by Michael D. Cohen, M.D.

It may be useful to know some more about the words epidemiologists use to describe disease statistics. Incidence refers to the number of new infections. Prevalence or “active cases” refers to the number currently infected. Infection Rate refers to the number of cases per unit of population (for example, per million population). Other measures of prevalence may also be used as indicators of the severity of the epidemic in a city or state or correctional system, such as: number currently hospitalized; number newly hospitalized, number in ICU; number on ventilator; number died. Similarly, infection rate per 1,000 persons incarcerated in a state system may be used to compare the severity of the epidemic among systems with widely differing total numbers of people imprisoned.

Infection rates are increasing rapidly throughout the U.S. At press time, the Midwest had the most rapid increase in rate of infection (steepest upward angle of the rate graph) and a higher rate of infection than ever before. In the Northeast, the current rate as of October 13 was about 95 per million population. In the Midwest, the rate was about 240 per million population. By the time you read this article, the rates will most likely be substantially higher in all regions.

Infection rates are rising because people are not using the protective measures we know help prevent infection: avoid large groups; avoid indoor groups; people who are in contact with others should be wearing face masks; frequent hand washing and surface disinfection; and effective ventilation of indoor spaces. Additionally, testing, isolation of cases and quarantine of case contacts are still not being carried out as effectively as is necessary to control the epidemic.

The increases are driven in part by reopening of schools, colleges and universities; indoor dining at bars and restaurants, and cooler weather driving people indoors for family and group activities.

Midwestern states have been surprised by the extent of rural spread of the disease. Local hospitals have been overwhelmed and patients transferred to urban hospitals for care.

Rural America is where people have resisted safety measures the most, so it is not surprising at all that the epidemic is taking off in those regions now. CDC monitoring suggests that many cases are spreading within households. However, indoor and outdoor large group gatherings are still causing super-spreader events in which dozens of people are infected and spread the disease to their families, friends and co-workers.

Trump’s Treatment

Trump was found to be infected with COVID-19 and had symptoms including fever and shortness of breath. He was treated with oxygen and sent to Walter Reed Army Hospital for treatment. He was given several medicines, including dexamethasone; Remdesivir; and manufactured antibodies. All three were given early in his illness. None of these medicines have been recommended or generally given to patients with early disease. 

Dexamethasone is a corticosteroid that suppresses the body’s immune response. It has been widely used for decades for that purpose. It was approved for emergency use in COVID patients with severe illness to suppress the out-of-control immune response that is killing people. Dexamethasone is not an anabolic steroid that promotes muscle growth.

Remdesivir is an antibiotic used to treat viruses. It was used successfully to treat Ebola, another disease caused by a coronavirus. It was approved for use in COVID patients with severe illness in ICU.

Manufactured antibodies are antibodies to coronavirus produced in cell cultures. Trump received a substantial dose of two antibodies made by the drug company Regeneron. The Regeneron antibody treatment has not been approved by the FDA yet for emergency use. Until Trump’s illness, it was only being given in a research study. Only a few hundred patients had received this medicine under a research protocol. Research studies are still ongoing to determine the safety and effectiveness of these specific antibodies for treatment or prevention of COVID.

Trump says he is “immune” since he appears to have recovered from his illness. However, he did not have a normal clinical infection. Early treatment with a steroid and manufactured antibodies may have suppressed his own immune response to the infection. His ability to produce his own antibodies may not have developed sufficiently to protect him from re-infection. As the manufactured antibodies he received as treatment disappear over the following 30 to 60 days, he may become susceptible to COVID again. This is the risk he now has from taking unapproved medicines and taking medicines for reasons other than those that were proven and approved.

Remdesivir was initially approved for use with COVID after a study showed fewer deaths among ICU patients treated with it. Interestingly, a larger, more recent international study has shown no effect on death from COVID among those treated with Remdesivir.

Rapid Tests Have Less
Accurate Results

Rapid diagnostic tests that can give results in as little as 15 minutes are being used at the White House, nursing homes, and colleges and universities. Rapid tests look for molecules that form part of the outer coat of the virus. These tests show a positive result when sufficient numbers of these molecules are present to cause a reaction with the test. However, early in the course of the infection, when viruses have not yet multiplied very much, there may be a negative result. In that case, the result is a false negative. The person has a negative test, but he is actually already infected and may be infectious to others.

Trump won’t say when his first rapid test was positive (probably because it was before the first presidential candidate debate). Thereafter, the White House medical staff did a much more accurate (and slower) test for coronavirus RNA that was reported to be positive two days after the debate.

Long Term Damage from COVID-19

Evidence continues to accumulate that many patients who have recovered from acute COVID infection have suffered long-term organ damage. Recently an elite college athlete was found to have suffered heart muscle damage from COVID infection, likely ending his promising career. A recent New York Times article reported on brain damage that has had lasting effects on memory and other higher functions. Loss of smell and/or taste also may persist after recovery from the acute infection. Persistent lung, liver and kidney damage have also occurred. Others have reported fatigue, “brain fog,” irregular body temperature, rashes, and insomnia persisting after COVID. People who experienced prolonged ICU and ventilator treatment may have PTSD, depression and persistent anxiety, including nightmares, fear of being alone, and fear of going to sleep, for example.

It is still unknown how frequent such injuries are or whether they are permanent. Recovery may occur very slowly. Doctors working with post-COVID patients suggest patients don’t try to resume normal activities right away; rather, increase activities slowly. These recommendations are similar to those given to people who have suffered a concussion: Too much activity can make symptoms worse and slow recovery. 

Michael Cohen was the Medical Director for the New York state juvenile justice system for 20 years and previously provided medical care for incarcerated adults at the New York City Rikers Island jail and at Greene CF in Coxsackie, N.Y. For 10 years, he participated in a support group for people with diabetes at Great Meadow CF in Comstock, N.Y. With the group, he co-authored the Prisoner Diabetes Handbook published by Southern Poverty Law Center and distributed by Prison Legal News. Heal the sick. Raise the fallen. Free the prisoners.

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