COVID-19

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Chinese researchers in Shanghai first shared the genetic sequence of SARS-COV-2, the virus that causes COVID-19, National Center for Biotechnology Information's website on January 5. According to the U.S. State Department, China then shared with the WHO a genetic sequence taken from a January 4 patient infected with the virus, which was published on January 12 by the Global Initiative on Sharing All Influenza Data (GISAID).

A senior State Department official told CBS News that disclosure is not enough. "It is critical to obtain live virus samples to understand how the virus evolved, and how to develop effective and safe therapeutics and vaccines."

The official also said that producing a vaccine only using a genetic sequence "introduces the risk of mutations, and the possibility that the reproduced virus (from which to develop a vaccine) doesn't mirror the virus circulating in the population."

But medical experts tell CBS News they are skeptical of the need at this point for early virus samples to develop a vaccine and treatments. "The fact that there isn't an actual replicating vial of virus is not a problem, as long as you have this sequence of what was in that tube," said Dr. Andy Pekosz of Johns Hopkins Bloomberg School of Public Health.

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Earlier this month, the Senate Republican campaign arm circulated a memo with shocking advice to GOP candidates on responding to coronavirus: “Don’t defend Trump, other than the China Travel Ban — attack China.”

The Trump campaign was furious.

On Monday — just days after POLITICO first reported the existence of the memo — Trump political adviser Justin Clark told NRSC executive director Kevin McLaughlin that any Republican candidate who followed the memo’s advice shouldn’t expect the active support of the reelection campaign and risked losing the support of Republican voters.

McLaughlin responded by saying he agreed with the Trump campaign’s position and, according to two people familiar with the conversation, clarified that the committee wasn’t advising candidates to not defend Trump over his response.

The episode illustrates how the Trump political apparatus demands — and receives — fealty from fellow Republicans and moves aggressively to tamp down on any perceived dissent within the GOP. The president maintains an iron grip on his party, even as his poll numbers sag and he confronts fierce criticism from Democrats over his response to the coronavirus pandemic.

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State health officials have confirmed an additional 1,000 cases of the new coronavirus in the past 24 hours, bringing Georgia’s total infections above 27,000.

As of noon Thursday, the Georgia Department of Public Health was reporting just over 26,000 confirmed cases. That number now stands at 27,134, according to data released at 12:25 p.m. Friday.At least 1,147 Georgians have died of COVID-19, the disease caused by the virus. The health department verified an additional 40 deaths since midday Thursday.

Heretic wrote:

 
In a conference call with top GOP officials, Dr. Brian Monahan said there is not sufficient capacity to quickly test senators for coronavirus — a contrast with the White House, where any people meeting with President Donald Trump and Vice President Mike Pence are tested for the disease.

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The White House is blocking Anthony Fauci from testifying before a House committee investigating the coronavirus outbreak and response, the panel’s spokesman said Friday.

Evan Hollander, spokesman for the House Appropriations Committee, said the panel had sought Fauci’s testimony for a hearing next week but that Trump administration officials denied the request. The committee was told by an administration official that the denial came from the White House.

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The research community is reacting with alarm and anger to the National Institutes of Health’s (NIH’s) abrupt and unusual termination of a grant supporting research in China on how coronaviruses—such as the one causing the current pandemic—move from bats to humans.

The agency axed the grant last week, after conservative U.S. politicians and media repeatedly suggested—without evidence—that the pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) escaped from a laboratory in Wuhan, China, that employs a Chinese virologist who had been receiving funding from the grant. The termination, which some analysts believe might violate regulations governing NIH, also came 7 days after President Donald Trump, asked about the project at a press conference, said: “We will end that grant very quickly.”

NIH declined to comment on why it canceled the grant, which was in its sixth year. But in emails reviewed by ScienceInsider, Michael Lauer, NIH’s deputy director for extramural research, suggested the Wuhan laboratory had not “taken all appropriate precautions to prevent the release of pathogens” that were the focus of the project. NIH offered no further support for that statement, however, and Lauer referred to the notion of the pandemic virus escaping the lab simply as “allegations.”

