Tulane Outbreak Daily | April 24, 2020

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Featured Headlines

The patient was a woman who had a previous episode of herpes encephalitis with seizures that had been well controlled for 2 years. She developed focal myoclonus suddenly and required hospitalization and intravenous (IV) anti-seizure medications; 12 hours later, she had a fever and tested positive for SARS-CoV-2, the virus that causes COVID-19 infection. [Related Study]

Mortality among intubated patients with COVID-19 is exceedingly high – FLARE
This issue of FLARE takes a closer look at the data presented April 22, 2020 study published in JAMA: Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area.

Coronavirus Has Infected A 5th Of New York City, Testing Suggests – NPR
Based on the preliminary results of the first round of antibody testing conducted across New York, state officials estimate that 21.2% of New York City residents have contracted the coronavirus. Statewide, Gov. Andrew Cuomo said an estimated 2.7 million residents — or 13.9% of the state’s population — have been infected.

Why The Warning That Coronavirus Was On The Move In U.S. Cities Came So Late – NPR
In early February, the Centers for Disease Control and Prevention was looking for ways to stop the novel coronavirus before it got out of control in the United States. The agency selected six cities for sentinel surveillance — a sort of early warning system to detect if the coronavirus was spreading freely. The idea was to look for the virus among patients who had mild respiratory symptoms and no known travel-related risk factors — patients who weren’t being tested under CDC guidelines at the time.

Europe urged to ease pandemic distancing slowly – CIDRAP
European Centre for Disease Prevention and Control (ECDC) said stay-at-home policies and other interventions are responsible for the drop in cases and that 20 of the 31 countries it monitors appear to be past the peak of their initial waves. Eight countries reported no change, and three reported increasing trends: Ireland, Sweden, and the United Kingdom.

S. Korean studies show antibodies could thwart COVID-19 reinfection, spread – ABC
Results from two new South Korean studies shed light on whether antibodies will be a reliable form of protection against COVID-19 for those who have recovered from the disease.

China’s Virus Cases Could Have Been Four Times Official Tally – Bloomberg
Infections would have been 232,000 in China as of Feb. 20 if the calculation of cases confirmed by “clinical diagnosis” had been applied throughout the outbreak, the Lancet reported. That compares to the 55,508 cases announced at the time by the country’s National Health Commission. [Related Lancet Study]

Georgia open for business despite being 12th in highest cases over past three weeks. Atlanta Magazine
Georgia’s confirmed coronavirus cases and deaths from COVID-19 are still steadily rising, and the Centers for Disease Control and Prevention (which happens to be based in Atlanta) describes community spread coronavirus as “widespread” in the state. That goes against all the principles laid out in the guidelines. [Related NYT: Why Georgia Isn’t Ready to Reopen, in Charts]

Researchers Look To Behavior To Explore Why The Coronavirus May Hit Men Harder – NPR
Men appear more likely to suffer more severely or die from COVID-19 than women. But experts don’t know why. At Johns Hopkins University, researchers have begun to wonder whether biological factors — like women’s immune systems producing a stronger response than those of men — can help explain the difference.

COVID-19: reminder of risk of serious side effects with chloroquine and hydroxychloroquine – Europa.EU
Chloroquine and hydroxychloroquine are known to potentially cause heart rhythm problems, and these could be exacerbated if treatment is combined with other medicines, such as the antibiotic azithromycin, that have similar effects on the heart. [Related EU Study]

The US needs to do 20 million tests a day to reopen safely, according to a new plan – MIT Technology Review
A group of experts has produced a plan for the US to reopen its economy safely this summer. However, it’s contingent on doing at least 20 million tests every day, scaling up contact tracing, and ensuring that those who need to isolate can be properly supported.


Editor’s note: Regarding the case counts below, please consider due to limited testing capabilities in some locations, the real number of cases could be considerably higher.

Official Reporting for April 24, 2020

WHO SITREP #95 ECDC | Country Data Johns Hopkins
Confirmed Cases 2,626,321 2,668,135 2,766,611
Deaths 181,938 190,236 194,456


Total cases: 828,441
Total deaths: 46,379
(Numbers close out at 4 p.m. the day before reporting.)

