COVID-19 Update March 20, 2020

Coronavirus COVID-19

Nik Nikam, MD, MHA, DTM. Houston, Texas

COVID-19 spread continues to be the top news all around the globe, as the state of California implements, “Shelter-in-Place,” which is a basically fancy term for “Lock Down”. It allows only essential movement of people for groceries, medicines, and family visits. The only other group of people who are allowed to move are people who work in the public works, hospitals, and law enforcement. No beaches, meetings, or gatherings, period.


The total number of active coronavirus cases all over the world stands at 255,305, with an additional 10,000 cases in the past 24 hours.

The total death toll is at 10,044 and climbing by the hour! Now, more than 163 countries have reported the presence of COVID-19. Outside of China, Italy leads the world in the total number of cases and has the heist death rate, surpassing that of China.


Italy reported 5322 new cases on March 19, 2020, which is higher than the previous day.

After having leveled off the number of new cases seem to be on the rise again.

The number of dead was 427, which was lower than the 457 reported the previous day

Still, there is no clear signal that the Bell curve has reached the peak in terms of number of new cases or the number of deaths.

The Italian data are of particular interest to us in the US, as they had a total lock down, and they are still experiencing a rise of new cases and deaths.

This will be a closer model for the United States than the Wuhan model where the quarantine was very strictly enforced. There the city of 60 million people had come to a virtual halt.


Germany’s total number of cases is at 18, 3621 which means it added more 3000 new cases, which was similar to the previous day. Still, there is no sign in Germany that the incidence had reached a peak. The silver lining in the COVID cloud comes from Germany where the death toll stands at 52, even though the number of new cases continue to stay up.


The total number of cases in the US stands at 14, 631 and the death toll at 210 cases.

As predicted and expected, there is a big surge in the number of new by about 4500 cases. Part of this surge is due to increased number of people getting tested for the coronavirus. Hopefully by the end of next week, we will know if the number of new cases is still on the upslope of the Bell curve

Below is the chart showing the breakdown of the number of cases from the top states. New York, California, and Washington continue to add large number of new cases.

The number of cases in New York surpasses the total number of cases in many small countries. Yet, New York seems to be lagging behind California in implementing more drastic measure like “Shelter-in-Place,” introduce by California on March 19, 2020.

Well, the writing is on the chart here. We need the army hospital in the near future. But New York needs to restrict non-essential people movement, NOW!

Ask not what the Federal government is not doing, ask what you need to do NOW! Follow California!

Any amount of medical supplies and personnel is not going to be adequate if we don’t cut down this escalation in the number of cases.


It is a form of lock down, except for travel to grocery store, drug store or to see a family member. Practically, all businesses are shut down. No social gathering of more than 10 people. It sent into effect on March 19, 2020. It nearly affects 40 million people. Essential workers like police, firemen, healthcare workers, first responders, and public service people need to show up for work, unless advised otherwise.


Texas Gov. Greg Abbott issued an executive order shutting schools, no visitors to nursing homes and retirement communities and limiting bars and restaurants to carry-out until April 3rd.


New York mayor De Blasio put out a call on Tuesday to those retire medical professionals and those who have been displaced from their private practice groups to join the city in providing the much-needed medical help. In less than 24 hour I had more than 1700 are willing to come and take part in this medical mission.

A great lesson that we all can learn ask whatever we are short off, be it medical professionals, supplies, or medicines. Since, most of the private hospital and outpatient surgery centers are closed, send out a memo.


That’s what they promised in the WH press conference.

In Little Rock, where I worked last month, the University has a drive by testing. I got an email stating that they performed 500 tests yesterday. This probably has to come from places like hospitals, drug stores, and other drive-by testing centers.

I don’t think you need a doctor’s prescription. But, you may have to fill out a questionnaire, which will determine whether you need the test now or not.


This is a real dilemma. On one had we don’t want people in crowded places. On the other hand, they are there for a purpose. This idea comes on the heels of Iran releasing 85,000 prisoners. There are no plans to release the prisoner in the US.

We truly are experiencing the devastating after effects this COVID- 19 pandemic.

If the prisoners become sick, then the states have to take care of them. We as medical professional will treat everyone equally. What are your thoughts? We have a similar challenge with the homeless, who live in unhealthy, crowded places. Just read an article where 22 people from one nursing home were tested positive for the coronavirus. How do we address this issue of concentration of elderly people in nursing homes, who could be vulnerable?


Texas reported a death of an elderly patient living in a retirement home, who had no known outside exposure. Now, the Texas governor asks people to avoid making visits the nursing homes.


Bayer AG said on Thursday it has donated 3 million tablets of the malaria drug Resochin to the U.S. government for potential use to treat COVID-19. President Trump has ordered the FDA approval for use of his drug for COVID- 19 infected patients.

There are no real studies showing the benefit of this drug in patients with coronavirus infection compared to those who did not receive the drug. How do we measure the benefit? What are our primary and secondary end points?

Along the similar lines, statins have been recommended. We have seen benefits in cardiac patients, beyond its ability to reduce cholesterol levels. The additional benefit is supposed to be related to its anti-inflammatory action. So, it is possible that statins may reduce the inflammation in the lungs, as we have no specific drug to treat the COVID-19 infection.

However, steroids did not provide the protection, even though they have anti-inflammatory properties.


Your local grocery stores may have a job for you to stock items, work the checkout counters. In fact, when I went to HEB around 10 am, there were more people stocking the shelves than the number of customers. Check with Kroger, Walmart, or other local stores.


What is meant by Bioengineered?

It is producing a virus like particle in the lab. They can be used to treat illnesses. The recombinant DNA technology was used to produce the clot buster used in treating acute heart attacks.

On the other hand, certain viruses can be manufactured in the lab that can be used as a bioweapon. Remember the Anthrax scare we had when during former Pres. George Bush era. It is a powerful bio weapon that can wipe out civilizations.

There are already people finger pointing as to whether this COVID-19 was laboratory produced bioweapon. If it was, now it has proved that no one can escape the tyranny as this global monster can travel worldwide and not spare anyone.


The senate has approved $1200 for individuals and $2400 for a couple. You should expect to receive the money by April, 6, 2020.


This is perplexing to everyone in medical profession. How can we not test whether someone had coronavirus or not? How are we going to protect ourselves if we don’t know if someone had coronavirus and doesn’t know? How could Korea perform 20,000 tests a day. It goes back to preparedness.

The medial experts who are running the show must know the first we need to test to see if someone has the coronavirus.

How come Germany, Hong Kong, South Korea and many other countries had tests available in the early stages of this epidemic. We are in the midst of the COVID epidemic and still don’t have testing kits in many places. Also, many people can’t get tested, because they don’t meet the criteria. We may miss a large number of asymptomatic carriers.

The CDC, and the state government COVID task force should announce on their websites where people can go and get the coronavirus tests done.

I have seen drive by clinic set up in the parking lots and hospitals, where people can come and get tested. The fact that medical professionals are asking this question underscores urgent needs for more testing center


There are very reliable and credible up-to-the minute data coming from John Hopkins and worldometers websites. We also scan world reports from many US and international sources.

We use those data and try to get a better understanding of where we are in the US, in terms of the slope of the Bell curve of COVID-19 epidemic here in the US.