Researchers familiar with the laboratory are skeptical of claims of lax safety practices. Trump administration officials have reportedly pressed U.S. intelligence agencies to produce firm evidence linking the virus to the lab, but key spy agencies have not confirmed any connection so far. Today, a U.S. intelligence assessment added that the U.S. intelligence community “concurs with the wide scientific consensus that the COVID-19 virus was not manmade or genetically modified.” The statement left open the possibility that an accidental release of a natural virus could have launched the pandemic. (Later today, Trump said he was confident the virus came from the Wuhan lab, but that he was “not allowed” to say why he believed that.)

NIH’s move, which was first reported by Politico, “is the most counterproductive thing I could imagine,” given the research’s relevance to understanding the current pandemic and avoiding future viral outbreaks, says Gerald Keusch, a former director of NIH’s Fogarty International Center who is now with the National Emerging Infectious Diseases Laboratory at Boston University. “This is a horrible precedent.” (Keusch recently partnered with the canceled grant’s principal investigator to apply for a different NIH grant; they were unsuccessful.)

Others fear the project has become a casualty of an overtly political attempt by the Trump administration to shift attention away from its own troubled response to the pandemic and blame China. “There’s a culture of attacking really critical science for cheap political gain,” says Dennis Carroll, who recently retired as director of the emerging threats division of the U.S. Agency for International Development (USAID).

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Over three weeks ago, hydroxychloroquine was all the rage in MAGA world, despite flawed and scattered evidence about whether the drug could help cure coronavirus. Now there is another drug, remdesivir, with positive early scientific data.

Much of MAGA world wants little to do with it.

At first, it may seem like a head-scratching response. President Donald Trump’s base has been quick to trumpet any potential solutions to the coronavirus pandemic — especially those Trump himself promotes — regardless of the red flags from medical experts. But with remdesivir, it’s the Trump-boosting pundits who are raising the red flags, even as the president expresses optimism.

Indeed, the same segment of the right that claimed scientists and the media were deliberately downplaying hydroxychloroquine in order to hurt Trump’s standing are now the ones downplaying remdesivir. On Fox News, Laura Ingraham suggested that remdesivir, as a newer drug being produced by the pharmaceutical company Gilead Sciences, could be unsafe and expensive. Those who initially helped raise the profile of hydroxychloroquine raised doubts about the remdesivir studies.

The unexpected reaction appears to stem from the differences in how the two drugs came into the public spotlight. Hydroxychloroquine bubbled up through the MAGA grassroots — little-known investors promoted it online, got on Fox News and suddenly the president was talking about it from the White House. Remdesivir’s progress came through a government-funded trial that had the blessing of Dr. Anthony Fauci, the bête noire of Trump hardliners who blame the government’s top infectious disease expert for undermining the president and causing unnecessary economic damage with his social-distancing guidelines.

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President Trump moved on Friday night to replace a top official at the Department of Health and Human Services who angered him with a report last month highlighting supply shortages and testing delays at hospitals during the coronavirus pandemic.

The White House waited until after business hours to announce the nomination of a new inspector general for the department who, if confirmed, would take over for Christi A. Grimm, the principal deputy inspector general who was publicly assailed by the president at a news briefing three weeks ago.

The nomination was the latest effort by Mr. Trump against watchdog offices around his administration that have defied him. In recent weeks, he fired an inspector general involved in the inquiry that led to the president’s impeachment, nominated a White House aide to another key inspector general post overseeing virus relief spending and moved to block still another inspector general from taking over as chairman of a pandemic spending oversight panel.

Mr. Trump has sought to assert more authority over his administration and clear out officials deemed insufficiently loyal in the three months since his Senate impeachment trial on charges of abuse of power and obstruction of Congress ended in acquittal largely along party lines. While inspectors general are appointed by the president, they are meant to be semiautonomous watchdogs ferreting out waste, fraud and corruption in executive agencies.

