Day 49: A Quarter Million Strong

Today the international case count has hit 255,000, with 10,000 deaths and almost 90,000 recovered. Italy has over 41,000 cases and 3,400 deaths. Spain has exceeded Iran in cases; both are nearing 20,000. Germany has well over 17,000 cases and the US is approaching 15,000, with 160 deaths.

Today the Treasury Secretary moved Tax Day to July 15th; filing and payment can be delayed without penalty. In a sudden move, Governor Newsom locked down the entire state of California late yesterday with a "shelter in place" order, though marijuana dispensaries and other "essential" businesses will remain open. Pennsylvania is also under a similar order. Massachusetts is still looking good, having dropped to 9th in the nation in case count with no deaths (unlike 28 states and the District of Columbia).

The Internet dug up this gem of a paper from 2007 [PDF]:

[SARS'] acute and dramatic impact on health care systems, economies, and societies of affected countries within just a few months of early 2003 was unparalleled since the last plague. The small reemergence of SARS in late 2003 after the resumption of the wildlife market in southern China and the recent discovery of a very similar virus in horseshoe bats, bat SARS-CoV, suggested that SARS can return if conditions are fit for the introduction, mutation, amplification, and transmission of this dangerous virus.

And lastly, the gift that keeps on giving: plague ships! Lucky Germ Boat #13 is the Ruby Princess, a Princess Cruises ship that (despite Carnival allegedly suspending operations of Princess Cruises a week ago) was still cruising around as late as yesterday when it docked in Sydney. Although thirteen people were ill with flu-like symptoms, the 2,700 passengers were allowed to disembark. Only the ill seem to have been tested; two passengers and one crew member tested positive. Another passenger who travelled to Tasmania has been hospitalized there and is a suspected case.

PlagueBlog trusts this germ boat will continue yielding cases for some time.

P.S. Forbes has an article on the homemade mask movement.

P.P.S Governor Cuomo tweeted his intention to lock down New York State.

P.P.P.S PlagueBlog apologizes for jinxing us: the governor reported the first death in Massachusetts during a press conference this afternoon. The victim was a Suffolk County man in his 80's with pre-existing conditions who died yesterday. The remaining numbers for today are not out yet.

P.P.P.P.S Our numbers are now out. Massachusetts has 413 cases, up 85 (26%) over yesterday, with 17 new cases of local transmission, 15 more travel-related cases, and the remainder under investigation. Middlesex County has 25 new cases, Suffolk 14, Norfolk 12, and Essex 10. Fifty of the new positives were found by the commercial and mystery labs. The state lab positive rate has gone down to 11% while the commercial lab rate has gone up to 5%. (There is still no denominator on the mystery labs.)

Day 48: Lies, Damn Lies, and Statistics

The international case count has exceeded 222,000, with over 9,000 deaths and 84,500 recovered. Italy is approaching 36,000 cases and 3,000 deaths. Iran, Spain, and Germany remain in the teens, and the US, at nearly 9,500 cases and 157 deaths, is now on the wrong side of both France and South Korea.

Massachusetts has dropped to 8th in the nation in case counts. We still have no deaths, though 23 states have at least one already. Many Massachusetts grocery stores have implemented senior hours, and daycare centers will be shut down on Monday, except in certain circumstances involving essential workers.

The Sun Chronicle reports a hospitalized case in Attleboro from an unspecified nursing home, as well as the first case in Mansfield. As of yesterday, there were twelve cases in Southeastern Mass: five cases in Bristol County, five in Plymouth County, two in Barnstable County (the Cape), and none on the islands.

PlagueBlog recommends a New York Times opinion piece from Tuesday about the public health consequences of lying to the public about the need for face masks.

P.S. BBC News reports Italy's death toll has exceeded China's.

P.P.S. Our numbers are out for today: 328 cases total in Massachusetts, up 72 cases (including 4 in Southeastern Massachusetts), with 8 more cases of local transmission, 8 more travel-related, and 56 still under investigation. Hospitalizations went up from 27 to 43 (with a large number still unclassified).

