reason they are sick, call you names, and ask why you have to wear all that 'stuff' because they don’t have COVID, it’s not real."
   
• Nearly two weeks ago, Dr. Dave Burkard woke with fatigue, a cough and shortness of breath. The 28-year-old emergency medicine resident knew exactly what it was: COVID-19. After months of living and working through the pandemic, he had somehow caught it. Yet, he was surprised by how sick he became even though he was healthy and active. For two days, Burkard’s fever wouldn’t break, but then he started improving and feeling closer to his "normal self." But around day 6, things took a turn for the worse, and he had to go to the ER. If we don't take COVID-19 seriously, it will affect all of us, not just health care providers or patients, it'll reach farther. While he doesn’t want to shame people who don't wear masks or think COVID-19 is a hoax, he hopes that his story inspires them to take precautions because they want to be kind to people in their communities. It's not about fear mongering. It's about just having love for the people around us and respect for them.
   
• As usual, I am showing statistics from two dashboards/data portals: Florida's Dept. of Health (DOH) statistics and Florida's COVID Action statistics (both developed by Rebekah Jones). (Click on images to enlarge them.)  However, their accuracy may be off since testing is down and there were reporting issues, but you still should be able to see the trends.

• Per the Florida Department of Health's dashboard* as of Friday, November 20th, the state now has 910,065 residents testing positive for COVID-19, with 53,091 hospitalized, and 17,889 deaths.** As you can see, the number of cases are on the rise again. The breakdown of confirmed cases in our tri-county area is: Sumter County: 3,248 cases (3,229 residents, 19 non-residents), 310 hospitalizations, with 92 deaths (median age still: 56, 57% males, 43% females)    Lake County: 9,946 cases (9,867 residents, 79 non-residents), 796 hospitalizations (14 non-residents), with 243 deaths (median age still: 44, 46% males, 52% females)   Marion County: 12,220 cases (12,185 residents, 35 non-residents), 1,142 hospitalizations (2 non-residents), with 375 deaths (median age still: 43, 41% males, 59% females) * The new data includes the number of test results the department receives from the counties, along with additional demographics and graphs that show hospital admissions for patients complaining of cough, fever or shortness of breath. Previously, that data was only provided for larger counties. Still not included is how many infected people have recovered from the virus and, unlike other states, Florida does not report "probable" deaths from the virus.   ** The newest reported deaths are the latest logged into the DOH system, and that process could take as long as two weeks or longer before they show up.

  Per the Florida's COVID Action dashboard as of Friday, November 20th, the state now has 1,009,562 residents testing positive (9,085 cases today, 53,157 cases this past week, 82,103 K-12 pediatric/staff cases this week); with 3,439 requiring hospitalization; and 18,110 deaths (80 deaths today, 451 deaths this past week). The breakdown of confirmed cases in our tri-county area is: Sumter County: 3,483 cases (18 cases today, 116 this week), 152 K-12 Pediatric cases (62 students/16 staff), 15 hospitalizations this week, and 92 deaths (1 death today, 3 this week).    Lake County: 10,546 cases (74 cases today, 373 this week), 847 K-12 Pediatric cases (139 students/83 staff), 52 hospitalizations this week, and 246 deaths (0 deaths today, 2 this week).    Marion County: 12,625 cases (159 cases today, 632 this week), 965 K-12 Pediatric cases (191 students/82 staff), 44 hospitalizations this week, and 375 deaths (3 deaths today, 13 this week). None of these counties meet the criteria for the next phase of reopening.

Friday, November 13th

• Want to know how risky it would be to travel for Thanksgiving? The COVID-19 Risk Assessment Planning Tool, built by Georgia Tech researchers, helps you see the risks of gatherings across the country given the event size and location. Enter the event size (e.g., 10 people), then find the state and county you want to visit. If we stay in Sumter County for Thanksgiving dinner with 10 guests attending, we have a 6% chance of at least 1 COVID-19 positive individual will be present, but if we travel to Hillsborough County, our chances increase to 10%. The tool is updated daily so that percentage may change tomorrow.
   
• A study of nearly 2,000 Marine recruits who went through supervised quarantine before starting basic training revealed several instances of asymptomatic transmission of SARS-CoV-2, the virus that causes COVID-19. Few infected recruits had symptoms before diagnosis. The study data revealed asymptomatic spread of the virus even under strict military orders for quarantine and public health measures that most likely experienced better compliance than what would be possible in other youth settings like college campuses. The researchers noted that daily temperature and symptom checks did not detect infections.
   
• We look forward to holidays so we can reconnect with family and friends. Unfortunately, the COVID-19 epidemic is worsening, and small household gatherings are an important contributor to the rise in COVID-19 cases. CDC offers things you should consider during small gatherings, when you should not attend in-person holiday gatherings, guidelines if hosting or attending a gathering, food and drink considerations, safety measures you can take if traveling or staying overnight, steps you should take if exposed to COVID-19 during a gathering, and be informed about the risk connected with your activities.
   
