"Excess Deaths" Suggest Many Undiagnosed Cases and Perhaps Suicides?
https://www.washingtonpost.com/investigations/2020/04/27/covid-19-death-toll-undercounted/?arc404=true

Too Bad He Cancelled, He was Showing his True Colors
https://www.reuters.com/article/us-health-coronavirus-usa-briefings-idUSKCN22920I



​

Taiwan gets the Gold Medal 
https://www.jhsph.edu/covid-19/events/april-24.html

1) Testing capacity must be developed and employed immediately upon detection of a new pathogen.  Testing accuracy must be continuously improved and testing must be repeated when accuracy is not good or the pathogen is already circulating in the community.  Nobody has to wait or wonder.  Even people who think they are not sick or have not been exposed are tested in order to detect and isolate asymptomatic  or pre-symptomatic cases.
2) Cases must be detected immediately and isolated.  Isolated means zero contact with other people and no shared spaces.  Sharing a bathroom or kitchen is not isolated.
3) All possible contacts of positive cases must be traced, located and isolated for more than the incubation period.  Contacts mean anyone who was in the same physical space with the infected person, not just people that they know.  People who were in the same line at the grocery store, and the person who sat in the same chair at the barbour shop later in the day, are contacts.  Tracing contacts requires the use of technology and specifically location monitoring.  A mobile phone app will work when people carry mobile phones.  Tracing won't be successful if you just count known contacts.  Some possible contacts will not be infected, but by quarantining everyone who might be infected you prevent contagion.
4) If the above steps are completed early enough then stay at home orders and economic shutdown are not necessary.

People are all worried about this particular virus and its economic and social aftermath.  Please remember that new infections continue to evolve and that another pandemic will come behind this one.  We should learn from this one, the way that Taiwan learned from the last few, and be better prepared the next time.

Americans are averse to thinking that the government knows where they go or who they associate with.  This is considered antithetical to "freedom".  But what if you could give up this information in exchange for our society being resilient?  What if we were able to shut down pandemics instead of shutting down business?  It's a compromise worth considering.

This virus disproportionately kills people who are older or are obese.  You can't stop the flow of years, but you can do something about obesity and the chronic health conditions that accompany it.  Here in Oregon a man who is more than 100 years old has survived the virus.  He is lean.

The next pandemic could be more deadly.  This is our chance to learn.

Zwickey on Antibody Testing: What's Going On?
https://www.heatherzwickey.com/articles/antibody-testing-questions

Cuomo on the Nursing Home Situation
​https://www.governor.ny.gov/news/video-audio-photos-rush-transcript-amid-ongoing-covid-19-pandemic-governor-cuomo-announces-12

Animations Showing Cumulative and New Cases Worldwide
https://coronavirus.jhu.edu/data/animated-world-map



​

Updated 4/24

1/5 of New Yorkers have had the Dread Virus
https://www.nytimes.com/2020/04/23/nyregion/coronavirus-antibodies-test-ny.html

Vitamin C Reduces ICU and Ventilator Duration, Might Help Before That
​https://todayspractitioner.com/respiratory-health/is-vitamin-c-the-unsung-covid-19-hero/#.XqMVz9NKgiN

Parisian Poop Patterns Parallel COVID-19 Cases
https://www.medrxiv.org/content/10.1101/2020.04.12.20062679v1

Arguments about ReOpening Especially Interesting Given the Politics
https://www.foxnews.com/us/americans-support-extending-coronavirus-stay-at-home-orders

Virus is Expanding in Navajo Nation
https://www.knau.org/post/northern-arizona-coronavirus-cases-grow-navajo-nation-infections-continue-surge

Hemostatic Derangement?  Washing Post Reports Clots Killing Pts
https://www.washingtonpost.com/health/2020/04/22/coronavirus-blood-clots/

Antibody Testing (Serology) Strategy
https://www.centerforhealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2020/200422-national-strategy-serology.pdf

Accuracy of Current Serology Testing Variable
https://www.fiercebiotech.com/medtech/covid-19-antibody-testing-a-disaster-says-roche-ceo-as-its-diagnostics-sales-rise

Vaccination Rates in Freefall
​https://www.nytimes.com/2020/04/23/health/coronavirus-measles-vaccines.html?referringSource=articleShare

Covid Patients Should NOT Discontinue ACE Inhibitors or ARB's 
https://www.ahajournals.org/doi/abs/10.1161/CIRCRESAHA.120.317134

​

India's First Spike, Government Doses Slumdwellers with Hydroxychloroquine
https://apnews.com/31c3c682c6ba37596c3e74cd1a6ce12f

Georgia's Impending Spike: Tongue In Cheek Laughs
https://www.washingtonpost.com/opinions/2020/04/21/georgia-leads-race-become-americas-no-1-death-destination/

Situation Report from the WHO (4/22)
https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200421-sitrep-92-covid-19.pdf

Evidence of Community Spread in California in Early Feb (maybe Jan?)
https://www.sccgov.org/sites/covid19/Pages/press-release-04-21-20-early.aspx

Transmission Before Symptoms, Infx before Positive Test, on USS Teddy R
https://www.cnn.com/2020/04/20/politics/theodore-roosevelt-covid-investigation-navy-cdc/index.html

In L.A. People Who've Had the Virus FAR Outnumber Those Diagnosed
https://neurosciencenews.com/covid-19-underestimated-16211/

UpToDate's Clinical Summary is Excellent
https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-clinical-features-diagnosis-and-prevention

New England Journal of Medicine NEJM has started a Covid Notes Series
https://www.nejm.org/doi/full/10.1056/NEJMc2010025

NY City Subway: Transmission Central
https://www.nber.org/papers/w27021

On Achieving Mass Vaccination--Faster
https://www.sciencedirect.com/science/article/pii/S0264410X20305302?via%3Dihub

Explains the Pneumonia and Why People are So Sick at Admission
https://www.nytimes.com/2020/04/20/opinion/coronavirus-testing-pneumonia.html

Why We Need the World Health Organization
https://warontherocks.com/2020/04/the-answer-is-to-empower-not-attack-the-world-health-organization/
​

I just heard resilient defined as "hard to kill".  That is what we all want to be. We want to be resilient, and we want our businesses and families and communities to be resilient also. This pandemic is revealing the weaknesses in our government, our healthcare system, and our lifestyles.  It kills people who haven't been able to quit smoking, or loose that extra 50 pounds, or get their blood pressure or blood sugar down.  This virus reveals just how poorly our so-called healthcare system builds resilience.