The state lab found 37 of the new positives, the commercial labs (only LabCorp today) found 18, and the underspecified other labs found 17. Total test rates are still unavailable for the other labs, but the state and the commercial labs are still holding at 13% and 4% positive, respectively.

Day 47: 200k and Still Rising

In an overnight leap, worldwide coronavirus cases have passed 200,000 and reached somewhere between 203,529 (JHU CSSE) and 204,831 (WoM). Italy is over 31,000 cases with over 2,500 deaths. Iran also leapt up overnight to over 17,000 cases and over 1,100 deaths.

Also on the wrong side of South Korea are Spain (at almost 14,000 cases and over 600 dead) and Germany (over 10,000 cases but only 27 dead). Portugal (642 cases, 2 deaths) stopped trains and flights to Spain Monday night at 23:00, for at least a month.

The US is still on the right side of South Korea (though not for long) at about 7,300 cases and 116 deaths. New York has not been doing as well as Massachusetts; WoM reports 2,480 cases and 16 deaths for them. In fact, New Jersey has pushed Massachusetts into 5th place, and Florida is looking likely to overtake us soon as well. We are the only state with more than 100 cases but no deaths (out of 12).

New Hampshire is up 9 cases to 26. In Maine (32), Reddit reports that the L.L.Bean flagship store in Freeport is installing locks in preparation to lock its doors for the first time since it opened. Apparently they did close on some occasions; like Massachusetts and RI, Maine law requires retail stores to close on Thanksgiving. (PlagueBlog thinks the rest of you are animals.)

P.S. The Massachusetts numbers are out in their PDF hidey-hole. We have 38 new cases, -5 attributed to Biogen (so it's hard to say exactly where those five presumably misclassified folks went), 5 to community spread, 2 to travel, and 36 under investigation. The Commonwealth tested 377 new cases, 28 of whom were positive. The commercial labs tested 144 new cases, 10 of whom were positive. Their overall rates are now 13% and 4% respectively.

The Boston Globe reports that a swab shortage is now interfering with coronavirus testing. PlagueBlog hopes you got tested back when PlagueBlog recommended it.

Day 46: The Swiftness of Wind

Through the sneaky approach of guessing the URL, PlagueBlog brings you the Massachusetts numbers for St. Patrick's Day before 4:30pm today. We have 21 new cases, for a total of 218: 2 new Biogen cases, 6 new travel cases, 5 new local transmission cases, and 8 new mysteries. Quest has reported 5 new positives, while LabCorp has 116 new negatives and no new positives.

I've been noticing the difference between the state lab positive rate (17% yesterday, 14% today) and the commercial lab one (4% yesterday, 3% today). The LabCorp rate is particularly low at 0.6%. Unfortunately, without a breakdown of where the commercial tests are being done, it's difficult to speculate about why the commercial lab rates are quite so different from each other. The state lab's high rates clearly have to do with its restrictive testing requirements, especially before they were eased up last week.

Elsewhere on the continent, Brazil announced its first death, of a 62-year-old São Paulo man who also had hypertension, diabetes, and an irrelevant prostate condition which O Globo felt the need to explain. His travel history was not provided.

P.S. The South China Morning Post reports that the coronavirus-positive Pomeranian died Monday, after having never shown symptoms, testing negative, and being released from quarantine to return home Saturday. The late Pomeranian first tested positive nineteen days ago (on Day 27 of the Boston count).

The owner has refused an autopsy; not surprisingly, the government that destroyed previous research into the disease seems to also be allowing this vital dog data to be lost. PlagueBlog notes that human beings have also died after testing negative.

P.P.S. West Virginia has joined the club.

Day 45: Last Diner Before Summer

The Governor's crackdown on eating out begins tomorrow, so tonight is your last chance. Other states besides Massachusetts following Hoboken's lead include Connecticut, New York, New Jersey, California, Ohio, Illinois, Washington, Oregon, Maryland, Minnesota, Michigan (on very short notice), and 5 counties in Pennsylvania. Also the cities of Los Angeles, Washington DC, and Harris County, TX (i.e., Houston). Abroad, countries like Poland, Belgium, France, the Netherlands, Albania, Israel, and Czechia have closed restaurants.

