COVID-19 Update #4

Monterey County (6/17/20 - 7/6/20):

1,084 new cases (2,151 total / 15 total deaths) *Incidence has more than doubled over the last 3 weeks

Worldwide (6/17/20 - 7/6/20):

3.23 million new cases (11.33 million total / 532,340 total deaths)

U.S.A. 6/17/20 - 7/16/20):

790,000 new cases (2.89 million total / 129,811 total deaths)

California (6/17/20 - 7/6/20):

118,124 new cases (271,684 total / 6,337 total deaths)

6/18/20

Face coverings are mandatory in public spaces in California

6/19/20

Monterey County Health Department issues “Social Circle Guidance”
- Less than or equal to 12 people are allowed to congregate outdoors in social gatherings
- Maintain social distancing of 6 feet or greater
- Wear face coverings
  Wash hands frequently

6/25/20

The CDC officially adds 3 new COVID-19 symptoms:
- Congestion / Runny Nose (Rhinorrhea)
- Nausea
- Diarrhea
The CDC expands its list of comorbidities that impose a higher risk of developing severe COVID-19
- Chronic Kidney Disease
- Chronic Obstructive Pulmonary Disease (COPD)
- Solid Organ Transplant Patients (Immunosuppressed State)
- Obesity
- Cardiovascular Disease (Coronary Artery Disease, Congestive Heart Failure, Cardiomyopathies)
- Sickle Cell Disease
- Diabetes Mellitus
- Age >65 years old
China starts to give the adenovirus based “Cansino COVID-19 Vaccine” candidate (Ad5-nCoV) to Chinese military only

6/28/20

California issues order to re-close bars, breweries, and pubs that do not offer sit-down dining

6/29/20

Global incidence passes 10 million
California issues new Face Covering Guidelines (www.ca.gov):
- Inside or in line for any indoor public space
- In any healthcare setting
- Waiting for or riding on any form of public transportation, taxi, private car service, or ride sharing vehicle. Also, drivers must wear masks at all times in the vehicle
- At work: When interacting with any member of the public or when working in an area that is visited by members of the public, even if no one from the public is present
- Any food preparation, packaging or distribution area
- Walking through commonly used areas (hallways, stairways, elevators, parking garages)
- In any room where social distancing of greater than 6 feet is unable to be achieved
- Outdoors: When social distancing (greater than 6 feet) is not possible
Florida begins to once again close down bars, as COVID-19 incidence and hospitalization rise

6/30/20

Total global deaths surpasses 500,000
European Union bans US citizens from entering Europe

7/1/20

California state parks will not allow vehicle access to all beaches in Marin, Monterey, Orange, San Diego, San Francisco, San Mateo, Santa Barbara, and Sonoma counties
New cases of COVID-19 are increasing in 35 states over the past 2 weeks, with nearly half of those states at record high daily incidences
University of Oxford / AstraZeneca vaccine is in Phase 3 trials, with 16 other candidates in Phases 1 and 2

7/2/20

The G614 mutation allows the SARS-CoV-2 virus to more efficiently infect human cells with the ACE2 receptor.

Monterey County placed on the California State COVID-19 Watch List due to the fact that Monterey County had a > 100/100,000 14 day case rate (112) and a > 8% 7 day average positive test rate (8.1%)
38 states in the US have reported increasing COVID-19 cases in the past 2 weeks, with increasing hospitalizations in 24 states. 13 states are halting their recovery programs / timelines
The spike protein has 2 subunits (S1 and S2). S1 is responsible for receptor binding and S2 is responsible for membrane fusion. Research is showing that a mutation of the SARS-CoV-2 virus at a single amino acid has propagated a new strain (D614—>G614). In approximately February 2020, in Italy, the SARS-CoV-2 virus underwent this genetic mutation in its S1 spike protein and steadily over a period of a month, became the dominant strain of this virus worldwide
- The G614 mutation allows the SARS-CoV-2 virus to more efficiently infect human cells with the ACE2 receptor. Research proposes that this mutation decreases the shedding S1 and subsequently increases the total number of spike proteins on the surface of the virus itself
- Further studies have shown that the SARS-CoV-2 virus with the new G614 mutation was able to infect human lung tissue 8 times more efficiently. Research suggests that once the virus has entered the host cell, its genome during replication is more resistant (2.5 times more) to termination by host cell mechanisms, therefore being more efficient in the production of both spike and viral capsid proteins. This suggests that the next group of viruses will have a higher number of spiked proteins on their surface, which could imply increased infectivity
- As an aside, this new mutation may affect the viability of some of the earlier vaccine candidates, which have been based on the SARS-CoV-2 virus with the original D164 genome

7/4/20

In the SOLIDARITY Trial run by the WHO, the hydroxychloroquine and lopinavir / ritonavir arms are officially terminated due to lack of effectiveness and/or potential side effects

7/6/20

Since 6/9/20, the daily incidence of COVID-19 has more than doubled in the US, from 20,338/day —> 47,389/day
In a recent commentary for the Infectious Disease Society of America, a collaboration of 239 scientists proposed that based on valid evidence, the SARS-CoV-2 virus is in fact viable and infective in particles of size < 5 microns (micro-droplets) and have been detected in the air in this form. They propose that particles of this size can travel tens of meters, suggesting that airborne transmission is a possibility. They propose the following prevention recommendations in an effort to reduce the risk of airborne transmission:
- Optimal ventilation, especially indoors, that incorporates outdoor air rather than recirculated indoor air
- Additional air ventilation systems that incorporate optimal air filtration, an efficient exhaust, and UV germicidal lighting
- Limit overcrowding in public areas

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