Dear Reader:

New York City (NYC) is 784 square km, Sao Paulo (not the city, but the Metropolitan area aka Regiao Metropolitana de Dao Paulo, which consists of 39 municipalities): close to 8,000 square km.  NYC has a population of about 8.4 millions, Sao Paulo: about 21 millions. The population density in NYC: about 11 thousands per square km; Sao Paulo: about 3,000 per square km.

Sao Paulo’s area is 10 times greater than that of NYC, but its population is only 2.6 times greater than that of NYC. The population density in NYC is therefore almost 4 times greater than that of Sao Paulo metro.

But not all areas in NYC are equally densely populated: Manhattan is the most populated of the five boroughs (Manhattan, Brooklyn, Queens, The Bronx and Staten Island) with close to 28 thousands people per square km.

Sao Paulo is way less populated than NYC, but among its 39 municipalities, Sapopemba is the most populated with 22 thousands people per square km (6 thousands less per square km than in Manhattans). Five of the municipalities have 15-16 thousand people per square km, and Parelheiros is the least populated with only 314 people per square km.

Population density is a huge factor when it comes to contagious diseases. Quarantines, lockdowns,  and other forms of social distancing are the counter population density measures.

www. bbc. com/ news/ world latin America, May 18: “The mayor of Brazil’s largest city, Sao Paulo, has said it’s health system could collapse as demand grows for emergency beds to deal with coronavirus cases. Bruno Covas said the city’s public hospitals had reached 90% capacity and could run out of space in two weeks… Sao Paulo is one of the country’s worst- hit regions, with almost 3,000 deaths so far.. Mr. Covas said he was now in talks with the state governor over introducing a strict lockdown to try to prevent hospitals being overwhelmed.. Sao Paulo (the city) has a population of about 12 million, and official figures show most residents are ignoring social distancing rules.

A quarantine in Sao Paulo state was imposed nearly two months ago- businesses, schools and public spaces were closed and people were asked to stay at  home. But there are no costly punishments for those who flout the rules.. A recent rule brought in that made the wearing of masks mandatory is often ignored.. It doesn’t feel as though the virus is being taken seriously… Many are expecting a tougher lockdown in the week ahead”.

anita

• This reply was modified 4 years, 6 months ago by .

Dear Reader:

Continued, from my post before last- of all the countries in the world, according to the numbers reported and presented by worldometer,  Sweden has the highest percentage of deaths out of the closed Covid-19 cases (the cases of infections that resulted either in recovery or in death): 46% of patients died (1% rise since yesterday following a two days sharp rise in deaths: 96 yesterday and 95 today). In the other three Scandinavian countries- Norway, Denmark and Finland- 3%, 5% and 6% of the patients died, respectively. This is a huge difference.

In the US, the epicenter of the pandemic, 17% of patients died (a 1% decline since yesterday). In the previous epicenter, Italy, 18% (1% decline since yesterday) of patients died. The highest percentages of deaths after Sweden are in France (30%) and in Belgium (38%).

More about the other countries, later. For now: Sweden, why is the highest percentage of deaths there? According to Wikipedia, 3.6% of the deaths were aged 0-59, 6% were aged 60-69, and 90.4% were aged 70 and older. 93% of the deaths had at least one of the following pre-existing conditions: a chronic cardiovascular disease (53%), diabetes (26%), chronic respiratory disease (18%), and chronic renal failure (16%). Most of the deaths were in Stockholm County, which is the most populated county in Sweden with about 2.4 million people (population density: 365 people per square km); almost a million people of the 2.4 millions live in Stockholm the capital, population density 5,200 people per square km.

* The total deaths from all causes in Sweden before the pandemic, from Jan 1 to May 7, was 34,656 in 2015 and in 2016, 34,314 in 2017, 35,205 in 2018, and 31,866 in 2019. In the same period of time in 2020, pandemic time, the number of deaths from all causes is 36,027 (Wikipedia)

Averaging the number of deaths from all causes in 2015, 2016, 2017, 2018, and 2019, the average is 34,139 deaths per year, Jan 1-May 7. The number of deaths from all causes in 2020, pandemic time, is 36,027. There have been additional 1,888 deaths in 2020 than the average of the previous five years. This means that very roughly (no way to know)  2,332 of the 4,220 people who died of Covid-19, would have died so far this year if there was no pandemic because of old age and disease.