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Her report, released last month and based on extensive interviews with hospitals around the country, identified critical shortages of supplies, revealing that hundreds of medical centers were struggling to obtain test kits, protective gear for staff members and ventilators. Mr. Trump was embarrassed by the report at a time he was already under fire for playing down the threat of the virus and not acting quickly enough to ramp up testing and provide equipment to doctors and nurses.

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After employees receive threats, one city is forced to nix rule requiring face masks in businesses

An emergency proclamation requiring face masks in stores and restaurants in Stillwater, Oklahoma, was nixed after store and restaurant owners received threats.

The proclamation was issued Thursday. Among other things, the order made businesses require patrons to cover their faces to combat the spread of coronavirus.

But on Friday, Mayor Will Joyce softened the rule to encourage, not require, face coverings, after several reports emerged of employees being verbally abused and being threatened with physical violence while trying to enforce the order -- all in just three hours of the rule going into effect.

"Many of those with objections cite the mistaken belief the requirement is unconstitutional, and under their theory, one cannot be forced to wear a mask. No law or court supports this view," said City Manager Norman McNickle in a statement. "It is further distressing that these people, while exercising their believed rights, put others at risk."

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The governor of Mississippi took a step back with continuing to slowly reopen the state after health officials said there was the largest increase of coronavirus diagnosis and deaths.

Gov. Tate Reeves was to proceed with his plan to get people back to work, but announced the change of plans on Friday as 397 new coronavirus cases were confirmed and 20 more people died.

"Things can change quickly. We have to stay flexible. Today, I was prepared to announce further reopenings. That was the plan and I was excited to get more of our people back to work," Reeves said. "This was a large enough change to make me take a step back… and I have come to the conclusion that I must hold on for now.”

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Trump’s focus was squarely on his declining political fortunes. His reelection team — including Kushner, campaign manager Brad Parscale and Republican National Committee Chair Ronna McDaniel — staged something of an intervention. They presented fresh polls that painted a picture so grim they hoped the president would be persuaded to curtail his daily press briefings, as the data suggested the performances had damaged him.

One of the polls, an internal RNC survey of voters in 17 battleground states, had former vice president Joe Biden leading Trump 48 to 45 percent, according to an adviser briefed on the 20-page polling memo. The coronavirus ranked as the most important issue to voters, and 54 percent of those surveyed said Trump was too slow to respond to the crisis, while 52 percent said they believed the government should be doing more.

Worse still were the matchups with Biden on a range of core characteristics. Just 36 percent said they considered Trump more honest and trustworthy; 35 percent said he was more compassionate and empathetic; 44 percent said he was more competent; 43 percent said they believed he fights more for people like them; and 36 percent said he was more calm, steady and relatable.

Trump did outperform Biden in some areas, such as being better at getting things done and better in handling a crisis. Still, on a question that historically has helped determine whether incumbents win reelection — whether the country is headed in the right direction — just 37 percent said they believed it was.

The decision to share the data with Trump backfired. The president went into one of his rages. He said he did not believe the numbers, arguing that people “love” his performances at the briefings and think he is “fighting for them,” according to a person with knowledge of the conversation. He berated Parscale for the polling data over the course of several days, threatening in one of the calls that he might sue his campaign manager — although it was unclear whether he made the remark in jest, and the two would later bury the hatchet.

On April 23, the day after his campaign team’s polling intervention, Trump continued with his usual behavior. During a lengthy and at times hostile question-and-answer session with reporters, Trump mused aloud about being treated with ultraviolet light or injecting bleach or another household disinfectant into the body to cure the coronavirus.

“I see the disinfectant, where it knocks [the virus] out in a minute — one minute — and is there a way we can do something like that, by injection inside, or almost a cleaning,” Trump said, referring to the human body.

Injecting or ingesting disinfectants is dangerous and can be deadly. Trump would later claim he was being sarcastic, but there was no trace of sarcasm in the president’s comments.