• The medical journal The Lancet Psychiatry published a report that says patients who are diagnosed with COVID-19 are at a greater risk for developing mental health disorders, including anxiety, depression, dementia, and insomnia. The study says that around 22%, or 1 in 5 patients who survive the illness, will have some signs of mental health issues within 90 days of being infected. People with a pre-existing mental illness were 65% more likely to be diagnosed with COVID-19 than those without. The good news, a significant proportion of people do get better with time and/or with treatment.
   
• On March 2nd, a 71-year-old hospital patient with leukemia tested positive for the novel coronavirus. On average, COVID-19 patients shed infectious virus particles for about eight days. But 70 days after her diagnosis, the patient was still shedding infectious particles. By mid-June, more than 100 days later, the woman was still testing positive, indicating that her body still contained traces of the virus, when she still could have passed the virus to others. The 70-day infectious period is the longest ever seen in an asymptomatic patient. Researchers believe it was because her weakened immune system was unable to mount a defense against the virus. A June study of immunosuppressed patients with the virus found that they shed viral particles for an average of 28.4 days. 
   
• The CDC reported earlier this week that 9% of hospitalized coronavirus patients were readmitted within two months of being discharged. Risk factors for readmission included age ≥65 years, presence of certain chronic conditions, hospitalization within the 3 months preceding the first COVID-19 hospitalization, and discharge to a skilled nursing facility or with home health care.
   
• As usual, I am showing statistics from two dashboards/data portals: Florida's Dept. of Health (DOH) statistics and Florida's COVID Action statistics (both developed by Rebekah Jones). (Click on images to enlarge them.)  However, their accuracy may be off since testing is down and there were reporting issues, but you still should be able to see the trends.
   

  Per the Florida Department of Health's dashboard* as of Friday, November 13th, the state now has 858,585 residents testing positive for COVID-19, with 51,542 hospitalized, and 17,445 deaths.** As you can see, the number of cases are on the rise again. The breakdown of confirmed cases in our tri-county area is: Sumter County: 3,140 cases (3,123 residents, 17 non-residents), 301 hospitalizations, with 89 deaths (median age now: 56, 57% males, 43% females)    Lake County: 9,466 cases (9,397 residents, 69 non-residents), 767 hospitalizations (13 non-residents), with 242 deaths (median age now: 44, 46% males, 52% females)   Marion County: 11,600 cases (11,571 residents), 1,111 hospitalizations (2 non-residents), with 362 deaths  (median age still: 43, 41% males, 59% females) * The new data includes the number of test results the department receives from the counties, along with additional demographics and graphs that show hospital admissions for patients complaining of cough, fever or shortness of breath. Previously, that data was only provided for larger counties. Still not included is how many infected people have recovered from the virus and, unlike other states, Florida does not report "probable" deaths from the virus.   ** The newest reported deaths are the latest logged into the DOH system, and that process could take as long as two weeks or longer before they show up.

  Per the Florida's COVID Action dashboard as of Friday, November 13th, the state now has 951,012 residents testing positive (6,933 cases today, 38,088 cases this past week, 13,611 K-12 pediatric/staff cases this week); with 2,349 requiring hospitalization; and 17,659 deaths (74 deaths today, 435 deaths this past week). The breakdown of confirmed cases in our tri-county area is: Sumter County: 3,349 cases (26 cases today, 92 this week), 75 K-12 Pediatric cases (59 students/16 staff), 17 hospitalizations this week, and 89 deaths (0 deaths today, 1 this week).    Lake County: 9,986 cases (42 cases today, 373 this week), 847 K-12 Pediatric cases (139 students/83 staff), 2,564 hospitalizations this week, and 244 deaths (1 death today, 6 this week).    Marion County: 11,944 cases (92 cases today, 394 this week), 885 K-12 Pediatric cases (175 students/73 staff), 40 hospitalizations this week, and 362 deaths (0 deaths today, 7 this week). None of these counties meet the criteria for the next phase of reopening.

Friday, November 6th

• New coronavirus cases in the U.S. reached staggering highs this week, the second week in a row of record-breaking increases. Hospitalizations rose quickly, too. On Wednesday, the country recorded more than 100,000 cases in a single day. By Thursday, cases jumped even higher to more than 121,000 in one day. On average, new U.S. cases are now up 55% over two weeks ago. Although there's been a modest increase in testing, not enough to explain how fast cases have increased in this recent surge. And positivity rates are high in many states, which indicates there are more infections in the community than are captured by testing.
   
• The virus is rapidly spreading throughout the country, but it's been reported that some of the worst hit regions still resist wearing masks. After touring North Dakota, which has the highest covid-19 death rate in the U.S., White House coronavirus task force coordinator, Deborah Birx, observed that Masks are not being worn in grocery stores, restaurants, and hotels. Meanwhile, an analysis of cases in Tennessee by Vanderbilt University found that regions without mask mandates also have the highest rates of hospitalization for covid-19.
   
