7/12/20 COVID information that you likely did not learn about last week from the news

On July 7th, data provided by the Oregon Health Authority reported that the 7-day average for new hospitalizations were 7 new patients per day and 0.7% of the emergency department visits were related to COVID-19 like illnesses for the 60 hospitals reporting in Oregon. This compares favorably to peak hospitalizations of 19 new patients per day in the week ending March 28th and peak emergency department visits of 6.3% with COVID-19 like illness on March 13th. This optimistic trend occurred despite a seven-day average of 272 new cases per day ending July 7th as compared to 75 new cases per day average for 7 days ending April 1st.

Even more encouraging is the disease severity data. Between July 5-11, Oregon hospitals reported 38 non-ICU admissions and 3 ICU admissions. This data compares favorably to 81 patients who were admitted to the hospital and 50 patients admitted to the ICU between March 22-28. In the state of Oregon, there are currently 56 patients with COVID in the ICU and 26 on ventilators. There are 776 available ventilators. The younger population who are testing positive to this virus are asymptomatic or have mild illness.

We almost certainly had many more cases in February and March that were not measured and reported due to our limited testing capacity then. Our public reporting during this pandemic continues to emphasize metrics that are not as important as the actual data noted above. Public health predictive modeling should not be emphasized over actual metrics that matter. Current case counts and testing is creating unnecessary fear about what might happen. To date, those models have repeatedly been incorrect. Perhaps, the models have not factored in fewer susceptible individuals to severe infections as a result of unrecognized acquired immunity.

There have been some very interesting studies recently about COVID-19 that suggests very good news in my view. The study links below are technical, so I have summarized some of the take home points below.

  1. The studies add to a growing body of evidence to confirm that antibody tests significantly underestimate the prevalence of the disease. These studies suggest that we are closer to herd immunity than is currently demonstrated by published antibody studies.

  2. T-cell or natural immunity appears to provide long term protection against SARS-Cov-2.

  3. CV-19 spike protein antigen mutations have resulted in a predominant strain that is highly transmissible since the end of March. The viral loads are higher in the upper respiratory tract of the predominant mutation but have not resulted in increased hospitalizations.

  4. The Sweden study is especially important. It suggested that approximately twice as many people developed CV-19 specific memory T cells than a humoral response. Another reason why antibody tests underestimate the prevalence of this disease.

  5. There is now evidence in blood collected between 2015-2018 that have residual T-cells in approximately half of the samples which will attack the new coronavirus. This would suggest that perhaps only 50% of a population may be fully susceptible to CV-19. This would also suggest that herd immunity may be closer than we thought.

Live well,

John Powell M.D.

A preprint study from the Icahn School of Medicine at Mount Sinai is titled: Seroconversion of a city: Longitudinal monitoring of SARS-Cov-2 seroprevalence in New York City. It provides evidence an earlier presence of the virus and suggests that the humoral antibody response does not reflect the true prevalence of the disease.


https://www.medrxiv.org/content/10.1101/2020.06.28.20142190v1.full.pdf


Accepted 6/26 for publication in Cell. Global transition of Spike protein amino acid D614 to G614. In SARS CoV-2 infected individual 614 is associated with lower PCR thresholds, suggestive of higher upper respiratory tract viral loads but not with increased hospitalizations.


https://www.cell.com/cell/pdf/S0092-8674(20)30820-5.pdf


La Jolla Institute for immunology team detected residual T-cells who had past Non-COVID-19 coronavirus infections in about half of blood samples collected between 2015-2018 that provided evidence of immunity against novel SARS-Cov-2. This study was published in Cell on June 25,2020.


https://www.cell.com/cell/pdf/S0092-8674(20)30610-3.pdf


A small study in France found that six of eight close family contacts of sick patients with SARS-Cov-2 didn’t develop antibodies but did develop Covid-19 specific T-cells. A preprint of their article is titled: “Intrafamilial Exposure to SARS-cOv-2 Induces Cellular Immune Response without Seroconversion.


https://www.medrxiv.org/content/10.1101/2020.06.21.20132449v1.full.pdf


A very significant study performed in Sweden that is waiting for publication is in the link below. The title of the research is: Robust T cell immunity in convalescent individuals with asymptomatic or mild COVID-19.


https://www.biorxiv.org/content/10.1101/2020.06.29.174888v1.full.pdf+html

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