New York: For Trump, the Most Dangerous Covid Phase Lies Ahead

Having first exhibited COVID-19 symptoms last Wednesday or Thursday, President Trump left Walter Reed medical center just as he was entering the disease’s danger zone. While he may seem outwardly fine, the complex interaction between the virus and his immune system taking place inside his body could quickly spiral out of control, according to experts.

The timing of the coronavirus’s peak danger is a function of how the virus attacks the body. During the early phase, the coronavirus multiplies inside the host’s cells and triggers the immune system response. It’s during this period that the first symptoms can manifest. The critical phase doesn’t come until seven to 10 days after the onset of symptoms, when the immune system can lurch dangerously into overdrive as it tries to beat back the infection.

It’s during this time that patients risk undergoing what’s called “decompensation” — a process in which the disease abruptly becomes life threatening, which can unfold over the course of hours. “People can be percolating along and doing fairly well, and then all of a sudden without warning, inexplicably just crash,” says Daniel Sterman, the director of pulmonary medicine, critical care, and sleep medicine at NYU Langone Health.

Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco, calls it “falling off a cliff.” Continue reading New York: For Trump, the Most Dangerous Covid Phase Lies Ahead

New York: Trump’s COVID Case Could Be Mild or Fatal. Here Are Signs to Watch For.

Dr. Scott Atlas, a special adviser on coronavirus to President Trump, told Fox News that he expected the president and First Lady to make a “complete, full, and rapid recovery” following their coronavirus diagnosis. “I anticipate that he will be back on the road in full swing.”

That’s entirely possible. “Patients might have symptoms for only one or two days,” says Adolfo Garcia-Sastre, director of the Global Health and Emerging Pathogens Institute in the Icahn School of Medicine. But he cautions that the disease strikes with a wide range of severity, and even mild cases can last a week or more. And if Trump’s condition worsens, he could easily be out of commission until after the election.

The progression of the disease is usually charted from when a patient starts to manifest symptoms. At first — no matter what the eventual course the infection migt follow — it starts out gently, with symptoms that often include a low fever, cough, fatigue, muscle ache, and nausea. The White House reported today that Trump has “mild symptoms,” and Melania tweeted that she had “mild symptoms but feeling good.” Questions about the severity of the president’s condition were triggered, however, when Trump failed to take part in a call with state governors scheduled for 12:15 p.m. and was replaced without notice by Vice-President Pence.

The White House has announced that President Trump will be hospitalized at Walter Reed Medical Center, suggesting that his condition is on the moderate to severe end of things. It also said that he was given a dose of experimental Regeneron monoclonal antibody therapy, a treatment that has not been approved for use by the FDA. “He may be sicker that they let on,” says John Emy, a physician at New York University Langone Medical Center, while conceding that “he isn’t an average citizen, so they may be acting extremely conservatively.”

What to expect if Trump’s case is mild or moderate

According to CDC guidance, if the disease remains mild or moderate, patients will start to feel better after ten to 14 days, with a cough lasting an average of 19 days. But that does not mean that they will necessarily feel totally back to normal. A New York-area physician who came down with what she considers a moderate case had a fever for 14 straight days. “But it was a full month until I really felt back to normal,” said Peggy E. (who asked that her last name not be used). “A colleague who got sick at the same time still has periodic shortness of breath,” she said.

After patients recover, the CDC recommends that they remain isolated for at least ten days after the appearance of symptoms or three days after recovery — whichever comes later. In the scenario, the odds are small that Trump will be able to meet Joe Biden for their second debate on October 15.

What to expect if Trump’s case is severe

If Trump’s condition instead worsens and the infection rages, the critical turn for the worse would typically come around the end of the first week. The CDC reports that the time from onset of symptoms to acute-respiratory-distress syndrome — the buildup of fluid in the lungs that puts people in the ICU — is usually around eight to 15 days.

Atlas told Fox that Trump “is a very, very healthy guy and the overwhelming majority of people even at his age do fine with this. He is very healthy and so I anticipate the same for him.”

In reality, Trump suffers from three risk factors: In addition to being elderly, he is male and he is obese. While overall only 12.2 percent of people between 65 and 74 who come down with COVID-19 will wind up being hospitalized, men have twice the risk of women. Beyond that, obese people are 113 percent more likely to be hospitalized than those of normal weight.

There is little hospitals can do to cure the disease; drugs like remdesivir only offer a moderate reduction in recovery time. What medicine can do is mitigate the effects of complications like pneumonia, septic shock, heart arrhythmia, and secondary infections as the immune system fights the virus.

Take, for example, British prime minister Boris Johnson, who came down with COVID-19 on March 27. Like Trump, it started with a persistent cough and a fever. Ten days later, Johnson was hospitalized, and two days after that, moved to intensive care. In all, he spent seven nights in the hospital, followed by two weeks recovering at home, not working. If Trump follows a similar trajectory, he will be back on his feet around November 2.