In other words, 2,332 out of the 4,220 (55%) of the Covid-19 deaths in Sweden this year would have died from old age and health conditions if there was no pandemic going on, most dying from chronic cardiovascular disease.

Sweden’s State epidemiologist Andres Tegnell, recently said that in the short term there is a higher death rate short term in Sweden, but long term- he doesn’t know. I didn’t understand what he meant then, but I think that I understand now. I think that what he meant is that Covid-19 may be wiping out the older generation for years to come, meaning older people who were to die in 2021, 2022, etc.,  are dying in 2020, the virus advancing their due date of death, so to speak. And so, there are more deaths in 2020 (short term death increase), but in the long term, there may be fewer deaths post pandemic,  in 2021, 2022, etc.

I will continue later, but will mention the following: the death rate from Covid-19 has to do with a number of factors, a few of which are: the quality of the health system and its availability to the sick, population density, population age and preexisting conditions, and the percentage of older people living in communal settings such as nursery homes.

anita

Dear Reader:

Thorax is one of the world’s leading respiratory medicine journals, publishing clinical and experimental research articles on respiratory medicine and more. Here is a recent article from three days ago (thorax. bjj. com/ content/ early/ 2020/05/27), all that follow is quotes:

“We describe what we believe is the first instance of complete Covid-19 testing of all passengers and crew on an isolated cruise ship during the current Covid-19 pandemic. Of the 217 passengers and crew on board, 128 tested positive for Covid-19 on reverse transcription-PCR (59%). Of the Covid-19 positive patients, 19% (24) were asymptomatic; 6.2% (8) required medical evacuation; 3.1% (4) were intubated and ventilated; and the mortality was 0.8% (1). The majority of Covid-19-positive patients were asymptomatic (81%, 104 patients)…

The expedition cruise ship departed from Ushuaia, Argentina, for a planned 21-day cruise of the Antarctic Peninsula, including Elephant Island.. The ship departed mid- March 2020, after the global Covid-19 pandemic was declared by the WHO, with all 128 passengers and 95 crew screened for Covid-19 symptoms, and body temperatures were taken before boarding. No passengers or crew that had transit through China, Macau, Hong Kong, Taiwan, Japan, South Korea or Iran in the previous 3 weeks were permitted to board, given that these countries were where Covid-19 infection was most prevalent at the time. Multiple hand hygiene stations were positioned throughout the ship and especially in the dining area… all passengers and crew had regular body temperature reviews performed by the ship’s two physicians.

The first recorded fever on board the ship was a febrile passenger on day 8. Isolation protocols were immediately commenced, with all passengers confined to cabins and surgical masks issued to all. Full personal protective equipment was used for any contact with any febrile patients, and N95 masks were worn for any contact with passengers in their cabins.  The crew still performed duties, including meal services to the cabin doors three times a day, but rooms were not serviced…

Further fevers were detected in three crew on day 10, two passengers and one crew on day 11, and three passengers on day 12.. The majority of febrile patients had improved with symptomatic treatment and were afebrile on arriving at Montevideo. Rapid testing kits for Covid-19 were delivered on board and performed on six passengers and crew, who had initial fevers. All returned negative results on day 14… Three additional passengers and crew developed fever on day 14, but with mild cough and lethargy only. One of these passengers, a 68 year old man who was a lifelong non-smoker with no comorbidities, deteriorated and required urgent medical evacuation to a hospital in Montevideo on day 17. He was intubated and ventilated and tested positive for Covid-19.

A total of eight passengers and crew were medically evacuated from the ship to hospitals in Montevideo, all for impending respiratory failure, including a 70 year old woman with chronic obstructive pulmonary disease (evacuate day 20), a 65 year old woman with no comorbidities (evacuated day 21), and two crew and one passenger evacuated on day 22. A seventh passenger, a 68 year old man, developed fever on day 23 and was evacuated for hypoxaemia on day 24. One of the two ship physicians required medical evacuation on day 27 also for hypoxaemia. All evacuated patients subsequently tested positive..

