Coronavirus Episode 16: Update and Where Are We Headed?

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The U.S. now has the most COVID-19 cases, so how does that change things? Where is all of this headed? Let’s run through some updates.

US Cases

At the time of this writing, the U.S. has almost 86,000 COVID-19 cases compared to China’s more than 81,000 (2). On a per million infected basis, we have four times as many coronavirus cases as the Chinese. Using that same metric we’re still trailing Italy by 5X.

On the one hand, this isn’t a good number. Why? China is many times the size of the United States. On the other, we have to be careful here as only a handful of countries including S. Korea and Germany have been using widespread testing. Why does that matter? We don’t know how many people in 1,000 each country has been testing for this disease.

On that subject, the United States is still ramping up testing. In addition, how we test is very different. For example, in S. Korea you can purchase a consumer test for $134 without a doctor’s referral and in the U.S. you still need to meet the criteria of being sick with suspected COVID-19 to get a test (1).

This is what our case ramp up looks like:

Has Italy Seen Its Peak?

I had thought that Italy (see above) had reached its peak of new cases per day earlier in the week. That may or may not have happened. The U.S. is 5X’s Italy’s size, so assuming we see similar caseloads, we would max out at 30K cases per day, or double our current cases per day. That means that it should be two weeks before we get to a similar place at our peak of cases per day. However, given that we have more piecemeal shutdowns than Italy, we could go higher in cases per day.

Wuhan Update

I had thought last week that Wuhan, the epicenter of this outbreak, was going to be open for business by now. However, it looks like Chinese authorities are looking at keeping the area mostly closed (other than limited reopenings) until April. A recent study in the Lancet demonstrated that by doing that, Chinese authorities are likely hoping to push back the second wave of coronavirus from August to October, giving health systems longer to prepare (3). That would mean 2 months of a Chinese shutdown with an additional month of semi shut down.

How Long Will Our Shutdown Last?

Updating my projections based on the Italy and Wuhan data, I would say that the U.S. is looking at a shutdown period of 2 months with regional areas opening up more or less depending on the outbreaks in those areas. 

Telehealth Update

More and more physicians are switching to Telehealth. This means office visits like new patient evaluations and follow-ups that can be conducted via your phone, tablet, or computer from your home. Legislation now allows these visits to be reimbursed by insurers and during the crisis, physicians can practice across state lines. Regenexx has it’s own specific system now up and running which is specific to the type of orthopedic regenerative medicine we offer to treat backs, necks, shoulders, knees, hips, etc…

I spent the better part of yesterday trying out our new system and I liked it. It was a great way to keep in touch with my patients during the crisis. I’ll blog more on what we did and how we’re doing it tomorrow. In the meantime, our call center can now set up national telehealth visits with an increasing number of our clinics.

Quercetin Update

I had reported that based on a molecular docking study and other lab research that Quercetin may be reasonable to take to help block the coronavirus from entering cells. Several readers have pointed to research summarizing the supplement’s ability to reduce blood pressure (4). One paper theorized that it may work similarly to blood pressure medications by blocking the ACE enzyme, however that same study posits many different ways quercetin may work. The concern was that if quercetin was acting like a blood pressure medication, then it too could cause more ACE 2 receptors, the place where the virus enters the cells. Nobody really has a good bead on that at this point, but it’s worth mentioning in an update.

COVID-19 Testing

As a country, we’ve done more than 500,000 tests for COVID-19. Near as I can tell, that number will now quickly ramp past a million within the next week. However, in order to reach S. Korea’s or Germany’s level of testing, we would need to test millions, which likely won’t happen for another two weeks or more.

Why is Germany’s Fatality Rate Still So Low?

Germany’s fatality rate when looking at the poor metric of the total positives versus those that have died is still 0.6%. Why? NPR did a nice piece on the fact that since Germany has no national public health authority, it allowed commercial tests to flourish early. Hence, they have been testing many more people, finding more asymptotic and barely symptomatic cases (5). All of that lowers their fatality rate, meaning that most everyone else’s is artificially inflated.

