April 21, 2020. The WHO just announced that "The Worst of COVID-19 is still ahead.' Yesterday, governments started to relax their isolation requirements, due to pressure from freedom groups and disastrous economic circumstances. World economies have been shattered in only one month of quarantine. The price of a barrel of top oil was 'minus 37 dollars,’ yesterday it cost producers money to dispose of it! The worst is yet to come, as, by my calculation, only about one in 4000 people has been positive for the virus. If I assume that we are missing 90% of those people infected, that still means only one in 400 people have been infected, and are either immune or deceased at present. This leaves 399 out of every 400 people on the planet still to become infected. Applying a low death rate of only 0.5%; you can see their figure of 100 million. The numbers are still the same, only the shape of the curve is now ‘flattened,’ but widened. JAMA announced yesterday that there are no effective treatments except hyperimmune globulin (convalescent), but this cannot be quickly mass produced. Vaccination, the only potential ‘cure,’ was delayed by four phases of required testing (to fully 1.5 to 2 years), but even worse, the disclosure today that the virus has mutated dozens of times as it has passed around the world, making the possibility of an effective vaccine even more remote. There are those, at high risk (age and premorbid condition) who may decide to remain ‘hunkered down’ until the cure is available. But, I believe governments are already moving towards the natural process of “herd immunity” and allowing the release of restrictions on most of the population, before our society degenerates back to the stone age. Those proven immune, followed by those less vulnerable, will start society, economy and industry functioning again. Without the vaccine at this point, there is nothing to change those numbers, and it is probably going to happen. The world bounced back after 1918, with 100 million lost then. As of April 21, 2020; that’s what I see is happening.
(On the bright side, I am drinking a little “tonic water” every day for two months now, with good results so far. Although completely anecdotal , I have espoused the potential prophylactic benefits to all relatives and friends, based upon purely laboratory analysis of l-quinine. I do not know anyone yet to contract COVID-19, and I hope it to stay that way. I am not aware of anyone else currently studying l-quinine, but I have previous explained why I think it is theoretically superior to the other synthetic that are being used currently. I am not saying that my discussion of this chemical is any more than anecdote, but please review the graphs below, noting that I am orating from British Columbia in Canada. Perhaps coincidence?)
COVID-19: Prophylaxis With Low-dose L-Quinine; Ponder This?
New discussion from March, 2020.
The infection viral dose is currently estimated at 100 virions. The amount of a prophylactic antiviral blocker at this stage would theoretically then be very low. L-quinine may be more potent and effective than low dose hydroxychloroquine, considering the natural source of l-quinine contains the pure desired enantiomer, versus HCQ is synthetic and composed of four enantiomers that probably competitively inhibit the binding of the desired enantiomer. Thus 20mg (one glass of tonic water) may have more biological activity than 100mg of HCQ. Side-effects of 20mg appear to be nil to nonexistent, as million of people have imbibed this over the centuries. Obviously, one should get their physicians' advice on this. Another point is that there are billions of people on this who do not have readily available medical access, but they do have access to tonic water, or may already use it to prevent other viral and protozoal infections. Millions of people already do this chronically for prophylaxis, and the risk is low. For a placebo controlled double blind study to be done, this could take years, and is unlikely to be done because there is no large amount of money to be made anyway. Tonic water is a dollar a bottle and lasts for a week at this dose. Risk: Nil (if not contraindicated). Benefit: Possibly thaumaturgic!
WHO is a pure bullshit. When China stopped internal flights, locked down Wuhan city, it did not stop international flights that spread the virus in the whole world. WHO chief was knowing this thing. WHO must be dissolved, it is pure China oriented. Trump got WHO very well.
Coronavirus in Africa Tracker: How many covid-19 cases & where? [Latest]
Confirmed coronavirus cases in Africa: 25,832
Recovered: 6,910
Confirmed coronavirus deaths: 1,242
https://africanarguments.org/2020/04/22/coronavirus-in-africa-tracker-how-many-cases-and-where-latest/
Covid-19 update worldwide
https://coronavirus.jhu.edu/map.html
We will surely overcome COVID-19, Like I have said before more problems will surface, science will conquer some and the rest will remain puzzled. Soon COVID-19 will go. the question is what next?. I foresee another pandemic stronger than COVID but this time, not a virus. Hunger is one of them. and the rest I can not tell you now, you may not be able to bear it. But when it comes, the world will feel it and forget COVID had ever occurred.
June 26, 2020: Highest recorded number of new COVID-19 cases in the USA yesterday. The Pandemic is definitely not over. Here is todays headline in Doctors Guide Alerts:
📷COVID-19JUNE 26, 2020
COVID-19: US records more than 37,000 new cases
According to CDC's update on June 25, the case count of COVID-19 in the US stands at 2,374,282* cases, including 121,809* deaths, in 55 (50 states, District of Columbia, Puerto Rico, Guam, Northern Marianas, and US Virgin Islands) jurisdictions. This represents an additional 37,667 cases and 692 deaths compared to the update on June 24.
I watched the news this morning, nothing stated about this. If we are not going into Phase Two of the 1918 pandemic curve, then it is still very worrisome. The breakdown of the public health protocols is starting to show up. The massive social unrest did not help this, as has been documented in the massive protests, with a lack of personal viral hygiene. Thank you, stay safe. Gary Ordog, MD June 26, 2020.
July 10, 2020: Yes phase two is becoming true. See DG Alerts, new records, and now the daily death numbers are at record highs too. Took a few extra weeks to catch up. By prediction
JULY 10, 2020
COVID-19: US records close to 65,000 new cases
According to CDC's update on July 9, the case count of COVID-19 in the US stands at 3,047,671* cases, including 132,056* deaths, in 55 (50 states, District of Columbia, Puerto Rico, Guam, Northern Marianas, and US Virgin Islands) jurisdictions. This represents an additional 64,771 cases and 991 deaths compared to the update on July 8.
By prediction from 1918, this phase two may be much worse than the phase one we already had.
The evidence underlying these public health interventions has not changed since the 1918 flu pandemic. Mathematical modeling studies and empirical evidence support that public health interventions, including home quarantine after infection, restricting mass gatherings, travel restrictions, and social distancing, are associated with reduced rates of transmission. Risk of resurgence follows when these interventions are lifted.
This was quoted from today's JAMA.
Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19) A Review July 10, 2020
and supports the information I have been espousing. Thank you, stay safe, Gary Ordog, MD.