Of the 217 passengers and crew on board, 128 tested positive for Covid-19 (59%)… There were 10 instances where two passengers sharing a cabin recorded positive and negative results.

Despite 128 (59%) of the population testing positive, fever and mild symptoms were present in only 16 of 128 Covid-19 positive patients (12.5%), with another 8 medically evacuated (6.2%) and 4 requiring intubation and ventilation (3.1%). There has unfortunately been one death to date (0.8%). There were therefore a total of 24 Covid-19 positive patients who were symptomatic (19%), with the majority being asymptomatic (104 patients or 81%).

From the departure date in mid-March 2020 and for the next 28 days, the expedition cruise ship had no outside human contact and was thus a totally isolated environment in this sense.

We conclude from this observational study that.. The majority of Covid-19 positive patients were asymptomatic (81%).. there may be a significant false-negative rate with RT-PCR testing. Follow-up testing is being performed to determine this… The timing of symptoms in some passengers (day 24) suggests that there may have been cross contamination after cabin isolation”-

– more about this article, later.

anita

• This reply was modified 4 years, 5 months ago by .

Dear Jessica (Jess):

So glad once again to read from you here, and to read such an intelligent and well written post. Regarding masks, yes, we should all wear masks or cloth face coverings all the time when in enclosed/ indoor areas, and outdoors where we are not distanced enough from others. The virus is way more infectious indoors than outdoors.

www. cdc.  gov/ coronavirus: “We now know from recent studies that a significant portion of individuals with coronavirus lack symptoms (‘asymptomatic’) and that even those who eventually develop symptoms (‘pre-symptomatic’) can transmit the virus to others… In light of this new evidence, CDC recommends wearing cloth face coverings in public settings .. e.g., grocery stores and pharmacies.. It is critical to emphasize that maintaining 6- feet social distancing remains important to slowing the spread of the virus… The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders”.

www. who. int/.. when and how to use masks: “If you are healthy, you only need to wear a mask if you are taking care of a person with Covid-19”- the reason WHO has a different instruction in regard to wearing masks is the same concern as the CDC’s, which is that if everyone wears a mask, there won’t be enough for health care workers, a concern that is more acute in poor countries with fewer masks available. (I didn’t read a mention of cloth face coverings by WHO).

WHO provides these instructions regarding wearing masks: “Before putting on a mask, clean hands with alcohol-based hand rub or soap and water. Cover mouth and nose with mask and make sure there are no gaps between your face and the mask. Avoid touching the mask while using it; if you do, clean your  hands .. Replace the mask with a new one as soon as it is damp and do not re-use single use masks. To remove the mask: remove it from behind (do not touch the front of mask); discard immediately in a closed bin; clean hands with alcohol-based rub or soap and water”.

* You wrote: “It would seem that the bulk of Covid-19 cases are asymptomatic”- in the CDC quote above there is a distinction between asymptomatic and pre-symptomatic. Asymptomatic means people who .. never develop symptoms, and pre-symptomatic are people who develop symptoms later. If the bulk of people who are infected are also asymptomatic, this means that if you and I are infected (and if we are younger and with no pre-existing conditions) to be asymptomatic as well and never develop symptoms.

But of course, we should wear masks or cloth face coverings because we don’t want to risk getting infected and we don’t want to spread the infection to people who are older and/ or with pre-existing conditions.

Regarding a new wave of infections in the fall, in Wikipedia‘s entries on the pandemic in different countries, it states a number of waves. For example, in its entry on Singapore, it lists: “Wave 1: Imported cases from China (January 2020)… a total 13 confirmed cases, all of whom were visitors to Singapore from China.. Wave 2: Early local clusters (February to March 2020)… More clusters emerged at various locations, where there were large scale gatherings.. Wave 3: Returning Singaporeans and permanent residents from overseas (March 2020).. Wave 4: Spread among migrant worker population (April 2020 to Present) In April, the bulk of cases began to shift from imported cases to migrant workers living in dormitories”-

– so appearing in waves is the natural behavior of an infectious epidemic or pandemic, it goes up in one area, then down, then up in another area, down.. etc., like waves in an ocean. The talk about a second wave refers to a big wave in the fall and winter of this year, a coronavirus wave that will coincide with the flu season.

www. health. com/… cdc warns second wave coronavirus (April 23): “The second wave? Think of it as literally a second wave, it  comes behind the first, doesn’t get that high, but ebbs and flows.. Those ‘ebbs and flows’ depend on the success of protective and preventive measures”, and an example of these ebbs and flows is given regarding China: the outbreak in Hubei (the epicenter of the original outbreak) was the first wave, then it was controlled, “After reporting near-zero local transmissions over several weeks, a new batch of Covid-19 cases in the city of Harbin, at the border with Russia”- that’s a second wave which “resulted in fresh lockdowns”.