Open Table reports things were looking pretty depressed for the industry already. PlagueBlog assumes the Open Table reservation numbers understate the situation, because you know you don't need a reservation these days.

The Boston Globe reports that unfortunate Worcester man who died on his way home Saturday has (posthumously) tested negative for COVID-19. The numbers for Massachusetts today are 197 total (+33 over yesterday), of which 100 have been connected to Biogen, 18 are travel-related, 28 are officially due to local transmission (apparently including the previous Western Mass cluster), and 51 are still under investigation. Of the positive tests, 8 are being excluded from further tabulation for being pre-March tests conducted by the CDC, 1 was done by LabCorp, 7 by Quest, and the remaining 181 were performed by the DPH.

Day 44: Dubaious Death

The National reports that a 59-year-old Worcester man returning home to Logan from Chennai via Dubai died of cardiac arrest en route. The state police here are awaiting the autopsy and coronavirus test results—as are the 321 other passengers and 18 crew aboard the Boeing 777, especially the crew members who attempted CPR. The man had no pre-existing conditions but had been ill with gastrointestinal issues for an unspecified number of days before his flight. (Unlike "cold symptoms", gastrointestinal symptoms are an early sign of coronavirus infection.)

Here on the ground, the Commonwealth reported 164 cases total as of today, 108 traced to Biogen, 35 not yet traced to Biogen, 8 new travel-related cases, and no change in the Western Mass. cluster. PlagueBlog has heard that it's not clear to outsiders from the news that the Greater Boston area has pretty much shut down, with most school systems closed and many bars and restaurants now voluntarily closing. The mayor of Boston has also declared a health emergency, though it's not clear that means much at this point.

Rhode Island reached 20 cases yesterday, with no new cases today. Two recent cases are particularly notable, though: the Providence Journal reports that two children (age not specified) are among the cases. One had been on a cruise, and the other had gotten a signature from one of the two infected Utah Jazz players at their game in Boston on March 6th.

New Hampshire is up to 13 cases. The seventh case, a Rockland County woman, apparently worked at the Manchester DMV. If you visited the DMV in early March, you may want to read more about the case.

The New York Times reports that, due in part to union pressure, even the New York City school system will be closing starting Monday, until at least April 20th. The school system has 24 hours to figure out how to provide meals and childcare to some of the displaced students; remote education is to be planned out later this week. Public schools on Long Island and in Westchester County will also close.

NYC has now had five deaths, all involving pre-existing conditions, and the state has over 700 cases. The New York presidential primary may be delayed from late April until the date of a local election in late June. Louisiana and Georgia have also delayed their primaries.

Because, understandably, people just keep on drinking, the city of Hoboken (NJ) has closed all bars and restricted all restaurants to take-out only service, as well as implementing a 10pm curfew. The mayor excused all this in part with a confusing story about lack of EMS response to a bar fight on Saturday night.

Across the US there are 3,621 cases with 63 deaths, still mostly in Washington State and California. Italy is approaching 25,000 cases and Iran 14,000. Rumors about the UK "herd immunity" plan are greatly exaggerated. Hopefully the rumored vaccine from Israel (193 cases) is slightly less exaggerated. Austria, at 800 cases, has banned all gatherings of more than 5 persons.

P.S. The Governor of Massachusetts held a rare Sunday night presser to announce that our gatherings are now restricted to 25 people (down from 250), our restaurants are restricted to delivery and take-out only, and all schools, public and private, are closed for three weeks starting Tuesday. He closed some number of government offices, and the RMV (our DMV) is offering some extensions.

Visits to nursing homes are no longer allowed, hospital visitors must be screened, and non-essential procedures will be cancelled starting Wednesday. All commercial insurers are required to cover telehealth now, for free in the case of COVID-19, and some pharmacists will be allowed to make hand-sanitizer. (I suppose you used to have to be a compounding pharmacy to do so.)

The presser also claimed community spread in seven counties, even though we only have six counties with more than one case documented by the MDPH. It seems they've been peeking at the commercial lab results (seven of these have been positive already) and have decided some other cases won't be traced. Still, I think they may be exaggerating a bit to get people to hunker down before it's too Washington State.