The Phases are the peaks in the 1918 pandemic daily death rates curve; the Stages of Reopening/Release from Isolation, usually one to Three. The graph shows that isolation works to slow the spread of the virus, but then reopening or releasing the population from isolation causes the virus to spread again and the death rate increases even greater. This is the 1918 Pandemic, but the 2020 Pandemic is following the same course; temporally we are on the upslope of Phase Two on this graph . Stay safe and thank you for your indulgence. Gary Ordog: July 14, 2020.
Todays CBC News free, COVID-19 case curve still showing exponential increase into the end of the year. This i predicted in my death curve of 8 months ago. This also shows the effects of "flattening the curve" into the future. Remember, we are still pending a good vaccine being administered to stop this whole process.
September 26, 2020: Ordog's Summary and Comments on: September 22/29, 2020
The COVID-19 Pandemic and the JAMA Network
by: Michael Berkwits, MD, MSCE; Annette Flanagin, RN, MA; Howard Bauchner, MD1; Phil B. Fontanarosa, MD, MBA
in: JAMA. 2020;324(12):1159-1160. doi:10.1001/jama.2020.18298
The following are some of the concerns noted in todays edition of JAMA Covid-19 edition. These include multiple organ injury and debility that result from COVID-19 infections. As I have noted before, up to 97% of patients who have recovered and survived a COVID-19 infection have been left with at least some of the following sequelae, and this is of major concern. As the conclusion of the editors' written article, "No single event since the end of the Cold War has so affected the lives of virtually every person living in every country of the world." (Comments by Gary Ordog, MD)
These are the most prominent of the currently recognized COVID-19 concerns:
1. Benefits and harms of treatments and identifying mortality risk markers beyond age and comorbidities
2. Cardiovascular consequences of COVID-19 infection, including risks to those with comorbid hypertension and risks for myocardial injury
3. Risk for direct central nervous system invasion and COVID-19 encephalitis and for long-term neuropsychiatric manifestations in a post–COVID-19 syndrome
4. Risks related to SARS-CoV-2 infection for patients with compromised immunity, such as those receiving treatment for cancer
5. Challenges unique to patients with acute kidney injury and chronic kidney disease
6. Risks of viral transmission from aerosol-generating procedures, including most minimally invasive surgeries, and the need for eye protection as well as personal protective equipment as part of universal precautions
7. The prevalence and pathophysiology of skin findings in patients with COVID-19, determining if they are primary or secondary cutaneous manifestations of infection, and how best to manage them
8. The prevalence and significance of eye findings in patients with COVID-19 and the risk of transmission and infection through ocular surfaces
9. The role of anticoagulation for managing the endotheliopathy and coagulopathy characteristic of the infection in some patients
10. Developmental effects on children of the loss of family routines, finances, older loved ones, school and education, and social-based activities and milestone events
11. Effects of the pandemic, mitigation efforts, and economic downturn on the mental health of patients and frontline clinicians
12. Seasonality of transmission as the pandemic enters its third season
13. How to implement reliable seroprevalence surveys to document progression of the pandemic and effects of public health measures
14. Effects of the pandemic on access to care and the rise of telehealth
15. Consequences of COVID-19 for clinical capabilities, such as workforce availability in several specialties, delays in performing procedures and operations, and implications for medical education and resident recruitment.
16. Additional important questions that require careful observation and research include
17. Randomized evaluations of treatment: what is effective and safe, and what timing of which drug will reduce morbidity and mortality? Will a combination of therapies be more effective than any single drug?
18. Randomized evaluations of preventive interventions, including convalescent plasma, monoclonal antibodies, and vaccines. Which are effective and safe enough to prevent COVID-19 at a population level?
19. How can COVID-19 vaccines and therapeutics be distributed and paid for in ways that are fair and equitable?
20. Is immunity complete or partial, permanent or temporary, what is its mechanism, and how best is it measured? Can the virus mutate around host defenses?
21. How important are preadolescent children to the spread of infection to older family members and adult communities, and what are the implications for parent, caregiver, and teacher personal risk and disease transmission?
22. Is SARS-CoV-2 like influenza (continually circulating without or with seasonality), measles (transmissible but containable beneath threshold limits), or smallpox and polio (eradicable, or nearly so)?
23. Has the pandemic fundamentally altered the way health care is financed and delivered? By shining a spotlight on health inequities, can the pandemic motivate changes in health care finance, organization, and delivery to reduce those inequities?
24. The public’s health is threatened by sophisticated campaigns churning disinformation into social media and other platforms as part of what the World Health Organization is calling an infodemic.15 Careful, deliberative science is at a disadvantage in today’s instantly networked information economy, validating the classic saying (misattributed to Mark Twain) that “lies travel halfway around the world while the truth is still putting on its shoes.” As a matter of health and potentially national security, health agencies, public health authorities, elected leaders, news organizations, and editors and publishers all need to find strategies to counter the disinformation.15-17 The health of the global population depends on this effort.
25. The pandemic has exposed vulnerabilities in public and private health systems, with the costs to health and lives borne by the least fortunate.