But if his symptoms are severe, he could be in recovery for months. And for every thousand people in their mid-70s or older who get COVID-19, 116 will die.

GQ: What It Will Take to Get to a Vaccine

The first volunteers are already waiting when Rosa G. gets to the lab. She’s worked as a technician on human trials before but never seen people so eager to be injected with an experimental vaccine. She meets the first subject, a young woman in a mauve tank top, in an examination room. She has her sit, then draws a few milliliters of clear fluid from a clear vial.

“Ready?” Rosa asks.

“Yup,” the woman answers.

Rosa jabs the sharp end of the needle into the soft flesh of her tricep and presses the plunger. The woman looks exactly as she did a moment before, but in an instant her body has become something profoundly different: a new front line in the battle between mankind and the novel coronavirus. Hundreds of thousands have died of COVID-19, and more than seven billion immunologically defenseless bodies await like dry chaparral at the height of fire season.

Rosa has dosed the volunteer with an experimental vaccine made up of a mishmash of microscopic particles of the SARS-CoV-2 virus that have been chemically chopped up and rendered harmless, like a pistol run over by a steamroller. Though incapable of causing infection, to the immune system they are antigens: foreign particles that are unfamiliar and presumed dangerous. In response to their presence, the body learns to create antibodies that will circulate and latch onto any identical antigens they may encounter in the future. In swarming an antigen, antibodies prevent it from carrying out infection, and they also mark it for destruction by hunter-killer cells.

The idea behind this kind of vaccine, called “whole killed” or “inactivated,” has been successfully used many times in the past, from the Salk polio vaccine to annual flu shots. But will this formulation stimulate the body’s immune defenses enough? Or, conversely, will it trigger dangerous adverse reactions, like the 1976 swine flu vaccine that left 450 with a crippling neurological disease? Continue reading GQ: What It Will Take to Get to a Vaccine

Vanity Fair: The Dangers of Trump’s ‘Warp Speed’ Vaccine Race

The end of the COVID-19 pandemic will come with the development of a safe and effective vaccine, a process experts say will take at least 12 to 18 months. Last week, however, the U.S. Department of Health and Human Services (HHS) blew that timeline out of the water, announcing that it would pay British drugmaker AstraZeneca upwards of $1 billion for 300 million doses of an experimental vaccine, which will start to become available as early as this October. AstraZeneca CEO Pascal Soriot was even more bullish, telling CNN, “We will start getting substantial doses by September, October,” and that “lots and lots of people will be able to be vaccinated before the end of the year.” At that pace, Soriot confirmed, the entire U.S. and U.K. populations could be vaccinated by early 2021.

Soriot cautioned that the vaccine’s delivery depends on its successful completion of human trials—“It has to work,” he told CNN. But he said AstraZeneca was on target to prove that it will through an accelerated testing schedule. To date, the vaccine has been tested on monkeys and a small group of human volunteers, with recruitment for a 10,260-subject study currently underway.

To begin mass inoculations against COVID in the month before the election would be a massive achievement for the Trump administration, which has seen its prospects for a second term dwindle with the lockdown caused by the coronavirus and its resultant economic carnage. According to reporting by Vanity Fair’s Gabriel Sherman, Donald Trump has privately expressed the belief that a COVID-19 vaccine would be ready within months.

Many experts, however, say that it is impossible to reliably demonstrate the safety and efficacy of a drug in such a time frame. Moreover, absent those assurances, it would be unethical to give what is essentially an experimental vaccine to hundreds of millions of people. “You cannot do that,” says Maria Bottazzi, a microbiologist at the Baylor College of Medicine in Houston. Continue reading Vanity Fair: The Dangers of Trump’s ‘Warp Speed’ Vaccine Race

New York: Safe Exit: The Risk-Mitigation Guide to Life After Quarantine

You know how to stay 100 percent safe from the coronavirus: total isolation. Stay in lockdown, work from home, physically interact with no one. But there’s only so long you can live like that. Eventually, you have to start coming out into the world. And while doing so is certain to increase your chance of getting sick, an informed risk-mitigation strategy can help you keep the danger to yourself and others quite low.

A relatively safe strategy for exiting lockdown can be boiled down to a few basic principles: stay outdoors; wear a mask; stick to small groups; try to avoid passing around objects; wash your hands. 

Here are some activities at the safer end of the spectrum as you exit lockdown, along with some data-based guidance on how best to minimize the risks of transmission:

Go to the Beach

There’s been a lot of outrage expressed over photos of people jammed into parks and beaches, but meeting outdoors seems to be one of the safest ways to interact with real people. One recent study of 318 outbreaks in China found that only one occurred in an outdoor environment.

