COVID19 update, May 2, 2020 edition: Remdesivir gets FDA approval; detailed German statistics

(1) The top news item of the day is probably that Gilead Scientific’s antiviral drug remdesivir was given FDA Emergency Approval for use in COVID19 patients. Remdesivir is not a “magic bullet”, but it’s a start.

(2) Roger Seheult MD, pulmonologist and medical school instructor, gives a 1.5 hour recap video on what we know about COVID19.

(3) Miscellaneous updates:

  • the Ma`ayanei haYeshua [Wellsprings of Salvation] hospital in Bnei Brak, Israel (a COVID19 hotspot) has deployed an Israeli-developed UV-C room sterilization system. This is of broader relevance than COVID19, and if successful, will prove very helpful in the protracted and increasingly worrying struggle against hospital “superbugs” — bacteria resistant to every known antibiotic. (Such bacteria tend to develop in hospitals and long-term care settings through “Darwinian selection”, as both infections and treatment with aggressive antibiotics are frequent.)
  • Die Welt has a detailed video (in English, with German subtitles) on significant progress with a vaccine in the USA
  • worrisome reports about some peculiar COVID19-like pediatric syndrome noted in earlier updates: these now appear to have been identified as Kawasaki’s disease, which is of uncertain origin but some sort of autoimmune etiology is suspected. Coincidence or new cases triggered by COVID19 infection?
  • disturbing reports of COVID19 “reinfections” in South Korea appear to have been false positives in the test
  • Abbott’s new rapid COVID19 test, which claims 99% accuracy, has been approved for use in Europe.
  • if you give people perverse incentives to cook the books, and don’t balance that out with a deterrent for the act of cooking — well, don’t be surprised if books get cooked. NYC funeral director on candid recording about people who obviously died from otehr causes being coded as COVID19. Mind you, I am sure the un-inflated COVID19 mortality in NYC would be quite bad enough (“thanks” to very high pollution density and the subway as “the mother of all superspreaders”) — but those numbers struck me as anomalously high from the start. (As discussed in previous updates, numbers from Italy and Belgium are inflated for different reasons.)

(4) In contrast, countries like South Korea and Germany have rather more scrupulous reporting standards. I’ve linked previously to the daily Korean CDC reports: here is the detailed daily update (in English) from the Robert Koch-Institute (Germany’s infectious diseases authority, named after the discoverer of the tuberculosis pathogen). A few highlights from the daily report:

  • Only 19% of all cases occurred in persons aged 70 years or older — but these account for 87% of deaths.
  • cases per 100,000 people in age cohorts are fairly homogenous across age cohorts 20-29 through 70-79, climb sharply in the highest age cohorts, and drop steeply for ages 10-19 and especially 0-9.
  • mortality in age cohorts 0-9 and 10-19 are ONE (1) patient each, while age cohorts 20-29 and 30-39 account for just 6 and 14 deceased out of a total of 6,472. Yes, Virginia, ages below forty account for just 0.3% of all dead, and all ages below fifty for just 1%. Fifty-somethings add another 3.2%, sixty-somethings another 9.0%.
  • Their technique of estimating the effective reproductive number R consists of dividing the 4-day moving average of new cases by the one 4 days earlier. At present it is R=0.79, with a 95% confidence interval of 0.66–0.90. Any R value below 1 implies that the epidemic will wither away, while any value over 1 implies slower or faster exponential growth.
  • the report points to a European Union website with all-causes excess mortality graphs. These serve as a useful “sanity check” on COVID19 death reporting criteria for different countries.

COVID19 update in brief, April 2, 2020: (1) Belgium followup; (2) German RKI recommends masks for everyone, Israel mandates them in public

A very busy day at the (remote) day job, so just a brief update:
(1) Following up on the earlier report from De Standaard (in Dutch) reports a grim peak of 183 dead in a single day, for a total of  1,011 in a country with 11 million people.

However, and this is the good news, hospital admissions have held steady between 450 and 650 for the past week. The last day, 584 new admissions were offset by 363 discharges. Out of 5,376 hospital patients with COVID19, 1,114 are in ICU, an increase by 56 (the smallest since March 23). 906 of those need ventilation, an increase by 72.

teven Van Gucht, head of the National Corona Committee, is quoted as saying, ‘The nummer of new admissions fluctuates already for days in the same range, which indicates we’ve reached a plateau. This is surely due to the [social distancing] measures.”

A friend sent me this graph. Note that both the graphs for Belgium and for Israel show a noticeable “inflection point” around 14 days beyond the introduction of social distancing measures.

(2) While Belgium is still reluctant to mandate masks for everyone, Germany’s authority for infectious diseases, the Robert Koch Institute (named after the discoverer of, among others, the tuberculosis bacillus) now recommends masks for everyone. Their prime benefit is said to be stopping asymptomatic infection carriers from spreading the disease.
For the same reasons, Israel’s ministry of health today mandated the wearing of masks in public areas.