26. The national US pandemic response has been halting and fragmented. Just as airport security has not and would never be ceded to individual states, health security for the country cannot come from states acting alone without coordination to manage regional infectious disease outbreaks. A restored and strengthened US Centers for Disease Control and Prevention—better funded and structurally protected from political influence—could provide the public health leadership necessary to manage future similar outbreaks and protect the US population.23
References:
1. Paules CI, Marston HD, Fauci AS. Coronavirus infections: more than just the common cold. JAMA. 2020;323(8):707-708. doi:10.1001/jama.2020.0757
2. Bonow RO, O’Gara PT, Yancy CW. Cardiology and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.15088
3. Shinkai K, Bruckner AL. Dermatology and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.15276
4. Redberg RF, Katz M, Steinbrook R. Internal medicine and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.15145
5. Winkelmayer WC, Khairallah P, Charytan DM. Nephrology and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.16779
6. Josephson SA, Kamel H. Neurology and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.14254
7. Disis ML. Oncology and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.16945
8. Bressler NM. Ophthalmology and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.17595
9. Piccirillo JF. Otolaryngology–head and neck surgery and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.15779
10. Christakis DA. Pediatrics and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.14297
11. Öngür D, Perlis R, Goff D. Psychiatry and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.14294
12. Kibbe MR. Surgery and COVID-19. JAMA. Published online September 22, 2020. doi:10.1001/jama.2020.15191
13. Rivara FP, Fihn SD, Perencevich EN. JAMA Network Open and COVID-19. JAMA. Published online September 22, 2020 doi:10.1001/jama.2020.15194
14. Ayanian JZ. JAMA Health Forum and COVID-19. JAMA. Published September 22, 2020. doi:10.1001/jama.2020.18432
15. World Health Organization. WHO ad-hoc online consultation on managing the COVID-19 infodemic. Accessed August 27, 2020. https://www.who.int/teams/risk-communication/infodemic-management/who-ad-hoc-online-consultation-on-managing-the-covid-19-infodemic
16. Tangcharoensathien V, Calleja N, Nguyen T, et al. Framework for managing the COVID-19 infodemic: methods and results of an online, crowdsourced WHO technical consultation. J Med Internet Res. 2020;22(6):e19659. doi:10.2196/19659
17. Eysenbach G. How to fight an infodemic: the four pillars of infodemic management. J Med Internet Res. 2020;22(6):e21820. doi:10.2196/21820
18. Fuchs VR. Is single payer the answer for the US health care system? JAMA. 2018;319(1):15-16. doi:10.1001/jama.2017.18739
19. Naylor CD. Canada as single-payer exemplar for universal health care in the United States: a borderline option. JAMA. 2018;319(1):17-18. doi:10.1001/jama.2017.19668
20. Fuchs VR. How to make US health care more equitable and less costly: begin by replacing employment-based insurance. JAMA. 2018;320(20):2071-2072. doi:10.1001/jama.2018.16475
21. Fuchs VR. Health care policy after the COVID-19 pandemic. JAMA. 2020;324(3):233-234. doi:10.1001/jama.2020.10777
22. Bauchner H, Fontanarosa PB. Health care is a right and not a privilege. JAMA. 2020;323(11):1049. doi:10.1001/jama.2020.0891
23. Gostin LO, Cohen IG, Koplan JP. Universal masking in the United States: the role of mandates, health education, and the CDC. JAMA. Published online August 10, 2020. doi:10.1001/jama.2020.15271
The summary above are some of the concerns noted in todays edition of JAMA Covid-19 edition. These include multiple organ injury and debility that result from COVID-19 infections. As I have noted before, up to 97% of patients who have recovered and survived a COVID-19 infection have been left with at least some of the following sequelae, and this is of major concern. As the conclusion of the editors' written article, "No single event since the end of the Cold War has so affected the lives of virtually every person living in every country of the world." How true! (Comments and further editorializing by by Gary Ordog, MD; County of Los Angeles, Department of Health Services, Physician Specialist, with roles of Residency and Research Director, Interim Vice-Chairman, Department of Emergency Medicine, King/Drew/UCLA Medical Center(retired)). September 26, 2020: Please add your thoughts to the current list condensed from JAMA:
Thank you, Gary Ordog, MD
COVID-19 as an apocalypse
It has been quite sometime that it is predicted that COVID-19 measure will be a new life-style and a never-ending story. It is being as an apocalypse since June 2020.
Please have a look at following links:
1. Article The World-After COVID-19 Apocalypse
June 20202. Article The Zombie Apocalypse and COVID-19
July 20203. Article Apocalypse Now?: Initial Lessons from the Covid-19 Pandemic ...
July 20204. Article COVID-19 Pandemic is not Apocalypse, is Strong Warning
August 20205. Article The four horsemen of a viral Apocalypse: The pathogenesis of...
September 20206. Article Apocalypse perhaps
September 20205. Preprint From Pandemic to Apocalypse
September 2020
A very interesting debate thanks for the updates. One of the issues has been the failure to accurate predict the course of the pandemic. For instance, the news in the UK referred to the absence of a second wave and the potential success of herd immunity. As we know now (and surmised then) all absolute speculative nonsense. So it is great to see some informed opinion.
Update November 18, 2020:
US surpasses 250,000 coronavirus deaths as virus mortality rate surges
Joe Murphy and Corky Siemaszko The United States has recorded a quarter-million COVID-19 deaths, the latest NBC News numbers showed Wednesday, and the death rate has been accelerating in recent weeks as cases have been surging across the country. Provided by TODAYThe 250,000th death was logged Wednesday morning, the data revealed.In the last four weeks there has been a 42 percent increase in the number of fatalities, from a weekly average of 821 per day in early October to last week’s average of 1,167 fatalities per day, according to an NBC News analysis of the available data. "White House task force warns of ‘aggressive, unrelenting spread’ of virus" White House task force warns of ‘aggressive, unrelenting spread’ of virus.And, a year after the first COVID-19 infection was reported in China, people were dying in America at a pace not seen since mid-August, the analysis showed. Meanwhile, the number of confirmed COVID-19 cases continued to climb rapidly and the pandemic showed no sign of slowing down as the holiday season loomed and two very promising vaccines were still months away from widespread distribution.In addition to deaths, the U.S. leads the world with 11.4 million COVID-19 infections, the NBC News figures showed."Right now, we are in an absolutely dangerous situation that we have to take with the utmost seriousness," Brett Giroir, the Trump Administration's coronavirus testing czar, told MSBNC's Andrea Mitchell. "This is not crying wolf. This is the worst rate of rise in cases that we have seen in the pandemic in the United States. And, right now, there's no sign of flattening."And with all 50 states plus Washington, D.C., the U.S. Virgin Islands and Guam reporting increases Wednesday in coronavirus cases over the past 14 days, according to the latest NBC News data, hospitals and the doctors and nurses contending with a deluge of sick patients were at the breaking point."We're approaching, I think, desperation," Dr. Julie Watson, Chief Medical Officer at Integris Health in Oklahoma, said on MSNBC. "I think we have to have our citizens helping us by wearing a mask and keeping their distance.”Asked for her reaction to Oklahoma Gov. Kevin Stitt's continued refusal to impose a mask mandate, Watson said “It is baffling to me how this has become a political issue.""The flu isn't political, heart disease is not political, kidney disease is not political, but somehow putting on a face covering to protect the person, you know, next to you or around you has somehow become political,” she said.The grim numbers were piling up as President Donald Trump continued to balk at conceding the election to President-elect Joe Biden. As a result, the Democrat’s COVID-19 team has been trying to prepare to take over the responsibility of fighting the pandemic without access to information currently in the hands of the White House coronavirus task force led by Vice President Mike Pence.“Our team cannot communicate with them,” Dr. David Kessler, a member of Biden’s advisory committee, said. “The sooner the Biden transition team can meet with officials working on these questions, the more seamlessly the transition will be the American people.”And a lot of the information the Trump team is sitting on is dire.In an internal report obtained Tuesday by NBC News, the White House coronavirus task force warned there is “now aggressive, unrelenting, expanding broad community spread across the country, reaching most counties, without evidence of improvement but rather, further deterioration.”Pfizer says its vaccine is now 95 percent effective.Also, the task force report warned that current efforts to stop the spread “are inadequate and must be increased to flatten the curve” and that the upcoming Thanksgiving holiday has the potential to “amplify transmission considerably.”That message was undermined by Dr. Scott Atlas, one of Trump’s top pandemic advisers, who during interviews on Fox News this week appeared to encourage large Thanksgiving family gatherings and dismissed any talk about the rising number of deaths as fearmongering.“Yes, there are people dying,” Atlas said Tuesday on the “Brian Kilmeade Show.” “But those deaths, the number of deaths, it’s not exploding like it did back in the spring.”Atlas, a conservative ideologue who is a radiologist and not an expert on infectious diseases, has been accused of, among other things, peddling misinformation about herd immunity and making false claims about the effectiveness of masks at preventing the spread of Covid-19.The federal Centers for Disease Control and Prevention and the world’s top public health experts say masks protect both the wearers and everybody else from infection.
