Day 84: Vegas Flu and DIC

APM Reports reports on an attendee at CES 2020 (the Consumer Electronics Show in Las Vegas this January 7th through 10th) who has since tested positive for COVID-19 antibodies. He recalls getting sick immediately after CES with what was referred to on Twitter at the time as "Vegas flu" which, in hindsight, sounds exactly like COVID-19: "Weeks later, people were still posting about the lingering coughs they just couldn't seem to shake." International attendees had come from various already-infected places in China, and returned to homes and businesses all over the world, including Silicon Valley in Santa Clara County, CA.

On the topic of the flu, pre-COVID-19 research indicated that the flu vaccine actually increased recipients' susceptibility to other respiratory diseases (for example, this journal article from 2012). One study even found a particular risk of catching coronaviruses. A Canadian study postulates a couple of direct immune mechanisms for the problem, including antibody-dependent enhancement (ADE). Note that the anti-protective nature of the flu vaccine is already a potential explanation for the variable mortality by age and country that others have previously attempted to explain by differing rates of (protective) BCG or MMR vaccination.

Also on the topic of the flu, a 107-year-old Spanish woman who survived the Spanish flu as a child has apparently recovered from COVID-19.

There's been a bit of a ruckus in the news about "mysterious clotting" in COVID-19 patients: the Washington Post goes on at length about it, apparently from the springboard of this earlier Reuters article. But disseminated intravascular coagulation (DIC) is no mystery. It's a known symptom of ARDS (acute respiratory distress syndrome), regardless of the cause of the ARDS itself. The Journal of Thrombosis and Haemostasis already has an accepted report up about it, and MedPage Today reported on the problem and possible treatments for it over two weeks ago.

"What really has become clear in the discussions in the last 2 weeks is that the COVID-19 disease is much associated with thrombosis: large vessel clots, DVT/PE [deep vein thrombosis/pulmonary embolism], maybe arterial events, and potentially small vessel disease, microvascular thrombosis," said Stephan Moll, MD, of the University of North Carolina at Chapel Hill Hemophilia and Thrombosis Center.

As U.S. cases have skyrocketed, it has also become clear that hospitalized patients often develop blood clots despite being on prophylactic anticoagulation, he told MedPage Today.

P.S. PlagueBlog was experimenting with some pretty maps of the increase in cases between the state's two reports of case counts by city and town, and noticed that Milford had dropped precipitously in case count in the course of 8 days. (There were other negative rate changes, but they were much smaller and more explicable by individual case reclassifications and the like.) Google provided no explanation for the 71 evaporated cases, but did provide a local news report of Milford's new standing among its neighbors at the state's increased reported rate of 114 cases.

Going back to the state, I saw they revised their data, allegedly at 7pm on the day they reported. PlagueBlog wasn't the only outlet to pick up the original numbers and the Middlefield craziness; MassLive reports on the small town's brief moment in the hospital and their return to a zero case count, and on other errors in the data. They also have a decent map of the updated data. PlagueBlog will issue our own corrected map later today.

P.P.S. Speaking of data errors, the Massachusetts case count leapt skywards today due to an eleven-day backlog/correction of lab results from Quest. Apparently the dashboard charts for today have been updated to reflect retroactively corrected daily counts (so today's jump was really only 6%), but the archives and the town-by-town data have not.