“It’s still too early to  identify Covid-19 patterns, though Dr. Adalja believes the biggest thread of a second wave appears to be during fall, which is the start of flu season… ‘A second wave starting in the fall could occur mixed with the flu and prove to be especially challenging for hospital systems to cope with,’ he says…

Urvish Patel, MD, MPH, a public health professional in the neurology department at Mount Sinai Hospital, New York.. points out that other SARS and MERS viruses have not shown a second wave, but says we should be ready for any possible condition. He advises that ‘prevention and precaution’ is always the best approach.”

* You wrote: My hope is that as it mutates through the months, it becomes less potent and less contagious”- which is what happened with the first SARS and MERS mentioned in the paragraph above, resulting in no additional waves of SARS (it was declared contained in 2003 by WHO), and no significant waves in the case of MERS.

– thank you for your thought provoking post, Jessica (or do you prefer Jess?) I hope to read from you again, anytime you are up to posting here.

anita

• This reply was modified 4 years, 5 months ago by .

* testing

Dear Reader:

Currently on the worldometer website, there are almost 430,00o global Covid-19 deaths, close to 3.4 million active cases of which 98% are in mild condition and 2% are in serious or critical condition. Of the over 4.4 million closed cases, 90% recovered/ discharged and 10% died.

The US accounts for about 117 thousands of the 430 thousands global deaths (55 deaths per million people). Brazil accounts for about 42 thousands of the 430 thousands global deaths (197 deaths per million), and the UK accounts for 42 thousand deaths of the 430 thousands global deaths (611 deaths per million).

As far as numbers of deaths within a population of a million people, these are the countries with most to least: San Marino (1,238), Belgium (833), Spain (580), Italy (566), Sweden (483), France (450). All other countries report lesser numbers.

* San Marino is a very small country completely surrounded by Italy, an enclave.

A few Covid-19 news from around the world:

* California‘s surge in the number of Covid-19 cases is a result of increased testing (60-80 thousand testing a day), not to the ongoing re-opening of businesses (Los Angeles Times).

* An area of the Chinese capital Beijing has been put under strict lockdown measures after the city’s first coronavirus cases in more than 50 days (BBC).

* The number of Covid-19 cases in India’s worst affected city, Mumbai, has surpassed Wuhan in China, where the virus first appeared. Hospitals in the country are struggling, people are dying without getting the treatment they need (BBC).

* Surfers have returned to the beaches in Rio and this week in Sao Paulo, shops and malls reopened- but this is the confusing bit- quarantine has been extended in Sao Paulo until the end of the month. Nobody knows where this pandemic is heading in Brazil. With such woeful levels of testing it’s hard to get a true picture of the extent of the virus here.

* International flights to and from Greek‘s main airports will resume on June 15, after a nearly three-month lockdown. Accounting for about 20% of Greece economic output, tourism is vital for Greece. The country will conduct coronavirus tests on all visitors arriving from airports deemed high-risk by the European Union’s aviation safety agency. Visitors will be quarntined up to 14 days, depending on the test result (The Sun)

* Turkey reopened restaurants, cafes, gyms, parks, beaches and museums on June 1 and eased stay-at-home orders for senior citizens and minors earlier this week. People crowded sea fronts and parks in the first weekend after the relaxation, often without masks or flouting social distancing (The Sun).

* Italy, Germany, France and the Netherlands have signed a contract with AstraZeneca to supply European citizens with a vaccine against the coronavirus, Italy’s health minister said on Saturday. The contract is for 400 million doses of the vaccine, which was developed with the University of Oxford and whose experimentation phase is already advanced and expected to end in autumn (The Sun).

anita