November 29, 2020. The Pandemic has barely started. The CDC in JAMA today reported that the seroprevalence rate in the US is less than 10%. Without an effective vaccination program in place, we have a long way to go.
Here is todays comments by me in JAMA:
1 Comment for this article.
November 29, 2020
SARS-CoV-2 Seroprevalence in the US comments.
Gary Ordog, MD, DABMT, DABEM | County of Los Angeles, Department of Health Services, Physician Specialist (ret.)
Thank you for the interesting study. Although your subject numbers seem large, I believe they represent less than one percent of the population, which makes the sample size small. Also, the method of using convenience blood, we really have no idea why these subjects were getting their blood drawn, but we do know it was not for the purpose of the study. That means that the small sample size may be skewed unknowingly and severely towards some unknown confounding variable, for example, perhaps most of them thought they had had COVID-19. So, the validity of drawing conclusions based upon these results is very low, and even trying to make valid conclusions about time trends is questionable because of the possibility of unknown changing confounding variables during that time. That said, I would like to comment on the implications of your study results, even though what I am concluding cannot be valid, just interesting. Most importantly, possibly only 10% of the population have been infected with SARS-CoV-2. That means that possibly, 90% of the population may be still prone to suffer from infection in the pandemic. Without a vaccination, the US could be facing a disaster. Fortunately, it looks like several vaccines are effective, and many more are in the works. If anything, it looks like your study shows that the vaccination program and its success is more important that ever. Thank you, and stay safe until then.
CONFLICT OF INTEREST: None Reported
Original Investigation
November 24, 2020
Estimated SARS-CoV-2 Seroprevalence in the US as of September 2020
Kristina L. Bajema, MD, MSc1; Ryan E. Wiegand, MS1; Kendra Cuffe, MPH1; et alSadhna V. Patel, MPH1; Ronaldo Iachan, PhD2; Travis Lim, DrPH1; Adam Lee, MS2; Davia Moyse, MA2; Fiona P. Havers, MD, MHS1; Lee Harding, MS2; Alicia M. Fry, MD, MPH1; Aron J. Hall, DVM, MSPH1; Kelly Martin, MPH2; Marjorie Biel, MPH2; Yangyang Deng, MS2; William A. Meyer III, PhD3; Mohit Mathur, MD, PhD4; Tonja Kyle, MS2; Adi V. Gundlapalli, MD, PhD1; Natalie J. Thornburg, PhD1; Lyle R. Petersen, MD, MPH1; Chris Edens, PhD1
Author Affiliations Article Information
JAMA Intern Med. Published online November 24, 2020. doi:10.1001/jamainternmed.2020.7976
COVID-19 Resource Center
editorial comment icon Editorial
Comment
Key Points
Question What proportion of persons across 52 US jurisdictions had detectable antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from July to September 2020?
Findings In this repeated, cross-sectional study of 177 919 residual clinical specimens, the estimated percentage of persons in a jurisdiction with detectable SARS-CoV-2 antibodies ranged from fewer than 1% to 23%. Over 4 sampling periods in 42 of 49 jurisdictions with calculated estimates, fewer than 10% of people had detectable SARS-CoV-2 antibodies.
Meaning While SARS-CoV-2 antibody prevalence estimates varied widely across jurisdictions, most people in the US did not have evidence of previous SARS-CoV-2 infection.
Abstract
Importance Case-based surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection likely underestimates the true prevalence of infections. Large-scale seroprevalence surveys can better estimate infection across many geographic regions.
Objective To estimate the prevalence of persons with SARS-CoV-2 antibodies using residual sera from commercial laboratories across the US and assess changes over time.
Design, Setting, and Participants This repeated, cross-sectional study conducted across all 50 states, the District of Columbia, and Puerto Rico used a convenience sample of residual serum specimens provided by persons of all ages that were originally submitted for routine screening or clinical management from 2 private clinical commercial laboratories. Samples were obtained during 4 collection periods: July 27 to August 13, August 10 to August 27, August 24 to September 10, and September 7 to September 24, 2020.
Exposures Infection with SARS-CoV-2.
Main Outcomes and Measures The proportion of persons previously infected with SARS-CoV-2 as measured by the presence of antibodies to SARS-CoV-2 by 1 of 3 chemiluminescent immunoassays. Iterative poststratification was used to adjust seroprevalence estimates to the demographic profile and urbanicity of each jurisdiction. Seroprevalence was estimated by jurisdiction, sex, age group (0-17, 18-49, 50-64, and ≥65 years), and metropolitan/nonmetropolitan status.
Results Of 177 919 serum samples tested, 103 771 (58.3%) were from women, 26 716 (15.0%) from persons 17 years or younger, 47 513 (26.7%) from persons 65 years or older, and 26 290 (14.8%) from individuals living in nonmetropolitan areas. Jurisdiction-level seroprevalence over 4 collection periods ranged from less than 1% to 23%. In 42 of 49 jurisdictions with sufficient samples to estimate seroprevalence across all periods, fewer than 10% of people had detectable SARS-CoV-2 antibodies. Seroprevalence estimates varied between sexes, across age groups, and between metropolitan/nonmetropolitan areas. Changes from period 1 to 4 were less than 7 percentage points in all jurisdictions and varied across sites.
Conclusions and Relevance This cross-sectional study found that as of September 2020, most persons in the US did not have serologic evidence of previous SARS-CoV-2 infection, although prevalence varied widely by jurisdiction. Biweekly nationwide testing of commercial clinical laboratory sera can play an important role in helping track the spread of SARS-CoV-2 in the US.
