More good news. It seems that each day, the results of another study of the actual extent of Covid 19 infection show that the actual number of people infected is much greater than we expected.
As always, this is good news.
Until now, Miami-Dade county in Florida has reported 10,600 cases of Covid 19. However today, a University of Miami reported on a study designed to determine the actual extent of infection by selecting a wide range of patients with and without symptoms for antibody testing.
They found that 6% of those tested were positive for the antibody. Assuming that their study group was representative of the Miami Dade county, this would mean that 165,000 were infected with Covid 19 instead of the 10,600 reported. About 50% of the people tested reported having no symptoms for 14 days before being tested.
This data is consistent with the data reported for Santa Clara (2-5 %) and Los Angeles County (4%) in California and New York (up to 21%) as well as testing in Robbi Italy (10%) and Gangelt Germany (14%). Although each study tested only a few thousand representative people, in all cases, the number of people tested ranged from 4 to 21% of the population- representing 10 to 80X the number of cases that have been reported.
This means that the ‘curve’ that we have been trying to flatten is NOT representative of the actual number of infections that have occurred. Taking an average of 5% infection for discussion sake, this would mean that in the US alone, there have been 18,750,00 infections, not 953,851. This would also make the fatality rate .28%. If it turns out that 10% of the population was infected, the fatality rate would be .14%. Recall that New York city reported an infection rate of 21%.
Caveat: All of these studies represent cross sections of different areas of the US, Italy and Germany. More data is necessary from many more places with wider demographic of study subjects until the actual infection rate is known.
However, even as we watch the daily count of new cases increase, it is certainly the case that the cases being measured are 10 to 80 times less than the actual number of people being infected. Again, this is good news. It means that 50-80% of the people who get infected have no or minor symptoms and that the fatality rate gets closer and closer to the values we associate with seasonal flu. This is especially good news as the seasonal flu numbers are WITH a flu vaccine. To date, there is no proven vaccine for Covid 19. The numbers for Covid 19 can only improve with more antibody testing and the introduction of a vaccine.
This also has implications on reopening businesses as sheltering in place may have been effective, but perhaps not nearly as effective as it was thought to be.
New York: Infection rate 10x higher than previously thought. This is good news.
New York reported their first results in larger scale antibody testing to see how many people may have had actually had a Covid 19 infection. 43% of the tests were conducted in New York City while 32.8% of the test were taken out of the city. The presence of the antibody means the person had and recovered from Covid 19 infection. In most cases, the person was unaware they were infected. This is GOOD NEWS. It means that most people who get infected have no or minor symptoms and it makes the fataility rate (the % of people who die after getting infected) much, much lower. See my earlier blog on antibody testing. Covid 19 Tests: What we can and can’t say.
The results reflected large differences between different areas of the state. The number of people who tested positive for the antibody was:
New York City: 21%
Long Island: 16.7%
Rest of New York 3.6%
This corresponds to 1.7 million people in New York City and more than 2.6 million statewide who have been infected. These number are much, much higher than the 275,000 confirmed cases that his reported today.
The tests show that the spread of covid 19 was not very different for different age groups:
45-54 age: 16.7%
65-74 age: 11.9%
Over 75 age: 13%
Less than 45 ranged from 8 to 15%
It is reminded here that this is percentage in each age group that had the antibody – they are the survivors. The fatality rate among the groups is very different, with those over 65 accounting for 40% of the deaths. The fatality rates will be discussed in a future blog.
Black, latino and multiracial New Yorkers had a 22% average positive tests while White accounted for 9.1% of the positive results. Although it is clear there is a racial component to the infection rate, strict comparison of the numbers should be done carefully, as most of the testing was done New York City which has more minorities.
Importantly, this make the fatality rate around .5%, 10x lower than what was known just a couple of weeks ago.
This does not negate the severe impact the disease has had on the public but it does provide more insight into the disease.
Caveat: This study and others should be considered preliminary studies. They clearly show a high number of infections but only in limited locales. Much more data from more locations and wider demographic inclusion will be necessary before the actual numbers of infections are known. The results may also vary from country to country or county to county. However, all indications so far are that the number of infections determined by antibody testing is far higher than the number of confirmed cases being reported.
This week, several states like Georgia and Texas are beginning to cautiously allow the opening of selected businesses. They are doing this in the wake of the Federal Guidelines for reopening their businesses which provides guidelines for reopening but allows local governors to make final specific decisions. I’m going use the opening of Hair Salons as my discussion focus because it is controversial but brings out all the complexities of reopening a business.
In the past month, grocery stores, pharmacies, big box stores and Home Depot have opened without starting any outbreaks – this suggests that other businesses may find ways to reopen and stay safe as well. It is hopeful that gyms, schools and other places can find ways to open and operate safely.
It should be emphasized that within a state the infection rate of Covid 19 can be very different. This means that you should know the situation around where you live. Some areas have much higher rate of infection and people should behave accordingly.