The upshot? We are in for a 2-3 month shutdown. Hopefully, mother nature will help by reducing viral transmission in the later spring and early summer, which is likely. In the meantime, we have mobilized our country to all pull together to get through this, which will hopefully be enough to ensure we have enough healthcare resources to help those in need.

___________________________

References:

(1) NBC News. This is how South Korea flattened its coronavirus curve. https://www.nbcnews.com/news/world/how-south-korea-flattened-its-coronavirus-curve-n1167376 Accessed 3/27/20.

(2) Worldometer. COVID-19 CORONAVIRUS OUTBREAK. https://www.worldometers.info/coronavirus/ Accessed 3/27/20.

(3) Prem, KieshaFlasche, Stefan et al. The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modelling study. The Lancet Public Health, Volume 0, Issue 0 DOI:https://doi.org/10.1016/S2468-2667(20)30073-6

(4) Larson AJ, Symons JD, Jalili T. Quercetin: A Treatment for Hypertension?-A Review of Efficacy and Mechanisms. Pharmaceuticals (Basel). 2010;3(1):237–250. Published 2010 Jan 19. doi: 10.3390/ph3010237

(5) National Public Radio. Why Germany’s Coronavirus Death Rate Is Far Lower Than In Other Countries. https://www.npr.org/2020/03/25/820595489/why-germanys-coronavirus-death-rate-is-far-lower-than-in-other-countries Accessed 3/27/20.

This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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12 thoughts on “Coronavirus Episode 16: Update and Where Are We Headed?

  1. Robert Lubbers

    Are you implying that quercetin may be the second part of a double whammy due to the ACE inhibitor factor? Would that mean that quercetin acts the same way as lisinopril or just does the same thing in a different way?

    1. Chris Centeno, MD Post author

      Nope, nobody knows how quercetin lowers blood pressure.

  2. Edith(Edy)Johnson

    Thanks for sharing your research.

  3. AG

    Dr Centeno,
    With this new information you shared on Quercetin, do you still have your family on the supplement?

    1. Chris Centeno, MD Post author

      Yep, but that’s my choice based on looking at the data. Everyone needs to review it all and make their choice.

  4. Mike Davis

    I’ve been following the discussion about quercetin with interest, years ago a farmer neighbor told me that his father told him that when a work horse got sore and lame they would put them out into the oak groves where they fed on the leaves and bark and recovered, sometimes overnight. Suggests an anti-inflammatory effect. Could this have been due to the natural compound quercitrin found in the bark. Quercus is the genus for oaks, hence the connection and name derivation.

    1. Chris Centeno, MD Post author

      Possibly. The bark of the eastern black oak contains quercitron which contains quercitrin. When the latter is exposed to acids, it yields quercetin. So it’s possible that a horse digesting oak bark would get lots of quercetin.

  5. LANCE W

    It’s almost impossible to believe the numbers coming from China reflect the real situation on the ground. There are many reasons to believe they are understating the impact. And yes, I’ll keep taking my quercetin until there is solid evidence it’s a bad idea.

    1. Chris Centeno, MD Post author

      Agree, lots of information coming out now from intelligence sources that China’s numbers and reporting not to be trusted.

  6. bob schwenkler

    Dr Centeno, I enjoy reading your posts which provide perspective. Why is the graph you show of daily US cases of coronavirus so much different (more severe) than the graph from https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html ?
    CDC is showing a topping out at about 4k new cases/day- the graph above is still rising with over 15k per day??

    1. Chris Centeno, MD Post author

      Bob, the data I’m reported is cited, it’s also the same that being reported by the Johns Hopkin’s site here: https://coronavirus.jhu.edu/map.html We’re heading towards about 20K cases a day right now…

  7. bob schwenkler

    From a day ago ” https://coronavirus.jhu.edu/map.html We’re heading towards about 20K cases a day right now…” I see why the difference between JHU and CDC USA numbers. CDC is looking only at the tests they control. JHU is summarizing available state data (plus cdc I presume). JHU wildly increasing #’s are likely due to all the increased testing being done in the US over the past weeks, whereas CDC has the same test base. Therefore this # of cases graph by JHU does not mean much at this point… maybe follow the actual deathrate, or hospitalization rate which surely will be flattening out with all the measures in place for the past 3-4 weeks.

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