Foundational data to formulate policies and develop counter measures.

Velandy Manohar, MD, 

Distinguished Life Fellow, Am. Psychiatric Association

Medical Director- Aware Recovery Care- CT, [ARC], President, ARC In-Home Addiction treatment, PC

Member, Governance Committee, Community Advisory Council- Office of Health Strategy-CT

Member- CT. State Medical Society Committees 1. Quality of Care, 2. Disaster Preparedness, 3. Bio-Ethics Committee.

Member: Medical Advisory Board- Commissioner - Dept of Motor Vehicles, Advisory and Review Board- Whiting Forensic Hospital, DMHAS, Hearing Panel- CT. Medical Examining Board- DPH.

Co-Founder and member- Community Resilience Collaborative-Mx County [ Early Childhood Trauma.]

Co- founder- past member of Steering Committee- Psycho-therapy Caucus- Am. Psychiatric Association. 

CT. Multi-Cultural Health Partnership- Nancy Berger Member Award- 2012.

American Health Council- Best in Medicine- 2018

IHAT Addiction Institute- First Impact Award Recipient- 2019

Foundational data to formulate policies and develop counter measures.

I.

https://www.cdc.gov/coronavirus/2019-ncov/about/index.html

https://virusncov.com/

Coronavirus Cases: 245,630

of which 7,378 in severe condition

Deaths: 10,048

Recovered: 88,437 Total doesn’t add to 245,630

The coronavirus COVID-19 is affecting 179 countries and territories 

 

ACTIVE CASES

147,145 Currently Infected Patients 

139,767 (95%) in Mild Condition 

7,378 (5%) Serious or Critical

 

TRANSMISSION RATE (RO)

(estimated range)

2 - 3 (2 - 3 newly infected from 1 case)

 

FATALITY RATE (CFR)

(WHO early estimate)

~ 3.4%  

 

INCUBATION PERIOD

(estimated)

2 - 14 days (outliers: 0 - 27 days)

 

COUNTRIES AND TERRITORIES

(affected by COVID-19)

179

https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html

How many people have recovered or died?

Current cases

Deaths

Source: Center for Systems Science and Engineering at Johns Hopkins University; Local governments.

 

Yellow: Current Cases. Red Band: Deaths. Green: Recovered. 

Numbers on X- Axis: 0- 50-100-150. 

The number of Total cases globally has exceeded 150,000,

The Red band from about 50,000 to it peaks at 75,000

 

II.

 

https://www.statista.com/topics/5994/the-coronavirus-disease-covid-19-outbreak/

 

As of March 19, 2020

 

 

# of COVID-19 cases Worldwide:

219427

 

# of Deaths Worldwide:

 

9115

 

Estimated COVID-19 mean infection rate:

2.5 %

https://twitter.com/jaketapper/status/1240671243097059343?s=21

03 19 20

Dr. Birx says 50% of the cases in the U.S. come from 10 counties. There are more than 3,000 counties in the U.S. Jake Tapper. CNN

 

III.

 

https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html

Coronavirus Map: Tracking the Global Outbreak

By The New York Times Updated March 19, 2020, 6:51 P.M. E.T.

The coronavirus pandemic has sickened more than 234,000 people, according to official counts. As of Thursday evening, at least 9,800 people have died, more than half of them outside mainland China. As the map below shows, infected people have been detected in at least 149 countries. 

Where cases are rising fastest

Avg. number of new cases each day (for the last 7 days)

Average New Cases/day for the last 7 days

None

+10 Australia, Indonesia, Japan, Indonesia, Singapore, India, Malaysia, Russia, Poland, Saudi Arabia, Egypt, So. Africa, Turkey, Canada, Mexico, Brazil, Chile,

+100- Norway, UK, Germany, France, USA, So. Korea

+1,000/ day- Spain, Iran, Italy

While the outbreak is a serious public health concern, most people who contract the coronavirus do not become seriously ill, and only a small percentage require intensive care. Older people and those with existing health conditions, like heart or lung disease, are at higher risk.

How many people have recovered or died?

Current Deaths

Recovered

Source: Center for Systems Science and Engineering at Johns Hopkins University; Local governments

The precise dimensions of the outbreak are hard to know. Not all infected people have received a diagnosis, and some countries, like Singapore, have more proactive testing and containment efforts than others do. 

https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html

How many people have recovered or died

 

 

Yellow: Current Cases. Red Band: Deaths. Green: Recovered. 

Numbers on X- Axis: 0- 50-100-150. 

The number of Total cases globally has exceeded 150,000,

The Red band from about 50,000 to it peaks at 75,000

Tips 

Experts’ understanding of how the virus spreads is still limited, but there are four factors that likely play a role: how close you get; how long you are near the person; whether that person projects viral droplets on you; and how much you touch your face. 

If your community is affected, you can help reduce your risk and do your part to protect others by following some basic steps: 

Wash your hands! Scrub with soap and water for at least 20 seconds, and then dry them with a clean towel or let them air dry. 

Keep distance from sick people. Try to stay six feet away from anybody showing flu- or cold-like symptoms, and don’t go to work if you’re sick. 

Prepare your family, and communicate your plan about evacuations, resources and supplies. Experts suggest stocking at least a 30-day supply of any needed prescriptions. Consider doing the same for food staples, laundry detergent and diapers, if you have small children. 

Here’s a complete guide on how you can prepare for the coronavirus outbreak. 

Note: Data are based on reports at the time of publication. At times, officials revise reports or offer incomplete information.