Texas. For instance, in the last 14 days 155 of the 255 counties of Texas have not reported any cases of Covid 19. Another 19 counties have reported less than 10 new cases of Covid 19. This is in contrast to the largest county, Harris and Dallas counties which reported 754 and 556 cases respectively in the same time period. Just 10 counties account for 72% of the Covid 19 cases in Texas. However, on percentage basis, on average 1.2% of the population of each county has been infected. Keep in mind that this is a lower percentage that catches the seasonal flu. Your risk of getting the disease is highly variable in Texas (and everywhere else).
Similarly the 10.6 million people of Georgia live in one of 158 counties. The top 10 counties account for over 55% of cases. It is a much different environment in Dekalb County (1600 cases including Atlanta) than in Montgomery County (2 total cases).
The reopening of businesses is not only economically crucial but also crucial to the health of the general population. Over 50% (some higher) of the people live paycheck to paycheck and lines for food banks are enormously long. Also, ‘elective’ surgeries and medical treatments have been stopped but the long term health implications of these stoppages are not yet known. For instance, cancer screening stopped so there are people who may have been able to be diagnosed with cancer and start treatment have been waiting over a month just to get the diagnosis. People with chronic pain are also not being cared for during this time. A topic for another blog will be the costs involved. BEFORE the over 5 trillion dollars recently allocated by congress, the national debt was 18 trillion dollars which translates into an interest payment of approximately $500 Billion each year. That is $500 billion that could be spent on other things like education, homes, health care etc….the new spending will send our interest payments to over $600 Billion/year – over 10% of the US budget.
On the other hand, no one wants to ‘reignite’ the infection of Covid 19 after working so hard and making so many sacrifices to get the disease under some management so it will be balance to get back to work and stay safe. I’m sure there will be some good decisions and some bad decisions in the coming weeks. Choices have to made on imperfect and incomplete data and the interpretation of the data we do have can often be interpreted in different ways.
It is important to emphasize that in these states that are beginning to allow businesses to open – it is NOT business as usual. Social distancing guidelines remain in effect and there are many more procedures that must be followed in order to reopen and stay open.
One of the big controversies is the opening of hair salons. It seems that this puts two people closer than social distance guidelines. Is this a good idea? The first answer is, that we don’t know how this will work – especially if they follow the guidelines. This may be too much detail, but it illustrates the details that have to be taken for ANY business to reopen. Here are the Georgia Guidelines for Hair Salons. Also, consider that everyone should use some common sense along with government guidelines.
If you feel sick – don’t go out.
If you’ve been in close contact who has been sick, don’t go out.
If you feel sick – don’t go to work.
If you have been in close contact who has been sick don’t go to work.
Be mindful of exposing others to risk. Most recent data suggests that 80-90% of infected people have few or no symptoms but can transmit the disease to others. So even if you are feeling good, be mindful of who you come into contact or close proximity with.
Also, getting testing for Covid 19 just tells you if you have been infected on that day. If you were recently infected, you may not have had the time for the infection to become detectable. The test also will not tell you if you get the virus the next day or anytime in the future. If you feel like you might be sick – stay away from others (test or no test).
Look the hair salon guide over, consider where you live and decide if you would go to hair salon if you were in need of a hair appointment. I know this is only a small segment of life, but the same decisions will have to be made for every business that opens and every business you frequent.
Salon Guidelines – Georgia
Salon/shop employees will be required to wear masks at all times. Salons may want to consider providing masks to clients. Clients should wear face masks to the extent possible while receiving services.
Salons/shops should also make use of face shields, gloves, disposable or re-washable capes, smocks, neck strips, etc.
These items should be disinfected or disposed of between each client. Employees should should arrive at the salon/shop showered and wearing clean clothing and change clothes before leaving the salon/shop each day.
Hand washing with soap and warm water, for a minimum of 20 seconds will be required by employees between every client service.
All salons/shops should be thoroughly cleaned and disinfected prior to reopening. Disinfect all surfaces, tools, and linens, even if they were cleaned before the salon/shop was closed.
Salons/shops should maintain regular disinfection of all tools, shampoo bowls, pedicure bowls, workstations, treatment rooms, and restrooms.
Additionally, salons/shops should remove all unnecessary items (magazines, newspapers, service menus, and any other unnecessary paper products/decor) from reception areas and ensure that these areas and regularly touched surfaces are consistently wiped down, disinfected, and that hand sanitizer is readily available to clients and staff.
Avoiding the exchange of cash can help in preventing the spread of the virus, but if this is unavoidable, be sure to wash and sanitize hands well after each transaction.
The use of credit/debit transactions is preferred, using touch/swipe/no signature technology.
Employees who are sick will be expected to stay home.
Salon/shop owners/managers should provide training, educational materials, and reinforcement on proper sanitation, hand washing, cough and sneeze etiquette, use of PPE, and other protective behaviors.
Ensure break rooms are thoroughly cleaned and sanitized and not used for congregating by employees.
Be flexible with work schedules/salon hours to reduce the number of people (employees and clients) in salons/shops at all times in order to maintain social distancing.