That day, 1,857 Americans died of the coronavirus. The next week, the number of cases reported in the United States surpassed 1 million.

And by month’s end, as Trump cheered businesses reopening in Georgia, Texas and several other states “because we have to get our country back,” the total dead climbed past 63,000, with no sign of slowing down.

Heretic wrote:

Prolife Tennessee.

Heretic wrote:

An emergency proclamation requiring face masks in stores and restaurants in Stillwater, Oklahoma, was nixed after store and restaurant owners received threats.

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The coronavirus response being spearheaded by President Trump’s son-in-law, Jared Kushner, has relied in part on volunteers from consulting and private equity firms with little expertise in the tasks to which they were assigned, exacerbating chronic problems in obtaining supplies for hospitals and other needs, according to numerous government officials and a volunteer involved in the effort.

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Although some of the volunteers have relevant backgrounds and experience, many others were poorly matched with the jobs they were assigned, including those given the task of securing personal protective equipment, or PPE, for hospitals nationwide, according to a complaint filed last month with the House Oversight Committee.

The complaint, obtained by The Washington Post, was submitted by a volunteer who has since left the group and who spoke on the condition of anonymity for fear of retribution from the administration. Key elements of the complaint were confirmed by six administration officials and one outside adviser to the effort, many of whom spoke on the condition of anonymity to discuss internal deliberations.

A spokeswoman for the oversight panel declined to comment.

The document alleges that the team responsible for PPE had little success in helping the government secure such equipment, in part because none of the team’s members had significant experience in health care, procurement or supply-chain operations. In addition, none of the volunteers had existing relationships with manufacturers or a clear understanding of customs requirements or Food and Drug Administration rules, according to the complaint and two senior administration officials.

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COVID-19 Coagulopathy
Kalb’s first and most widely-shared tweet paraphrased her father’s assertion SARS-CoV-2 was like “sticking your finger in an electric socket” in terms of hematological damage. Although we are unable to say precisely what Kalb’s father may have been describing, high-voltage electrical shocks are known to damage blood cells and vascular systems.

An April 22 2020 Washington Post article (via MSN.com), “A mysterious blood-clotting complication is killing coronavirus patients,” reported that doctors observed complications similar to those Kalb referenced in her Twitter thread — a novel finding about a novel virus:

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One doctor replied that one of his patients had a strange blood problem. Despite being put on anticoagulants, the patient was still developing clots. A second said she’d seen something similar. And a third. Soon, every person on the text chat had reported the same thing.

“That’s when we knew we had a huge problem,” said [Craig] Coopersmith, a critical-care surgeon. As he checked with his counterparts at other medical centers, he became increasingly alarmed: “It was in as many as 20, 30 or 40 percent of their patients.”

One month ago when the country went into lockdown [in March 2020] to prepare for the first wave of coronavirus cases, many doctors felt confident they knew what they were dealing with. Based on early reports, covid-19 appeared to be a standard variety respiratory virus, albeit a contagious and lethal one with no vaccine and no treatment. They’ve since seen how covid-19 attacks not only the lungs, but also the kidneys, heart, intestines, liver and brain.

Increasingly, doctors also are reporting bizarre, unsettling cases that don’t seem to follow any of the textbooks they’ve trained on. They describe patients with startlingly low oxygen levels — so low that they would normally be unconscious or near death — talking and swiping on their phones. Asymptomatic pregnant women suddenly in cardiac arrest. Patients who by all conventional measures seem to have mild disease deteriorating within minutes and dying at home.

With no clear patterns in terms of age or chronic conditions, some scientists hypothesize that at least some of these abnormalities may be explained by severe changes in patients’ blood.

Immediately thereafter, the article reported that “concern is so acute some doctor groups have raised the controversial possibility of giving preventive blood thinners to everyone with covid-19 — even those well enough to endure their illness at home,” and referenced COVID-19 autopsies indicating that victims’ lungs “fill with hundreds of microclots,” which can subsequently “break off and travel to the brain or heart, causing a stroke or heart attack.”