He also mentioned the postponement of the Boston Marathon until September, news I'd missed earlier in the week. The Boston Globe article mentions that the MBTA will be running in full force Monday, but public transit service is likely to get reduced as soon as they come up with a plan to do so.

Day 43: Just Get Tested

PlagueBlog has noticed that the mob microphone that is the Internet has not actually caught on to the fact that you can just get tested now in the US, by your own doctor, using the same labs (Quest and LabCorp) they use for every other test they give you, without any clearance, interference, or gate-keeping from your state, commonwealth, or the CDC. If your doctor refuses to test you, do not blame your state, commonwealth, or the CDC; blame the malfunctioning mob microphone.

The US is at over 2,800 cases and 57 deaths. Massachusetts is at 138 cases, 104 attributed to Biogen, 21 not yet attributed to Biogen, travel-related cases unchanged, and the Berkshire 8 unchanged except now somewhat anonymized as "Western MA cluster". (Nevertheless, the Boston public schools will be closed until April 27th.) New York State is at over 600 cases and two deaths, an 82-year-old woman in the city and a 65-year-old man in Rockland County. Connecticut has reached 11 cases.

Remember, you can just get tested.

Day 42: Fly Now or Forever Shelter in Place

Today's numbers (according to BNO) have exceeded 138,000 cases, 5,000 dead, and 70,000 recovered. Italy has exceeded 15,000 cases and 1,000 dead. Iran is over 11,000 cases and 500 dead. South Korea, the new social distancing capital of the world, has kept their numbers under 8,000 cases, with only 67 dead. Spain is over 4,200 with 120 deaths, while France and Germany are hovering around 3,000 cases.

The US is next up, with 1,832 cases and 41 deaths. (The new deaths appear to have occurred in Washington State, though the CDC hasn't recognized them yet.) No other countries have hit 1,000 yet besides China, whose new case counts have become negligible, though Switzerland and the Scandinavian countries are getting close.

Our World in Data is tracking doubling times, though they only have them listed for EOD Wednesday right now [updated since to Thursday, with cool new graphs], when the US and Spain were at 2 days and Denmark at 1 day to double the number of cases.

Portugal provides a handy map of cases, divided into the usual Norte/Centro/Lisboa/Alentejo/Algarve/Açores/Madeira divisions (except with a rather outsized notion of Lisboa compared to the usual one), along with a chart of symptom onset dates. For confirmed cases, age and sex, number hospitalized, and symptoms are summarized. The rates of symptoms (translated for your convenience) are:

Cough	Fever	Difficulty Breathing	Headache	Muscle Pain	Weakness
65%	46%	10%	37%	40%	24%

Today is your last chance to fly home to the US from the Schengen area of Europe (i.e., most continental EU countries and some non-EU states with open borders) before Trump's travel ban goes into effect. Forty-eight hours may not sound like much notice compared to the week most closing colleges and universities have given their students to bug out, but it's still generous compared to yesterday's events at CCSU. At 11:00am, in reaction to a student who was a mere contact of a mere suspected case (later proved negative), the President of Connecticut Central State University tossed everyone out immediately. A later update indicates that the residence halls aren't closing until this afternoon (though where the residents were supposed to be in the meantime remains unclear).

New York has opened a drive-through testing facility in New Rochelle which can handle up to 200 cases a day (though perhaps erev Shabbat is not the best time to do so, considering the demographics of that outbreak). The Miami Herald reports that Francis Suarez the mayor of Miami, has tested positive, "four days after the mayor attended a Miami event with a Brazilian government official who later tested positive for the virus." President Bolsonaro was allegedly exposed, and later met with President Trump.

Plague Ships: The Japanese Ministry of Health, Labour, and Welfare reports another case off of Germ Boat #2; one asymptomatic crew member of the Diamond Princess tested positive upon release from quarantine and was sent to hospital. This brings the case count up to 697.