Introduction
The first severe acute respiratory syndrome 2 (SARS-CoV-2) infection in the US was identified in January 2020,1 followed soon after by reports of community transmission.2-5 The US remains severely affected by the coronavirus disease 2019 (COVID-19) pandemic, with more than 9 million cases and 230 000 deaths reported through November 1, 2020.6 With limited testing availability and mild and asymptomatic infections contributing to underascertainment of SARS-CoV-2 infections through passive case reporting,7-9 seroprevalence surveys are important for refining estimates of infection and transmission.10
Most seroprevalence surveys conducted in the US thus far have been limited to specific geographic areas,11,12 focused on unique high-risk populations,13,14 or not designed for repeated sampling over time.15 Testing of commercial clinical laboratory residual sera has offered a practical, scalable approach to estimate in a more general population the prevalence of persons who develop SARS-CoV-2 antibodies over repeated time intervals.10,16
In a nationwide expansion of commercial clinical laboratory serologic testing, we aim to understand how seroprevalence varied across different geographic regions, sexes, age groups, and periods. In this biweekly, repeated cross-sectional study, we tested for SARS-CoV-2 antibodies using sera from persons across the 50 US states, the District of Columbia, and Puerto Rico who sought clinical care. Initial findings from the first testing period were released on the US Centers for Disease Control and Prevention (CDC) website (COVID Data Tracker).17 In this article, we present seroprevalence estimates from specimens collected over 4 periods from July to September 2020.
Methods
Study Design
Residual patient sera from specimens collected for routine screening (eg, cholesterol, thyroid) or clinical management by 2 commercial laboratories (laboratory A and laboratory B) across 50 US states, Washington DC, and Puerto Rico between July 27 and September 24, 2020, were analyzed. Approximately every 2 weeks, we selected a convenience sample of residual sera from the pool of all available, deduplicated specimens to target equal sample numbers in 4 age groups (0-17 years, 18-49 years, 50-64 years, and ≥65 years) in each jurisdiction. Because laboratory A completed biweekly sampling 3 days after laboratory B for each period, the total number of days included in each period across all jurisdictions was slightly more than 2 weeks. To reduce selection bias, the laboratories reviewed tests that were ordered on the same day as the specimen identified in the convenience sample and excluded the specimen if any requests for SARS-CoV-2 antibody testing were noted.
Laboratory A collected specimens from 7 jurisdictions (Arizona, Indiana, Maryland, Pennsylvania, New Jersey, New York, and Virginia), and laboratory B, which was involved in an earlier CDC-led seroprevalence survey,10 provided residual sera from the remaining 45 jurisdictions. Each performed chemiluminescent immunoassay testing for SARS-CoV-2 antibodies and provided CDC with deidentified information on patient age, sex, state, and specimen collection date. The zip code of residence and ordering clinician zip code were also collected. For both laboratories, most specimens were collected in the outpatient setting, although individual-level data on the source of specimens were not available. Information on patient race/ethnicity and symptoms was also not available.
This activity was reviewed by CDC and determined to be consistent with non–human participant research activity.18 Informed consent was waived, as data were deidentified. Reporting of this study followed the Strengthening the Reporting of Observational Studies in Epidemiology statement.19
Laboratory Methods
Each laboratory processed and transported specimens according to standard procedures. Most specimens did not require −4 °F storage, and none more than a single thaw cycle. Laboratory A tested all specimens at a central facility using the Roche Elecsys Anti-SARS-CoV-2 pan-immunoglobulin immunoassay that targets the nucleocapsid protein and has a sensitivity of 100% (95% CI, 88.3%-100.0%) and specificity of 99.8% (95% CI, 99.7%-99.9%). Specimens were considered reactive at a cutoff index of 1.0 or greater without serum dilution.20 Laboratory B performed testing at 19 regional facilities on samples from 45 jurisdictions using the Abbott ARCHITECT SARS-CoV-2 IgG immunoassay targeting the nucleocapsid protein or Ortho-Clinical Diagnostics VITROS SARS-CoV-2 IgG immunoassay targeting the spike protein. Specimens tested by ARCHITECT were considered reactive at a cutoff index of 1.4 or greater, whereas specimens tested by VITROS were considered reactive at a cutoff index of 1.0 or greater. Using these definitions of reactivity, ARCHITECT had a sensitivity of 100.0% (95% CI, 95.8%-100.0%) and specificity 99.6% (95% CI, 99.0%-99.9%); VITROS had a sensitivity of 90.0% (95% CI, 76.9%-96.0%) and specificity of 100.0% (95% CI, 99.1%-100.0%).20 An internal comparative study demonstrated 98.5% qualitative result concordance between the ARCHITECT and VITROS platforms.21 For all assays, sensitivity was determined in symptomatic persons with real-time reverse transcriptase polymerase chain reaction–confirmed SARS-CoV-2 infection. All assays were granted Emergency Use Authorization by the US Food and Drug Administration and used according to the Instructions for Use provided by the manufacturers.20,22
Statistical Analysis
Power analyses set a target of 980 samples (245 per age group) to be tested per jurisdiction within each 2-week period. Assuming a baseline seroprevalence of 3%,10 this sample size was determined to allow for 70% power to detect a 2% increase in seroprevalence.
For each testing period, we calculated overall seroprevalence estimates by jurisdiction, as well as site-specific age group, sex, and metropolitan status according to 2013 Rural-Urban Continuum Codes (RUCC) classification23 for states with sufficient samples to support precise subgroup estimates. We used patient residential zip code data (or the ordering clinician’s zip code if the patient’s zip code was missing) to determine county of residence and assigned metropolitan status based on RUCC codes 1 to 3 and nonmetropolitan status RUCC codes 4 to 9. To produce seroprevalence estimates, the samples in each jurisdiction were weighted to the population using iterative poststratification or raking.24 Full details on the weighting procedures are included in the eMethods in the Supplement. Briefly, seroprevalence was calculated as the number of reactive specimens divided by the number of specimens tested. Raking was performed across age, sex, and metropolitan status dimensions to create weights that were adjusted to 2018 American Community Survey 5-year population totals for sex, each age category, and metropolitan status.25 For the raking process to converge, probabilistic imputation was performed for patients with missing data on sex, age category, or metropolitan status.
Confidence intervals were calculated using bootstrap resampling.26 For each bootstrap resample, false-positive and false-negative rates were generated from a binomial distribution using results from the assay performance specifications.20 These rates were applied to the bootstrap resample, raked as described earlier in the article, and the seroprevalence was estimated. The process was repeated 500 times and 95% CIs were calculated from 2.5th and 97.5th quantiles of the bootstrap distribution. We report the final adjusted seroprevalence estimate as the mean of the bootstrap distribution. Estimates based on fewer than 75 specimens were not reported because of potential instability.