Doctors consulted for the piece repeatedly described effects unlike anything observed in common conditions, which often added their stuggles to understand the mechanism by which these complications were able to occur.

In their comments, doctors voiced their discomfort with the complications. While they felt confident anticipating or reacting to clotting abnormalities in diseases like cancer and in trauma cases, the COVID-19 clotting complications remained a mystery:

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Lewis Kaplan, a University of Pennsylvania physician and head of the Society of Critical Care Medicine, said every year doctors treat people with clotting complications, from those with cancer to victims of severe trauma, “and they don’t clot like this.”

“The problem we are having is that while we understand that there is a clot, we don’t yet understand why there is a clot,” Kaplan said. “We don’t know. And therefore, we are scared.”

Providing several examples of blood-related complications which were alarming, unexpected, and without clear cause in patients, with equipment, and during autopsies, Coopersmith acknowledged “a universal understanding that [COVID-19] was different.” Doctors at the time had “no consensus” on the cause of the clotting abnormalities, but were able to uncover evidence in early case reports from China and Italy:

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Although there was no consensus on the biology of why this was happening and what could be done about it, many came to believe the clots might be responsible for a significant share of U.S. deaths from covid-19 — possibly explaining why so many people are dying at home. In hindsight, there were hints blood problems had been an issue in China and Italy as well, but it was more of a footnote in studies and on information-sharing calls that had focused on the disease’s destruction of the lungs.

Harlan Krumholz, a cardiac specialist at the Yale-New Haven Hospital Center, explained that because this particular coronavirus is novel, it meant that doctors were ill-equipped to understand such complications as they arose:

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“There’s lots of speculation … That’s one of the frustrating things about this virus. We’re in a lot of darkness still.”

The American Society of Hematology (specialists in blood diseases and disorders) maintained a page, “COVID-19 and Coagulopathy: Frequently Asked Questions,” which described complications of COVID-19 involving blood. The page referenced a sub-condition described as “COVID-19-associated coagulopathy (CAC)”; “coagulopathy” is disordered blood clotting.

An April 15 2020 review in the Journal of the American College of Cardiology noted that “Coronavirus disease 2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may predispose patients to thrombotic disease, both in the venous and arterial circulations, due to excessive inflammation, platelet activation, endothelial dysfunction, and stasis.”

‘Random Strokes’
In one of Kalb’s tweets, she said that another way that young people “are falling off the face of the earth from this are the random strokes [COVID-19] causes”; an April 28 2020 New England Journal of Medicine case report was titled “Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young.” It described at least five cases of large-vessel stroke in patients under the age of 50 in New York City facilities during a two-week period from late March through April 7 2020:

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We report five cases of large-vessel stroke in patients younger than 50 years of age who presented to our health system in New York City. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed in all five patients.

[…]

Over a 2-week period from March 23 to April 7, 2020, a total of five patients (including the aforementioned patient) who were younger than 50 years of age presented with new-onset symptoms of large-vessel ischemic stroke. All five patients tested positive for Covid-19. By comparison, every 2 weeks over the previous 12 months, our service has treated, on average, 0.73 patients younger than 50 years of age with large-vessel stroke … Coagulopathy and vascular endothelial dysfunction have been proposed as complications of Covid-19[.]

On April 29 2020, NPR quoted Coopersmith, and reported:

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“The dialysis machines almost never clot,” Coopersmith says “And we were finding that the machines were clotting two or three or four times a day.”

Even so, blood thinners are able to reduce clotting in most patients with COVID-19. And if a dangerous clot does form, it can often be dissolved with a clot-busting drug.

But drugs that prevent clots or break them up can also cause uncontrolled bleeding, so patients on them have to be watched closely, Coopersmith says.

“We have literally five different teams in the hospital specifically and only looking at blood clotting, just because of COVID,” he says.

[…]

And some hints about how COVID-19 affects clotting are coming from lab tests of patients, says Dr. Tiffany Osborn, a professor of surgery and emergency medicine at Washington University in St. Louis.