These conditions that cause the virus to devastate are all treatable by us, as individuals.  We can quit smoking, lose weight, lower our blood pressure and sugar.  We can start exercising.  We can eat right.  But it isn't easy.  And for some it is too late. 

I hope that this harsh warning will be enough to shock the survivors into a new way of thinking about health.  Health isn't good numbers on a lab, attained by way of popping pills.  Health is real vitality, a strong immune system, a lack of chronic health conditions caused by an all-too American lifestyle and diet.  We don't call the diet here SAD for nothing.  The Standard American Diet is a recipe for disaster, and disaster is upon us.

In the short term we simply need to get through it.  The Flu of 1918 lasted two years.  The Black Plague lasted six.  No matter what the politicians say, this experience will change us.  It will change us as individuals, and it will permanently affect our culture and institutions.  COVID-19 will change our approach to health and wellness, I think for the better.

Future C19 Patterns: What Do We Know?
https://science.sciencemag.org/content/early/2020/04/14/science.abb5793.full

OC43: The Most Common Coronavirus
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194943/

HKU1 Coronavirus: New in 2005
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3374449/

​

Cases by the County in the U.S. (new)
https://coronavirus.jhu.edu/us-map

Cases Under-Reported: Nursing Home Deaths Undiagnosed
https://www.nbcnews.com/news/us-news/more-2-200-coronavirus-deaths-nursing-homes-federal-government-isn-n1181026

Cases Under-Reported: People Dying at Home Undiagnosed
​https://www.propublica.org/article/theres-been-a-spike-in-people-dying-at-home-in-several-cities-that-suggests-coronavirus-deaths-are-higher-than-reported

Margulis Out on a Limb with Theories about Glyphosate and COVID-19
https://jennifermargulis.net/glyphosate-and-covid-19-connection/

Iraq in Trouble Due To Rigid Social Mores
https://www.nytimes.com/2020/04/14/world/middleeast/iraq-coronavirus-stigma-quarantine.html

States Sorting Out How to Reopen in Absence of Federal Coherence
https://www.npr.org/sections/coronavirus-live-updates/2020/04/13/833662246/states-unite-on-reopening-economies-science-not-politics-will-guide-decisions

Singapore Reports Cases by Cluster: They KNOW How it Spreads
https://www.moh.gov.sg/news-highlights/details/26-more-cases-discharged-386-new-cases-of-covid-19-infection-confirmed
​
Don't Pay for your Stimulus Check
https://www.propublica.org/article/millions-of-americans-might-not-get-stimulus-checks-some-might-be-tricked-into-paying-turbotax-to-get-theirs

Buy Stamps, Write Letters, Save the USPS
​https://www.npr.org/sections/coronavirus-live-updates/2020/04/14/834336341/hoping-to-save-the-postal-service-people-rush-to-buy-stamps

First Confirmed Transmission from a Dead Body
​https://www.buzzfeednews.com/article/danvergano/coronavirus-spread-dead-body-coroner

As we settle into the reality that distancing and economic shutdown will be the fact for a while, a certain sadness is likely to set in.  Suicide rates are up.  People thought things were bad before and now they can't even do whatever it was that was helping them cope before.  Except drinking alcohol, and smoking dope, and all those bad habits that really bring us down in the long run though they might make us feel better in the short term.

But most of us are not about to leave this world.  Most of us are stubborn and optimistic enough to make it through.

Some of us are contrarian enough to be enjoying this situation.  I'm enjoying the clean air, the reduction in traffic, the fact that so many people are out walking every day.  I love the way people have time to stop and talk in the park now, instead of pushing past because they have to make some schedule.  A friend of mine who lives in a wheelchair goes out to sit in the sun where there is a view and talks to people walking by.  He says "this is normal", unlike the previous frenetic pace of going places in our cars.

I count myself an introvert, which is to say I require some alone time to recharge from social time.  I relish quiet home time.  My neighbors are chattier now than they used to be, but nobody gets up in my face, and we all can go home and be by ourselves if we like.

I'm working, even a bit more than usual in spite of the fact that I'm not seeing patients in person.  Everyone has questions.  Sales of herbs and supplements are up, and people are interested in making sure they have supplies to last a few months even if the supply chain is interrupted.

I'm reaching a degree of fatigue around studying COVID-19. I've been reading about it and talking with people about it incessantly since some time in March.  Balance in my own life needs to be restored.  Between working and studying the virus I find myself with less personal time than I need to do all the things I mean to do.  Exercise.  Meditate.  Cook delicious meals.  So I have deleted at least 20 emails about C19 this morning, and I will keep doing that until balance has been restored.

Here's hoping that you are finding ways to keep your own balance.  A schedule helps.  A little structure that tells you when it's time to move your body, to take a break, or to start a new project.  While you have the time, do your creative work!!  I find solace in knowing that this pandemic is likely to change our social and political climate, possibly for the better.  We are all in this together.  Blessed BE!