Corona virus; a review and projections of the pandemic.

Since its beginning in December 2019 in Wuhan city in Hubei province of China nearly 860,000 cases and 42,000 deaths due to Corona virus have been reported worldwide as of April 1st, 2020 8:00 GMT.  During this period, confirmed cases in select countries, are as listed in round numbers; US 190,000, Italy 105,000, China 82,000, Germany 71,000, France 53,000, Sweden 4,500, Greece 1,300, S. Korea 9,900 and Japan 2,200.  

During the same time the deaths per million of inhabitants in the above-mentioned countries are; US 12, Italy 200, China 55, Germany 10, France 58, Sweden 18, Greece 5, S. Korea 3 and Japan 0.5.  Interestingly, while China enacted strict quarantine of the 60 million inhabitants of the Hubei province, Japan and Holland lets individuals and businesses continue as in pre Covid-19 time expecting "herd immunity" will deal with the epidemic in a similar way as the annual flu.  S. Korea and Singapore have performed widespread testing of their populations, Sweden instituted social distancing only while the remaining countries enacted lockdown schemes of different severity. 

The first case in Greece appeared on February 25, 2020 and was related to an individual who had travelled to the north of Italy, as well as members a group of pilgrims who had travelled to Israel and Egypt.  

On May 1st the World count of confirmed Corona virus according to Johns Hopkins site was 3,330,000 cases and the death count was 235,000. The U.S. reported 1,100,000 cases and 64,000 deaths.  Next the two most affected countries were Spain with 240,000 cases and 25,000 deaths and Italy with 205,000 cases and 28,000 deaths.  Two countries that have done well are  Germany with 163,000 cases and 6,600 deaths and Austria with 15,500 cases and 585 deaths.  The Greek CDC reported 2,590 cases and 140 deaths.   The majority of those who died (70%) were older than 65 and had pre-existing conditions.  In my opinion, it is the deaths per million of inhabitants, is a useful indicator and points on how and if the countries' health systems cope with the stress of the pandemic.  The deaths per million for select countries are as follows: US 80, Spain 532, Italy 467, France 240, UK 409, France 364,  Sweden 260, U.S. 194, Germany 267, Austria 41 and Greece 14.  S. Korea  has 5, Japan has 3 and Taiwan's has only 0.3 deaths per million.

As of June 1st, 2020, 35,553 patients have been diagnosed with corona virus in the State of Ohio and 2,162 have died, which corresponds to 185 deaths per million.  Ohio and Greece have approximately 10 million inhabitants and have near identical land masses of 50,000 square miles and although geographically distant and with health systems which are distinct, both enacted early lockdowns and both had adequate number of ICU beds fare different when it comes to deaths per million for reasons I cannot explain other than obesity is more prevalent in Ohio. The State with the worst toll is New York with 379,902 cases and 29,918 deaths that corresponds to a death rate of 1,528 deaths per million. 

The Institute of Health Metrics and Evaluation (IHME) of the University of Washington estimates a total of 84,000 deaths for the United States.  Because we know that the deaths per million in Hubei province were 55 per million and because it is the only country that the epidemic has completed its course, I thought we could estimate the death toll in different countries but it turn a grossly inaccurate metric.  As of today, US has 316 deaths per million, UK has 584, Spain has 577, Italy 557, Germany 103, Austria will likely have higher death rates to the projected ones, Germany and Austria 74 and Greece 18.

Four Asian countries have very low death rates and are;  Taiwan with 0.3 deaths per million, Singapore 4, S. Korea 5 and Japan 7.  

Epidemiologists and others are using different models and have and will advance theories why the death rates will differ among countries.  I believe that the estimates of 100-240,000 deaths in the US  are very high while the IHME projection of 84,000 deaths will be closer to the real number at the end of the pandemic.  I also feel Spain's and Italy’s death rate will stay significantly higher than the projected ones while Germany’s, Austria's, Sweden’s, Greece’s, S. Korea’s, Japan’s and especially Taiwan's will be well below projections. In my opinion Greece’s and the State of Ohio death totals will be between 200 and 500 at the end of the pandemic.   I also believe the number of deaths of the United States will be approximately 60,000, which incidentally was the death toll CDC reported for the 2017-2018 flu season.  We will only know the exact number(s) at the completion of the pandemic in August 2020. 

The present was posted at 8:30 GMT on April 1, 2020. I decided I will update the incidence and death numbers  weekly in order for visitors to know the most recent tally of the coronavirus pandemic.

MRI safe for most patients with Pacemakers or Defibrillators

A study by Russo et al published in the NEJM found that MRI scans for patients with older not FDA approved pacemakers and implantable cardioverter-defibrillators (ICD) are safe even if the scan focuses on the chest area.

The researchers performed 1000 MRI in which patients had a pacemaker and in 500 MRI in which patients had an ICD in a 1.5T MRI scanner. No deaths, lead failures, losses of capture, or ventricular arrhythmias occurred during MRI. One ICD generator could not be interrogated after MRI and required immediate replacement; the device had not been appropriately programmed per protocol before the MRI.  Nine of the implants were disrupted but reset themselves to backup mode.  In all but one instance the effect was temporary.

Neither MRI performed on chest or in other parts of the body produced significant complications.   The concerns of potential magnetic field–induced cardiac lead heating, which could result in myocardial thermal injury and/or disrupt pacing properties of the devices were noted in this study.

The authors concluded that in their study, device or lead failure did not occur in any patient who was appropriately screened, and had the device reprogrammed in accordance with the pre-specified protocol.

Benefits and Risks of Mammography Screening

The article by Pace and Keating in JAMA reports on their MEDLINE search of articles and meta-analyses from 1960 to 2014 that describe benefits and/or harms of mammography, individualizing screening decisions and those promoting informed decision making.

They found that mammography screening is associated with a 19% overall reduction of breast cancer mortality (approximately 15% for women in their 40s and 32% for women in their 60s). For a 40- or 50-year-old woman undergoing 10 years of annual mammograms, the cumulative risk of a false-positive result is about 61%. About 19% of the cancers diagnosed during that 10-year period would not have become clinically apparent without screening (overdiagnosis), although there is uncertainty about this estimate.

They estimated that for every 10,000 women in their 40s who undergo annual mammograms for 10 years, 5 breast-cancer deaths will be averted. Of the remainder, about 25 would die despite being treated, and 36 would be treated unnecessarily because the cancer wouldn't have become life threatening.  For every 10,000 women in their 50s and those in their 60s screened annually for 10 years, 10 and 42 breast-cancer deaths would be averted respectively. But as many as 137 women in their 50s, and 194 in their 60s would be diagnosed and treated unnecessarily.  Women in all age groups will experience angst and inconvenience because of false positives diagnoses and unnecessary biopsies.

They conclude that although mammography screening may be associated with reduced breast cancer mortality it can also cause harm.  They suggest that in order to maximize the benefit of mammography screening, decisions should be individualized based on patients' risk profiles and preferences.

Pace LE, Keating NL; A systematic assessment of benefits and risks to guide breast cancer screening decisions: JAMA. 2014 Apr 2;311(13):1327-35.

doi: 10.1001/jama.2014.1398.