• Psychology Today had an interesting article about the psychology behind people who do not wear face coverings during the pandemic. It basically boils down to five categories of people.  1) Impotent personalities just don’t care about other people or what happens to them. Their only concern is what they want or don't want to do, and think it's too much trouble to wear one.  2) Magical thinking people follow an illogical approach, irrespective of the reality of circumstances. Their thinking is that they've been in self-quarantine for four months, they're tired of it, they want their life back to normal, before COVID-19.  3) Lack of knowledge people don't have any scientific and medical understanding of COVID-19 transmission. If they can’t see it, it must not be there. They have no appreciation of contagion or how viruses spread.  4) People that are Inexperienced with illness or death are usually younger adults who have grown up with vaccinations for polio, measles, mumps, etc. They have no experience with the military draft or people close to them dying in war so they don't fear illness or death.  5) Our politics and history predisposes us to not liking others telling us what to do. Some believe wearing a mask infringes their personal rights, failing to consider whether it makes sense in the middle of a pandemic.
   
• According to Dr. José Romero, head of the committee that develops evidence-based immunization guidelines for the CDC, told NPR (National Public Radio) that health care workers will get the first doses of COVID-19 vaccine in the U.S. when one is approved. That's a decision based on the science of what will quell the pandemic fastest. "It's not just the doctors and nurses that are interacting with patients, but also the support personnel that help, which could include those who are delivering food or maintenance people, as well.
   
• A new U.S. CDC study has concluded that Delaware’s stay-at-home order and face mask mandate helped reduce coronavirus infections, hospitalizations and deaths, with an 82% reduction in Covid-19 incidence and an 88% reduction in hospitalizations. However, there were several barriers to the state's contract tracing efforts that could have prevented the virus from spreading even further early in the pandemic. Among the more than 9,700 laboratory-confirmed cases reported between March 11th and June 25th, nearly two-thirds of the patients were interviewed, but 83% either refused to name contacts or couldn't recall contacts. "Early detection, self-isolation, and investigation of COVID-19 cases and self-quarantine of close contacts can be effective in preventing community transmission, if contacts are identified and reached soon after exposure," the study said. Polk County, Iowa
   
• As usual, I am showing statistics from two dashboards/data portals: Florida's Dept. of Health (DOH) statistics and Florida's COVID Action statistics (both developed by Rebekah Jones). (Click on images to enlarge them.)  However, their accuracy may be off since testing is down and there were reporting issues, but you still should be able to see the trends.
   

  Per the Florida Department of Health's dashboard* as of Friday, November 6th, the state now has 816,376 residents testing positive for COVID-19, with 50,077 hospitalized, and 16,961 deaths.** As you can see, the number of cases are on the rise again. The breakdown of confirmed cases in our tri-county area is: Sumter County: 3,047 cases (3,034 residents), 298 hospitalizations, with 88 deaths (median age still: 55, 57% males, 43% females)    Lake County: 9,103 cases (9,038 residents), 750 hospitalizations (11 non-residents), with 236 deaths (median age now: 43, 46% males, 52% females)   Marion County: 11,205 cases (11,179 residents), 1,088 hospitalizations (1 non-resident), with 355 deaths  (median age still: 43, 41% males, 59% females) * The new data includes the number of test results the department receives from the counties, along with additional demographics and graphs that show hospital admissions for patients complaining of cough, fever or shortness of breath. Previously, that data was only provided for larger counties. Still not included is how many infected people have recovered from the virus and, unlike other states, Florida does not report "probable" deaths from the virus.   ** The newest reported deaths are the latest logged into the DOH system, and that process could take as long as two weeks or longer before they show up.

  Per the Florida's COVID Action dashboard as of Friday, November 6th, the state now has 913,085 residents testing positive (5,245 cases today, 32,567 cases this past week, 72,336 K-12 pediatric/staff cases this week); with 2,349 requiring hospitalization; and 17,224 deaths (54 deaths today, 297 deaths this past week). The breakdown of confirmed cases in our tri-county area is: Sumter County: 3,256 cases this past week (21 cases today, 118 cases this week), 146 K-12 Pediatric cases, 2,564 hospitalizations, and 88 deaths (1 death today, 2 this week).    Lake County: 9,623 cases (56 cases today, 448 cases this week), 814 K-12 Pediatric cases, 2,564 hospitalizations, and 232 deaths (0 deaths today, 8 this week).    Marion County: 11,549 cases (45 cases today, 304 cases this week), 848 K-12 Pediatric cases, 2,564 hospitalizations, and 355 deaths (3 deaths today, 8 this week). None of these counties meet the criteria for the next phase of reopening.