Finally, seroprevalence estimates were used to predict the total number of SARS-CoV-2 infections in each jurisdiction by applying the estimated seroprevalence to each site’s population.25 To determine the ratio of estimated to reported infections, we assumed that most persons develop detectable antibodies by 7 to 14 days following infection.27 We then divided the estimates of total infections per testing period by cumulative reported case counts28 as of 14 days before the median collection date for each jurisdiction. SAS Software, version 9.4 (SAS Institute), and R, version 3.6.3 (R Core Team), were used for data management and analyses.
Results
During 4 collection periods between July 27 and September 24, 2020, we tested 177 919 residual sera specimens from all 50 states, Washington DC, and Puerto Rico (Table). Of all specimens, 103 771 (58.3%) were from women, 26 716 (15.0%) were from persons 17 years or younger, and 47 513 (26.7%) were from persons 65 years or older. The Abbott ARCHITECT and Ortho-Clinical Diagnostics VITROS assays were the most commonly used assays, accounting for 84 815 (47.7%) and 65 258 tests (36.7%), respectively. The remaining 27 846 specimens (15.7%) were tested using the Roche Elecsys assay. Specimens were collected from 2496 of 3141 US counties (79.5%) (eFigure 1 in the Supplement), and 26 290 specimens (14.8%) were from persons residing in nonmetropolitan areas (Table).
Seroprevalence estimates were calculated by jurisdiction over the 4 collection periods (Figure 1 and eTables 3-6 in the Supplement). Seroprevalence ranged from 0.0% (95% bootstrap CI, 0.0%-4.4%) in South Dakota in period 2 to 23.3% (95% bootstrap CI, 20.1%-26.3%) in New York in period 1. In jurisdictions with enough tested samples to calculate an estimate, which included 46 of 49 sites (93.3%) in period 1, 46 of 51 sites (90.2%) in period 2, 48 of 50 sites (96.0%) in period 3, and 46 of 52 sites (88.5%) in period 4, fewer than 10% of specimens had detectable SARS-CoV-2 antibodies.
SARS-CoV-2 prevalence estimates were also calculated by jurisdiction stratified by sex, age group, and metropolitan status during each collection period (Figure 2, Figure 3, and Figure 4 and eTables 3-6 in the Supplement). Overall seroprevalence estimates varied by jurisdiction and period. There were no consistent differences between men and women across all jurisdictions, although in certain states (eg, Iowa, Louisiana, and Mississippi), seroprevalence was higher in women, while in others (eg, Maryland and Pennsylvania) seroprevalence was often higher in men. Seroprevalence in persons 65 years or older was generally lower than in adults age 18 to 49 years. Fewer samples were available for children and adolescents age 0 to 17 years, and among the 26 jurisdictions for which we could estimate seroprevalence across all periods, estimates varied relative to adult age groups. In the 23 jurisdictions with sufficient samples to calculate estimates by metropolitan status, seroprevalence in certain jurisdictions (eg, Iowa, Pennsylvania, and Tennessee) was higher in metropolitan counties, while in others (eg, Alabama and Mississippi) seroprevalence was higher in nonmetropolitan counties.
In 49 jurisdictions with sufficient samples to estimate seroprevalence across all periods, changes from period 1 to 4 varied across sites (Figure 1). The largest absolute percentage point decreases occurred in New York (6.3%) and North Dakota (6.1%), while large increases occurred in Georgia (6.2%) and Minnesota (4.5%). Ratios comparing estimated to reported SARS-CoV-2 infections during periods 1 and 4 ranged from less than 1 in Alaska for both periods to 12.5 in Pennsylvania during period 1 (eTables 1 and 2 in the Supplement).
Discussion
In a US nationwide survey of SARS-CoV-2 seroprevalence, we tested more than 177 000 residual specimens submitted for non–SARS-CoV-2 testing during 4 periods from July to September 2020 and found that in nearly all jurisdictions, fewer than 10% of people in the US had evidence of previous SARS-CoV-2 infection using currently available commercial IgG assays. Seroprevalence varied across regions and between metropolitan/nonmetropolitan areas, with estimates as high as 23% in the Northeast and 13% in the South, while estimates in the Midwest and West were less than 10%. Seroprevalence was often lowest in older age groups. Changes in seroprevalence over 2 months were generally modest and differed across jurisdictions.
We expanded a previous CDC-led seroprevalence survey from 10 to 52 represented jurisdictions,10 broadening the geographic scope and representativeness of SARS-CoV-2 serosurveillance in the US. Early surveys in California and New York focused on distinct community transmission hot spots.11,12,15 Others concentrated on high-risk populations, such as health care workers13,29 and adult patients receiving dialysis,14 in addition to other unique groups like blood donors.30 By testing for SARS-CoV-2 antibodies in persons of all ages who are receiving outpatient and inpatient clinical care, we may be better able to estimate seroprevalence in the general US population. Furthermore, our study includes 15% of samples tested from persons living in nonmetropolitan areas, which matches the distribution of US residents23 and achieves wider geographic representation than previous nationwide studies.14 We also present state-level estimates, whereas other studies were more optimally designed to calculate regional-level estimates.30
Our findings add to a growing body of work examining population-level SARS-CoV-2 exposure, as well as differences in transmission across regions. We found that most people in the US did not have evidence of previous SARS-CoV-2 infection. This is consistent with other large-scale seroprevalence surveys conducted in the US,10,14,30 as well as population-based surveys in the United Kingdom,31 Spain,32 and Geneva33 that were conducted over periods with substantial SARS-CoV-2 community transmission. Similar to other US surveys, we found the overall prevalence of SARS-CoV-2 to be highest in the Northeast,10,14,30 likely reflecting the high incidence of SARS-CoV-2 transmission in New York City (New York) and surrounding regions during the spring and summer of 2020.34 While several studies reported higher seroprevalence in more densely populated metropolitan areas,14,31,32 our findings were more mixed and reflect the heterogeneity of SARS-CoV-2 transmission across the US.
Similar to numerous other surveys, we found SARS-CoV-2 seroprevalence to be lower in older adults compared with younger adults across nearly all jurisdictions.14,30-33 With endemic coronaviruses, seroprevalence typically increases through childhood into early adulthood,27 and a few studies of SARS-CoV-2 have shown seroprevalence to be lower in children and adolescents younger than 18 years compared with young adults.30,32,33 Seroprevalence among children and adolescents in our survey was more varied compared with adults and was likely affected by differences in exposure risk across the regions sampled.
