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COVID-19 updates: The U.S. socially isolates as pandemic spreads

Everyday life across the country has dramatically changed as cases skyrocket. The DO speaks with an infectious diseases specialist in Oregon about his observations.

The novel coronavirus disease (COVID-19), now classified as a pandemic, has significantly disrupted everyday life across the country and the world. Here’s the latest as of 9 a.m. CT on Thursday:

Number of cases in the U.S.: The CDC is reporting 7,038 COVID-19 cases and 97 deaths. The CDC is reporting confirmed and presumptive positive cases of COVID-19 reported to CDC or tested at CDC since Jan. 21, 2020. The New York Times is reporting at least 8,317 cases and 147 deaths in the U.S.

States that have one or more COVID-19 cases, according to the New York Times: All 50 states, three U.S. territories and Washington, DC, have at least one confirmed COVID-19 case.

Global cases: There have been 191,127 confirmed cases worldwide and 7,807 deaths, according to the WHO.

Social distancing nearly ubiquitous: On Monday, President Donald Trump shared recommendations from the CDC calling for Americans to avoid social gatherings of more than 10 people and limit discretionary travel. He said the country should be prepared for the possibility that these guidelines may be necessary into July or August.

Across the country, many cities and states have mandated the closures or partial closures of restaurants, bars and other gathering places. Cities in the Bay Area were the first to institute shelter-in-place orders, and Oak Park, Illinois, followed suit on Wednesday. Other cities are expected to issue similar orders in the coming days. Operations for most major sports and events worldwide have been halted or postponed until further notice, and many corporate jobs have begun mandating working from home.

President Trump to invoke Defense Production Act: During a press briefing on Wednesday, President Trump said he would invoke the Defense Production Act. The Defense Production Act gives the president the authority to influence domestic goods production for the purpose of national defense—in this case, President Trump may use the Act to address shortages of medical supplies.

U.S. government seeks to offset financial burden of virus: On Tuesday, Treasury Secretary Steven Mnuchin said the Trump administration was considering “immediately” sending checks to Americans. Last week, Trump expressed his preference for a payroll tax cut, but Mnuchin said the process would take too long and keep money from reaching Americans’ pockets in a timely manner. He did not reveal how much citizens could expect to receive, but for the time being, he encouraged all who haven’t already to file their personal taxes before the April 15 deadline to ensure they receive their refunds.

Senate passes relief bill: On Wednesday, the Senate passed a relief bill that, if enacted, will provide paid sick leave, unemployment benefits, free COVID-19 testing, and food and medical aid to people affected by the disease. President Trump is expected to sign it into law.

More travel restrictions: On Wednesday, President Trump announced that the border between the U.S. and Canada would temporarily close to nonessential travel.

Q&A: An infectious diseases specialist in Oregon shares his perspectives

Christopher Cirino, DO, a board-certified infectious diseases specialist and a medical officer for his county’s health department in Portland, Oregon, has been tracking the spread of COVID-19 since well before it impacted his community. As his hospital prepares for an increase in cases—though they have yet to see one as of Monday—the building is doing all it can to protect its patients and staff.

In an effort to streamline the information available on COVID-19, Dr. Cirino has started posting regular updates on a personal website he started in January 2019 called Your Health Forum. His goal is to produce approachable, informative and accurate content on COVID-19 for patients.

In this edited interview, Dr. Cirino shares his outlook on COVID-19 as it stands now, what he’s learning about ongoing research, and what future treatment options for this virus may look like.

What is your hospital doing to protect patients, staff and the rest of the population during this pandemic?

In most hospitals, there are usually no more than five to ten rooms designated for containing airborne spreads. To prepare for an influx of cases, we’re planning to designate a whole wing of our hospital to protecting this population. We have some negative air rooms that we’ve engineered using ventilation systems.

With regard to fecal-oral spread in a hospital setting, which has been suggested in some studies as being possible, any time you have a viral infection, especially in the respiratory tract, there’s always potential for shedding in feces. But this organism is most efficiently transmitted through respiratory droplets, around the range from ten to 100 microns. These are smaller droplets so there’s a potential for fecal spread, but I think it’s very similar to most respiratory viruses in how it spreads.

More broadly, we’re trying to educate the population on social distancing. Of course, if you’re sick, you know you should stay home. But if you’re healthy, you should stay home right now, too. We want to protect our at-risk population, which would be caregivers, and the population with the greatest risk for severe consequences: those who are immunocompromised, are advanced in age, or who have underlying health problems.

Recent research has also suggested a correlation between angiotensin-converting enzyme 2 (ACE2) expression and risk of COVID-19 infection. What are your thoughts on that?

It’s important to note that there are hundreds of polymorphisms or genetic defects that increase one’s risk in various viral infections. This is going to be a great direction for future research, but we’re focusing on ACE2 when there are so many other factors. We know that patients with vascular disease have impairments in their immune system, and it could have something to do with ACE inhibitors, and that ACE2 may be one way that the virus binds to target cells.

Some medications, like Ibuprofen, do increase ACE2, but it’s probably a little too soon to say you should only be using Tylenol for fevers instead. We should be aware that there are probably multiple mechanisms involved that increase the risk of someone who has these diseases.

How do you anticipate treatment for COVID-19 will evolve long-term?

It’s not exactly the same, but H1N1 caused a lot of harm, and now that is incorporated into our vaccines yearly. We just don’t have the capacity to accelerate vaccine development at this point to immediately incorporate COVID-19.

Looking into the future, it’s still possible that we can try to accelerate testing for vaccines. Sometimes these desperate times help us re-assess the bureaucracy of testing.

During an outbreak, it’s extremely hard to say exactly what the future will look like. There’s a good possibility that COVID-19 could have endemic spread that emerges on a seasonal basis in either hemisphere.

What do you think the world and the profession will learn from COVID-19?

This will alter the approach to how we address pandemics in the future. Hopefully, as testing becomes more readily available, people will be able to get tested more easily and triage themselves.

This is an unprecedented time. We have to adapt. Things can shift very rapidly over a course of a few days, and plans can be altered rapidly. It is and will continue to be a very touch-and-go time. It’s critical that we all do everything we can to try to stop this chain reaction.

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