Surveillance Headlines


Brazil: Manaus, Brazil, a city of 2.2 million located in Amazonas state is the new COVID-19 hot spot – CIDRAP

Equador: Guayaquil, the city’s mayor Cynthia Viteri said Soldiers and police have blocked off neighborhood epicenters and are enforcing strict lockdowns, and city task force members are going house to house looking for new cases. She said independently gathered numbers suggest the outbreak death tol in the city of nearly 3 million is more than 8,000, well above Ecuador’s officials number of 507.


Georgia: set to open up lots of businesses today, despite not meeting the benchmarks to move into phase one of the White House’s reopening guidelines.NPR


UK: Essential workers in England to get tests – BBC


Japan: Experts call for more coronavirus tests as positive rate rises – Kyodo News

Science and Tech

AstraZeneca starts Covid-19 trial of diabetes drug Farxiga – Clinicaltrialsarena

AstraZeneca, in alliance with Saint Luke’s Mid America Heart Institute, has started a Phase III clinical trial of its diabetes drug Farxiga (dapagliflozin) to treat hospitalised Covid-19 patients at risk of serious complications.


Remdesivir Fails in Severe COVID-19 Trial in China: No clinical benefit between groups in randomized trial, mistakenly released data show – Med Page Today

Investigational agent remdesivir showed no difference in time to clinical improvement or mortality at 28 days among hospitalized patients with severe infection versus a control group, a draft abstract accidentally published by the World Health Organization (WHO) showed.


Antigen testing could be a faster, cheaper way to diagnose covid-19 – MIT Technology Review

The gold standard for covid-19 testing is the polymerase chain reaction (PCR) test. In a PCR test, genetic material collected in a nasal swab is copied millions or billions of times over so that markers for covid-19 infection can be identified (the virus’s RNA is too tiny to identify on its own, but making more copies makes it easier to find). PCR testing isn’t perfect, but it’s seen as the most accurate form of testing available for viruses. Unfortunately, it takes time, energy, and trained personnel to run these tests. That makes PCR testing too hard to scale up to the numbers we really need.

Published Research

Focal status epilepticus as unique clinical feature of COVID-19: a case report – Seizure

Effect of changing case definitions for COVID-19 on the epidemic curve and transmission parameters in mainland China: a modelling study – The Lancet

Information Technology–Based Tracing Strategy in Response to COVID-19 in South Korea—Privacy Controversies – JAMA

Profile of RT-PCR for SARS-CoV-2: a preliminary study from 56 COVID-19 patients – Clinical Infectious Diseases

Identification of inhibitors of SARS-CoV-2 in-vitro cellular toxicity in human (Caco-2) cells using a large scale drug repurposing collection – PrePrint Drug Discovery Design and Development

FDA Warns Providers About Limits of SARS-CoV-2 Antibody Tests – NEJM Watch

Pre-Pub (not yet peer reviewed, should not be regarded as conclusive)

Evaluation of antibody testing for SARS-Cov-2 using ELISA and lateral flow immunoassays – Rxiv

Coping in Quarantine

Surviving a Pandemic, in 1918 – JSTOR

For all the devastation of pandemics, there is a historic forgetfulness around them. They are not events that get grand public memorials, and their tolls tend to be remembered individually, rather than collectively, by those who experienced loss.

On a recent trip to Svalbard, Norway with friends we hired a local guide to show us around. One of the stops I wanted to make was the only cemetary on Svalbard. It’s illegal to die in Svalbard, due to the permafrost the bodies tend to pop back up. The cemetery was built in 1918 for the miners who died during the worldwide Spanish Flu epidemic. As I was hiking up the hill to the graves I explained to my husband and friends about the 1918 pandemic, the miners who died, and the horrors of a novel virus sweeping the globe. Glancing behind me, I was alone, they had gone back to the warm van. I believe it was the -20 temps, not my intriguing lecture on novel influenza that sent them back.

Here is the photo I took of the cemetary.

On a lighter note, If you are weary of quarantine, and dreaming of travel again one day I highly recommend venturing to the top of the world to Svalbard! We went in Feburary, it’s dark 24 hrs a day, but also the best way to see some spectacular Northern Lights. We climbed down inside of a glacier, skidded across frozen rivers on snow mobiles under the Northern Lights. We drank whiskey in the hot tub and froze our hair into very tall ice sculptures. We were kicked out of the hot tub. The website for Norway is here. Send an email if you want some tips on going there. Have a good weekend readers.