The changes in overall seroprevalence over 4 collection periods that spanned 2 months were modest. The 6.1–percentage point reduction in North Dakota was affected by low sample sizes, particularly in nonmetropolitan counties, and is likely not a reflection of true population changes. The few population-level seroprevalence surveys with repeated measurements are generally consistent with small changes over time.16,30,33 While the estimates in our study cannot be directly compared with results from an earlier commercial clinical laboratory seroprevalence survey10,16 because of differences in the geographic distribution of the 2 study populations, participating laboratories, and SARS-CoV-2 serology tests used in each study, we observed similar patterns of declining seroprevalence in New York and increasing seroprevalence in Minnesota. The ability to conduct repeated commercial clinical laboratory residual sera testing over an extended period will be valuable to assist in the tracking of the jurisdiction-level spread of SARS-CoV-2.
Another potential application of repeated serological surveillance is the calculation of the ratio of estimated to reported SARS-CoV-2 infections. We observed a wide range of ratios across jurisdictions that may be affected by multiple factors, including differences in care-seeking behavior. Therefore, we caution against comparing these ratios across jurisdictions. Instead, monitoring relative changes over time within a jurisdiction may provide a complementary measure of testing capacity and other metrics of public health interest.
Although cross-sectional seroprevalence studies often indicate a higher burden of infection than reported cases alone,10 they may still underestimate the total number of prior infections. For one, persons with asymptomatic or mild infection may mount a less robust immune response than persons with more severe disease.35-38 Further, declines in SARS-CoV-2 antibodies following infection have been observed.35-39 The kinetics of waning antibodies also appear to differ by type of assay, viral target, and severity of infection35,40 We do not yet understand the association of these factors with estimating seroprevalence in the population or interpreting changes in seroprevalence over time.
More research is also needed to fully understand how the presence or absence of SARS-CoV-2 antibodies affects continued susceptibility to the virus and potential immunity in terms of severity of illness once exposed, subsequent recovery, and future reinfection. Large-scale seroprevalence surveys have relied on qualitative immunoassays10,14,30 which can be implemented at scale. However, these are not sufficient to estimate correlates of protection against SARS-CoV-2.41,42 Furthermore, other elements of innate or cellular immunity may confer protection to SARS-CoV-2 despite the absence of measurable antibodies.43 The dynamics of waning antibodies and persistence of B-cell and T-cell memory44-46 may lead to further underestimation of immunity over time when using qualitative immunoassays. Assays to detect other factors associated with the immune response, such as quantitative antibody levels and neutralizing antibodies for SARS-CoV-2, are resource intensive and not yet widely available.22
Limitations
This cross-sectional study has several important limitations. Persons who have blood taken for routine screening or clinical care may not represent the general US population. They can differ with regard to their underlying health, access to care, care-seeking behavior, exposure risk, or adherence to prevention measures, including use of masks and social distancing.47 While we excluded specimens collected for SARS-CoV-2 antibody testing, we could not exclude persons seeking care for COVID-19–related symptoms. The overall direction of bias resulting from these factors is unclear; for example, even if persons with acute SARS-CoV-2 infection were included, they may have presented for care during the window before antibodies could be detected.27
The study was not designed to produce a nationwide estimate of seroprevalence, nor does it necessarily represent the demographic or geographic distribution of residents within each jurisdiction. The concordance between the ARCHITECT and VITROS platforms was excellent but did not include comparison with the Roche assay, which further limits the ability to compare estimates across jurisdictions. Information on patient race/ethnicity or important social determinants of health that affect COVID-19 outcomes14,48-50 was not available, limiting our ability to further refine our weights and adjustments.
The geographic catchment of samples was determined by the distribution of the commercial clinical laboratory testing sites in each jurisdiction, which are often concentrated in urban areas. We also used convenience sampling in selecting from the pool of available commercial specimens, a method which is subject to potential biases. Despite the large size of the study, we did not reach our target sample numbers in all age groups or jurisdictions. We were therefore unable to estimate seroprevalence in Hawaii, South Dakota, and Wyoming for all periods or in the 0- to 17-year age group for many jurisdictions. Low sample numbers in nonmetropolitan counties also limited reliable metropolitan/nonmetropolitan subgroup estimates in several jurisdictions. Finally, specimens were tested using 1 of 3 immunoassays, each with slightly different performance characteristics. The specificity of all 3 assays was 99.6% or greater, while there was a broader range of sensitivity. Although we adjusted for assay performance specifications, including uncertainty based on validation testing, assay sensitivity among symptomatic persons with reverse-transcriptase polymerase chain reaction–confirmed SARS-CoV-2 infection as described in the manufacturer Instructions for Use is expected to be higher than in our study population, in which persons experiencing previous infection may have had milder disease or had blood drawn for antibody testing at differing times since infection.
Conclusions
In this US nationwide seroprevalence cross-sectional study, we found that as of September 2020, most persons in the US did not have detectable SARS-CoV-2 antibodies, and seroprevalence estimates varied widely by jurisdiction. Continued biweekly testing of sera collected by commercial laboratories will allow for assessment of the changing epidemiology of SARS-CoV-2 in the US in the coming months. Our results reinforce the need for continued public health preventive measures, including the use of face masks and social distancing, to limit the spread of SARS-CoV-2 in the US.
Article Information
Accepted for Publication: November 6, 2020.
Published Online: November 24, 2020. doi:10.1001/jamainternmed.2020.7976
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Bajema KL et al. JAMA Internal Medicine.
Corresponding Author: Kristina L. Bajema, MD, MSc, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Mailstop H24-6, Atlanta, GA 30329 ([email protected]).
Author Contributions: Drs Bajema and Edens had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Bajema, Iachan, Havers, Harding, Fry, Hall, Gundlapalli, Thornburg, Petersen, Edens.
Acquisition, analysis, or interpretation of data: Bajema, Wiegand, Cuffe, Patel, Iachan, Lim, Lee, Moyse, Harding, Kelly, Biel, Deng, Meyer, Mathur, Kyle, Gundlapalli, Thornburg, Petersen, Edens.
Drafting of the manuscript: Bajema, Wiegand, Cuffe, Patel, Iachan, Harding, Edens.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Bajema, Wiegand, Iachan, Lim, Lee, Harding, Kelly, Biel, Deng, Edens.
Obtained funding: Bajema, Cuffe, Havers, Fry, Hall, Gundlapalli, Petersen, Edens.
Administrative, technical, or material support: Bajema, Wiegand, Cuffe, Patel, Moyse, Havers, Fry, Hall, Meyer, Mathur, Kyle, Gundlapalli, Thornburg, Petersen, Edens.