IV.

https://www.nytimes.com/article/prepare-for-coronavirus.html

March 19, 2020, 7:19 a.m. ETMarch 19, 2020

How to Protect Yourself and Prepare for the Coronavirus How to Protect Yourself and Prepare for the Coronavirus

The World Health Organization has declared the coronavirus a pandemic, and the number of cases continues to rise worldwide. These basic steps can help you reduce your risk of getting sick or infecting others.

By Amelia Nierenberg

Here’s what you can do:

• Stay home if you can.

• Wash your hands. With soap. Then wash them again. 

• Stay informed.

• With children, keep calm, carry on and get the flu shot.

• Don’t stockpile masks. 

• But do stock up on groceries, medicine and resources.

The coronavirus continues to spread worldwide, with over 200,000 confirmed cases and at least 8,000 dead. In the United States, there have been at least 8,000 cases and more than 100 deaths, according to a New York Times database.

 

V. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1628163/

 

Arch Dis Child. 1983 Jul; 58(7): 500–503. 

doi: 10.1136/adc.58.7.500 PMCID: PMC1628163 PMID: 6307189

Epidemiology of coronavirus respiratory infections.

D Isaacs, D Flowers, J R Clarke, H B Valman, and M R MacNaughton

Abstract

Human coronaviruses were found by enzyme linked immunosorbent assay in upper respiratory tract secretions taken during 30% of 108 acute respiratory infections experienced by 30 children under age 6 years with recurrent respiratory infections (index group), and during 29% of 51 acute infections experienced by their siblings. Lower respiratory tract infection--predominantly wheezy bronchitis--occurred in 30% of the index children's coronavirus positive infections but in none of their siblings' infections. Reinfections were common. Two peaks of infection were seen each year in the late autumn/early winter and in the early summer.

Liver Injury Risk is real with COVID-19 PLEASE READ IMPORTANT

Discuss your Concern about ACE Inhibitor medication for Hypertension with your Doctor because you may have read that ACE 2 is an Entry Point for COVID -19. These are present in the Alveoli in the lungs and the cells of the Bile Duct and perform important functions. The Hypertension medication- ACE Inhibitors act on ACE-1 not ACE 2. ALSO CONSUMING UNTESTED MEDICATIONS CAN ACUSE DAMAGE TO LIVER. Don’t stop ACE – 1 inhibitor Blood pressure medication or take unproven medications – these can cause liver damage without any chance of accruing benefit even remotely. VM

 

VI.

https://www.mdedge.com/infectiousdisease/article/219309/coronavirus-updates/patients-covid-19-may-face-risk-liver-injury?ecd=wnl_evn_200319_mdedge_8pm&uac=184919MN&oc_slh=c49df033d7a299ad4eca444020440c8b0821e426b83df7ab469c90179308ca3a&utm_source=PANTHEON_STRIPPED&utm_medium=PANTHEON_STRIPPED&utm_content=PANTHEON_STRIPPED 

Patients with COVID-19 may face risk for liver injury

Publish date: March 19, 2020

By Will Pass 

FROM LIVER INTERNATIONAL

Patients with COVID-19 may be at risk for liver injury, but mechanisms of damage remain unclear, according to investigators.

Proposed mechanisms include direct virus-induced effects, immune-induced damage due to excessive inflammatory responses, and drug-induced injury, reported lead author Ling Xu of Huazhong University of Science and Technology, Wuhan, China, and colleagues.

“From a clinical perspective, in addition to actively dealing with the primary disease caused by coronavirus infection, attention should also be paid to monitor the occurrence of liver injury, and to the application of drugs which may induce liver damage,” the investigators wrote in Liver International. “Patients with liver damage are advised to be treated with drugs that could both protect liver functions and inhibit inflammatory responses, such as ammonium glycyrrhizinate, which may, in turn, accelerate the process of disease recovery.”

The review of liver injury associated with major pathogenic coronaviruses included severe acute respiratory syndrome coronavirus (SARS-CoV), the Middle East respiratory syndrome coronavirus (MERS-CoV), and the newly emergent SARS-CoV-2, which causes COVID-19.

In cases of COVID-19, reported incidence of liver injury ranges from 15% to 53%, based on elevations of alanine transaminase (ALT) and aspartate aminotransferase (AST), along with slightly elevated bilirubin levels. In severe cases, albumin decreases have also been documented.

Liver injury appears to be significantly more common among those with severe infection. In one cohort of 82 patients who died from COVID-19, the incidence of liver injury was 78%, while another study of 36 non-survivors reported a rate of 58%.

According to the investigators, both bile duct epithelial cells and liver cells express angiotensin converting enzyme II (ACE2), which is an entry receptor for SARS-CoV-2; however, expression of ACE2 in bile duct cells is “much higher” than in liver cells, and comparable with alveolar type 2 cells in the lungs.

“Bile duct epithelial cells are known to play important roles in liver regeneration and immune response,” the investigators noted

Beyond direct- and immune-induced effects of COVID-19, postmortem findings suggest that drug-induced liver injury may also be a possibility, with a number of theoretical culprits, including antibiotics, steroids, and antivirals. Although the investigators emphasized that data are insufficient to pinpoint an exact agent, they highlighted a recent preprint study, which reported a significantly higher rate of lopinavir/ritonavir administration among patients with abnormal liver function, compared with those who had normal liver function (56.1% vs. 25%; P = .009).

“Drug-induced liver injury during the treatment of coronavirus infection should not be ignored and needs to be carefully investigated,” the investigators concluded.

Fundamental Research Funds for the Central Universities supported the work. The investigators reported no conflicts of interest.

SOURCE: Xu L et al. Liver Int. 2020 Mar 14. doi: 10.1111/liv.14435.

The graphs are instructional and helpful to plan strategy to flatten the curve.

Velandy Manohar, MD

 

 

 

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