“We are seeing lab values that are off the wall,” she says.

An April 28 2020 Popular Science article emphasized once again the novel nature of novel coronavirus SARS-CoV-2 and COVID-19, and the challenges faced by doctors in anticipating and responding to unexpected complications like clotting disorders and strokes:

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[Doctors] do have some ideas. They think that the virus may bind to receptors on endothelial cells, which are found on the inside of blood vessels, like veins and arteries. It’s possible that the virus’s presence there triggers an immune reaction to the foreign substance which results in clotting, Mocco says—and it’s those clots which, if they travel to the brain, can cause stroke. In other organs, they can cause damage by preventing blood from flowing normally. Doctors are seeing an uptick in these conditions, too, in young COVID-19 patients who without the infection would rarely develop them.

It’s important to underline that researchers are not certain about any of this yet. “Whether COVID-19 can cause a stroke is a question mark,” says Renyu Liu, a critical care professor at the Perelman School of Medicine at the University of Pennsylvania. Some medical centers, though, are taking no chances and have started using blood thinners as an early part of their COVID-19 treatment, says Mocco. Others are doing lab work exploring the usefulness of medicines used to break up blood clots. Again, he says, the research is in early stages.

COVID-19’s ‘Cytokine Storm’
Kalb specifically described a “cytokine storm” in her tweets, the sort of complication one might expect to be “national news,” if accurate.

It has been. An article published on April 27 2020 in The Lancet (“COVID-19 cytokine storm: the interplay between inflammation and coagulation”) reported:

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The pathophysiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced ARDS has similarities to that of severe community-acquired pneumonia caused by other viruses or bacteria. The overproduction of early response proinflammatory cytokines (tumour necrosis factor [TNF], IL-6, and IL-1β) results in what has been described as a cytokine storm, leading to an increased risk of vascular hyperpermeability, multiorgan failure, and eventually death when the high cytokine concentrations are unabated over time. Therefore, therapeutic strategies under investigation are targeting the overactive cytokine response with anticytokine therapies or immunomodulators, but this must be balanced with maintaining an adequate inflammatory response for pathogen clearance.

Activation of coagulation pathways during the immune response to infection results in overproduction of proinflammatory cytokines leading to multiorgan injury. Although the main function of thrombin is to promote clot formation by activating platelets and by converting fibrinogen to fibrin, thrombin also exerts multiple cellular effects and can further augment inflammation via proteinase-activated receptors (PARs), principally PAR-1. Thrombin generation is tightly controlled by negative feedback loops and physiological anticoagulants, such as antithrombin III, tissue factor pathway inhibitor, and the protein C system. During inflammation, all three of these control mechanisms can be impaired, with reduced anticoagulant concentrations due to reduced production and increasing consumption. This defective procoagulant–anticoagulant balance predisposes to the development of microthrombosis, disseminated intravascular coagulation, and multiorgan failure—evidenced in severe COVID-19 pneumonia with raised d-dimer concentrations being a poor prognostic feature and disseminated intravascular coagulation common in non-survivors.

An April 2020 pre-print in The Journal of Infectious Disease, “The pathogenesis and treatment of the ‘Cytokine Storm’ in COVID-19,” defined the term in its abstract:

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Cytokine storm is an excessive immune response to external stimuli. The pathogenesis of the cytokine storm is complex. The disease progresses rapidly, and the mortality is high. Certain evidence shows that, during the coronavirus disease 2019 (COVID-19) epidemic, the severe deterioration of some patients has been closely related to the cytokine storm in their bodies. This article reviews the occurrence mechanism and treatment strategies of the COVID-19 virus-induced inflammatory storm in attempt to provide valuable medication guidance for clinical treatment.

A May 1 2020 Health.com piece indicated that doctors were hamstrung by a lack of existing data on the illness and cytokine response:

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There isn’t much data available on how many patients recover from cytokine storms, especially ones caused by the novel coronavirus, though Dr. Fichtenbaum says the fatality rate is higher for patients who experience this heightened inflammatory response.