Supervision: Iachan, Havers, Fry, Hall, Mathur, Meyer, Thornburg, Edens.
Conflict of Interest Disclosures: ICF, Inc, Quest Diagnostics, and BioReference Laboratories were awarded federal contracts from CDC for the execution of this project. No other disclosures were reported.
Funding/Support: This work was supported by CDC (Atlanta, Georgia).
Role of the Funder/Sponsor: CDC had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: The findings and conclusions in the article are those of the authors and do not necessarily represent the official position of CDC.
Additional Contributions: We thank Gabriele Richardson, PhD, CDC, for mapping support as well as other members of CDC for administrative and technical support: Teresa Kinley, MS, Melissa Carter, PhD, Lauren Peel, JD, Adrean Mabry, BS, Saraine Ross, BA, Jasmine Chaitram, MPH, Alex Hoffmaster, PhD, Subbian Panayampalli, PhD, William Duck, MS, Eduardo Azziz-Baumgartner, MD, Adam MacNeil, PhD. We thank Quest and BioReference for testing specimens. From Quest: Brian Jaffa, MS, Caterina Powell, BS, Rebecca Parsons, BS, Brian Young, AA, Carol Bledsoe, Nicki Sylvester, MBA, Bonnie Bouck, AA, Georgia Schoemaker, BS, Stephanie Buchler, Larry Hirsch, BS, Narshimlu Ramdas, BTech, Neelima Donur, MS, Jeff Crawford, BS. From BioReference: James Weisberger, MD, Dan McNichol, MBA, Ada Gazzillo, BS, Nick Cetani, MS, Cesar Abril, MBA, Angela Canada, BS, Amal Abadeer, BA, and Pamela Depuy. These individuals were not compensated directly by CDC for their participation in this specific study.
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1 Comment for this article
November 29, 2020
SARS-CoV-2 Seroprevalence in the US comments.
Gary Ordog, MD, DABMT, DABEM | County of Los Angeles, Department of Health Services, Physician Specialist (ret.)
Thank you for the interesting study. Although your subject numbers seem large, I believe they represent less than one percent of the population, which makes the sample size small. Also, the method of using convenience blood, we really have no idea why these subjects were getting their blood drawn, but we do know it was not for the purpose of the study. That means that the small sample size may be skewed unknowingly and severely towards some unknown confounding variable, for example, perhaps most of them thought they had had COVID-19. So, the validity of drawing conclusions based upon these results is very low, and even trying to make valid conclusions about time trends is questionable because of the possibility of unknown changing confounding variables during that time. That said, I would like to comment on the implications of your study results, even though what I am concluding cannot be valid, just interesting. Most importantly, possibly only 10% of the population have been infected with SARS-CoV-2. That means that possibly, 90% of the population may be still prone to suffer from infection in the pandemic. Without a vaccination, the US could be facing a disaster. Fortunately, it looks like several vaccines are effective, and many more are in the works. If anything, it looks like your study shows that the vaccination program and its success is more important that ever. Thank you, and stay safe until then.
CONFLICT OF INTEREST: None Reported
DECEMBER 7, 2020
COVID-19: Close to 207,000 new cases reported in US
According to CDC's update on December 6, the case count of COVID-19 in the US stands at 14,462,527* cases, including 280,135* deaths, in 55 (50 states, District of Columbia, Puerto Rico, Guam, Northern Marianas, and US Virgin Islands) jurisdictions. The CDC noted that this represents an increase of 206,992 cases and 2,310 deaths compared to the update on the preceding day.
Yes, vaccine almost ready to distribute, but we are breaking all-time record numbers of infections and deaths. Like I said previously, the worst part is just before the end.
JANUARY 8, 2021
COVID-19: US confirms close to 300,000 new cases
According to CDC's update on January 7, the case count of COVID-19 in the US stands at 21,259,997* cases, including 359,849* deaths, in 55 (50 states, District of Columbia, Puerto Rico, Guam, Northern Marianas, and US Virgin Islands) jurisdictions. This represents an additional 299,904 cases and 3,844 deaths compared to the update on the preceding day.
This is truly a disaster. I don't think anyone envisioned that the big problem would be vaccine distribution, that should be the easy part. I thought the hard part was 'Operation Warp Speed,' but, that went really smoothly. Perhaps, FATE is true, and we had to satisfy the area under the Pandemic (1918) Death Curve. I thought when the vaccine was certified that the Phase Two peak would be cut short. But, oh no, it is continuing on with a vengeance, at the highest levels ever, all because of the failure of vaccine distribution. (Then people suggest temporizing measures such as redistribute the second dose to others who haven't have the first dose, cut the dose in half, etc. This will not solve the problem folks, the problem is the distribution of the vaccine, not the actual vaccine amount).
Happy New Year 2021. Here is the latest CDC numbers report, with the new definition of death due to COVID-19 or more specifically SARS-CoV-2:FEBRUARY 4, 2021COVID-19: Case count in US rises by close to 117,000According to CDC's update on February 3, 2021 12:26 pm ET, the case count of COVID-19 in the US stands at 26,277,125* cases, including 445,264* deaths, in 55 (50 states, District of Columbia, Puerto Rico, Guam, Northern Marianas, and US Virgin Islands) jurisdictions. The CDC noted that this represents an increase of 116,915 cases and 3,433 deaths compared to the update on the preceding day. * As of April 14, 2020, CDC case counts and death counts include both confirmed and probable cases and deaths. This change was made to reflect an interim COVID-19 position statement issued by the Council for State and Territorial Epidemiologists on April 5, 2020. The position statement included a case definition and made COVID-19 a nationally notifiable disease.A confirmed case or death is defined by meeting confirmatory laboratory evidence for COVID-19.A probable case or death is defined by one of the following:
- Meeting clinical criteria AND epidemiologic evidence with no confirmatory laboratory testing performed for COVID-19
- Meeting presumptive laboratory evidence AND either clinical criteria OR epidemiologic evidence
- Meeting vital records criteria with no confirmatory laboratory testing performed for COVID-19
- Stay safe it is still not good even though the vaccines have been out for 2 months, but their distribution is failing!!. As it may be another year before we all get our vaccinations, this may well portend the death of a million in the US alone by COVID-19 by then. Remember, only 10% of the US population has been shown to be infected to date. Many of those infected have already reverted back to non-immune status and can get it again. Let alone the new mutations that are re-infective too. Nasty situation getting worse. These numbers will actually approach those of 1918, by 2022, at the rate that things are going now. Poor vaccine roll-out has allowed history to repeat itself again!
- Gary Joseph Ordog, MD.