The environmental conditions found on a beach in summertime serve as a natural line of defense against COVID-19. A fresh ocean breeze can disperse the droplets of moisture that are expelled when an infected person coughs, sneezes, talks, or even just breathes. High humidity and temperature have been shown to slow transmission of the virus. And the UV radiation in sunlight kills a wide variety of pathogens on surfaces. (It’s absolutely false, however, to think that beaming UV light into the body would be effective, as President Trump has speculated.) Continue reading New York: Safe Exit: The Risk-Mitigation Guide to Life After Quarantine

New York: We Might Never Get a Good Coronavirus Vaccine

Hopes for a return to normal life after the coronavirus hinge on the development of a vaccine. But there’s no guarantee, experts say, that a fully effective COVID-19 vaccine is possible.

That may seem counterintuitive. So many brutal viral diseases have been conquered by vaccination — smallpox, polio, mumps, tetanus — that the technique seems all but infallible. But not all viral diseases are equally amenable to vaccination. “Some viruses are very easy to make a vaccine for, and some are very complicated,” says Adolfo García-Sastre, Director of the Global Health and Emerging Pathogens Institute at the Icahn School of Medicine at Mount Sinai. “It depends on the specific characteristics of how the virus infects.”

Unfortunately, it seems that COVID-19 is on the difficult end of the scale. Continue reading New York: We Might Never Get a Good Coronavirus Vaccine

Vanity Fair: Experts: Trump’s Touting of an Untested “Game Changer” Coronavirus Drug Is Dangerous

It started with a Google Doc.

On March 13, cryptocurrency investor James Todaro and New York City lawyer Gregory Rigano tweeted out a link to a paper they’d put on the file-sharing service. In it, the men described a drug they’d been following, chloroquine, that in early trials in China and France appeared to show promise as a COVID-19 treatment. Long used as a treatment for malaria, the drug is cheap and plentiful and available to combat the pandemic immediately. Not only has it been deemed “effective in treating COVID-19,” they wrote, but it “also has strong potential as a prophylactic (preventative) measure against coronavirus.” The pandemic, they suggested, could be snuffed out in one stroke—if the authorities would just take action. The paper ended with a call for readers to disseminate it and translate it into other languages.

At a time when public anxiety about the pandemic was snowballing, the paper offered a rare ray of hope. As its authors had urged, the paper was quickly disseminated over the internet. On March 16, Elon Musk tweeted a link to the Google Doc, writing: “Maybe worth considering chloroquine for C19.” On March 18, right-wing websites Breitbart and The Blaze picked up the story. On March 19, Rigano went on Fox News and told Tucker Carlson that a chloroquine study had shown “a 100% cure rate against coronavirus.”

From there it was a short leap to the biggest bullhorn of all. Continue reading Vanity Fair: Experts: Trump’s Touting of an Untested “Game Changer” Coronavirus Drug Is Dangerous

New York: How the Coronavirus Could Take Over Your Body (Before You Ever Feel It)

You call a friend and arrange to meet for lunch. It’s unseasonably springlike, so you choose a place with outdoor seating, which seems like it should be safer. As usual, you take all reasonable precautions: You use hand sanitizer, sit a good distance from other customers, and try to avoid touching your face, though that last part is hard. A part of you suspects that this whole thing might be overblown.

What you don’t know is that ten days ago, your friend’s father was a guest of his business partner at the University Club, where he caught the novel coronavirus from the wife of a cryptocurrency speculator. Three days after that, he coughed into his hand before opening the door of his apartment to welcome his son home. The saliva of COVID-19 patients can harbor half a trillion virus particles per teaspoon, and a cough aerosolizes it into a diffuse mist. As your friend walked through the door he took a breath and 32,456 virus particles settled onto the lining of his mouth and throat.

Viruses have been multiplying inside his body ever since. And as he talks, the passage of his breath over the moist lining of his upper throat creates tiny droplets of virus-laden mucus that waft invisibly into the air over your table. Some settle on the as-yet-uneaten food on your plate, some drift onto your fingers, others are drawn into your nasal sinus or settle into your throat. By the time you extend your hand to shake good-bye, your body is carrying 43,654 virus particles. By the time you’re done shaking hands, that number is up to 312,405

One of the droplets gets drawn into the branching passages of your lungs and settles on the warm, wet surface, depositing virus particles into the mucus coating the tissue. Each particle is round and very small; if you magnified a human hair so that it was as wide as a football field, the virus particle would be four inches across. The outer membrane of the virus consists of an oily layer embedded with jagged protein molecules called spike proteins. These stick out like the protrusions on a knobby ball chew toy. In the middle of the virus particle is a coiled strand of RNA, the virus’s genetic material. The payload.

As the virus drifts through the lung’s mucus, it bumps into one of the cells that line the surface. The cell is considerably larger than the virus; on the football-field scale, it’s 26 feet across. A billion years of evolution have equipped it to resist attackers. But it also has a vulnerability — a backdoor. Protruding from its surface is a chunk of protein called angiotensin converting enzyme 2, or ACE2 receptor. Normally, this molecule plays a role in modulating hormone activity within the body. Today, it’s going to serve as an anchor for the coronavirus. Continue reading New York: How the Coronavirus Could Take Over Your Body (Before You Ever Feel It)