Heretic wrote:

 

The complaint, obtained by The Washington Post, was submitted by a volunteer who has since left the group and who spoke on the condition of anonymity for fear of retribution from the administration.

Heretic wrote:

 
This will kill people.

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As President Trump presses for states to reopen their economies, his administration is privately projecting a steady rise in the number of coronavirus cases and deaths over the next several weeks. The daily death toll will reach about 3,000 on June 1, according to an internal document obtained by The New York Times, a 70 percent increase from the current number of about 1,750.

The projections, based on government modeling pulled together by the Federal Emergency Management Agency, forecast about 200,000 new cases each day by the end of the month, up from about 25,000 cases a day currently.

The numbers underscore a sobering reality: The United States has been hunkered down for the past seven weeks to try slowing the spread of the virus, but reopening the economy will make matters worse.

“There remains a large number of counties whose burden continues to grow,” the Centers for Disease Control and Prevention warned.

As the administration privately predicted a sharp increase in deaths, a public model that has been frequently cited by the White House revised its own estimates, doubling its projected death toll.

The Institute for Health Metrics and Evaluation at the University of Washington is now estimating that there will be nearly 135,000 deaths in the United States through the beginning of August — more than double what it forecast on April 17, when it estimated 60,308 deaths by Aug. 4. (The country has already had more than 68,000 deaths.)

The institute wrote that the revisions reflected “rising mobility in most U.S. states as well as the easing of social distancing measures expected in 31 states by May 11, indicating that growing contacts among people will promote transmission of the coronavirus.”

The projections confirm the primary fear of public health experts: that a reopening of the economy will put the nation back where it was in mid-March, when cases were rising so rapidly in some parts of the country that patients were dying on gurneys in hospital hallways.

On Sunday, Mr. Trump said deaths in the United States could reach 100,000, twice as many as he had forecast two weeks ago. But that new number still underestimates what his own administration is now predicting to be the total death toll by the end of May — much less in the months to come. It follows a pattern for Mr. Trump, who has frequently understated the impact of the disease.

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While the earliest cases of coronavirus in the United States were reported primarily in urban areas, which still remain hardest hit, there is increasing concern about the impact of the pandemic in rural America. To the extent that rural areas face an increasing impact, they could experience particular challenges given their relative lack of hospital capacity, older average age, and higher shares of their populations with underlying health conditions.

In this analysis, we compare coronavirus cases and deaths in metropolitan and non-metropolitan counties in the United States. We find that while metro counties still have significantly higher cases and deaths per capita, non-metro counties are experiencing faster growth rates, potentially signaling challenges ahead. Some counties with the highest rates of cases and deaths are located in Georgia, where the state has moved to significantly ease social distancing measures.

. . .

Less densely populated rural areas initially saw slower spread of the new coronavirus, and both cases and deaths remain lower in non-metro areas than metro areas. However, there are troubling signs that the rates of growth in both cases and deaths are increasing more rapidly in rural areas, where the population tends to be older, younger people are more likely to have-risk health conditions, and hospitals have fewer ICU beds per capita.

Due to concerns over the economic effects of stay-at-home orders, some states have started to ease social distancing measures previously put in place. For example, Georgia has started to reopen certain businesses and allow limited dine-in at restaurants, despite some of its counties rising toward the top of this list of U.S. metro and non-metro counties with the highest numbers of COVID-19 deaths per capita. Similarly, Oklahoma and Montana have also begun easing restrictions, despite each having a county among the top five for non-metro COVID-19 deaths per capita. The findings presented here suggest that there may be particular challenges in these states and others, given recent case and death trends in their rural counties.

And Wisconsin's Republican chief justice just dismissed a coronavirus flare up because it only impacted people who work in meat packing plants and not "the regular folks."

— Ian Millhiser (@imillhiser) May 5, 2020

Heretic wrote:

Models Project Sharp Rise in Deaths as States Reopen