We have a Germ Boat #12, a Viking Cruise Journey riverboat, the RV Bassac Pandaw, with a capacity of 60 passengers. VOA Cambodia reports that one out of five passengers tested positive on Tuesday after Vietnamese authorities alerted Cambodian authorities of a case on their flight from London to Hanoi. Subsequently the remaining 59 passengers [sic] were tested and two more positive cases were found, for a total of three. (The five mentioned in the headline is the total across Cambodia.)

Business Insider reports that Viking Cruises has since suspended operations, and the Washington Post reports (behind a paywall) that Disney has as well. Once again #12 may be the last germ boat, though PlagueBlog suspects otherwise.

Local cancellations: Universal Hub reports that nine local Orthodox Jewish congregations (though that's not nearly all of them) have suspended services starting immediately.

P.S. The President declared a national emergency at a White House presser this afternoon, during which far too many important American health care industry executives (including one from Quest) got far too close to the possibly-exposed President. During questioning he mentioned that Bolsonaro has tested negative (though his wife tested positive), but PlagueBlog doubts the negative result can be relied upon so early on.

P.P.S. Massachusetts' numbers for today are 123 cases (15 over yesterday), with 94 connected to Biogen and 16 not yet connected to Biogen ("under investigation"). The Berkshire cluster and travel numbers are unchanged.

Day 41: Celebrity Death Pool

The upper echelons of Iranian society were hit "early" on (due to the same people ignoring community spread for weeks on end), but as of yesterday the US is accumulating celebrity cases: Tom Hanks, his wife Rita Wilson (apparently on location in Australia), Utah Jazz player Rudy Gobert (who shut down the NBA single-handedly, possibly by touching all the mics at a presser), a congressional staffer, and a production crew member of Riverdale, a CW TV show. On the other hand, Steve Wozniak's wife turned out to just have a sinus infection after all, and Daniel Radcliffe was also just a rumor.

Kim Jong-un has allegedly fled Pyongyang to avoid infection. In Italy, you can be charged with murder for breaking quarantine. Ravenous wild monkeys with no tourists to feed them are "terrorizing" Lopburi, Thailand.

The Germ Boat count may finally be slowing down. Newsweek reports that Carnival Corporation has suspended all Princess Cruises (operators of Germ Boats #2, #6, #8, and #10) operations for two months. But Carnival is a bigger company than that, with 9 other cruise lines, many of which have already hit the germ boat list: the Holland America Line (#4), AIDA Cruises (#5), Carnival Cruise Line (#7), Costa Cruises (#9), Carnival CSSC, the Cunard Line, the Seabourn Cruise Line, P&O Cruises, and P&O Cruises Australia. Politico reports on the shenanigans of cruise companies in general; PlagueBlog expects more plague ships to come.

Cancellations: Congress has closed the Capitol, House, and Senate to the public. Apparently we have a pro soccer league here in the US, and their season is suspended, too.

P.S. Today's count for Massachusetts is 108, 82 from Biogen, 5 from travel, a cluster of 8 at the Berkshire Medical Center, and 9 still under investigation. Of the 13 new cases, 5 are Biogen-related (thus far). A coronavirus patient who had not travelled was not properly isolated at the Berkshire Medical Center earlier this month, leading to the quarantine of over 50 nurses. The governor has already said we have community spread out there, but the county has only 9 cases total so far so PlagueBlog is unsure what exactly is going on in the Berkshires.

Day 40: Mens et Manus

China continues to report low numbers, though they are now experiencing significant importation of cases. Italy has exceeded 10,000 cases, with 631 deaths. Iran has 9,000 cases with 354 deaths, plus 27 deaths from methanol poisoning resulting from a rumored alcohol cure (and, PlagueBlog presumes, a lack of understanding about what sorts of alcohol one should drink). Teheran is now the epicenter of the outbreak, with over 1,800 cases. A second case has been confirmed in Nigeria, in a contact of the first case. In Harare, Zimbabwe, a Thai man fled the hospital to avoid testing.

The US is at 1016 cases with 31 deaths, the latest being a Sacramento County assisted living resident in their 90's. Currently, Washington State leads the nation with 267 cases and 24 deaths. New York, with 173 cases (no deaths), has pulled ahead of California's 109 cases (3 deaths). Massachusetts has the only other large number at 92 cases (though PlagueBlog expects another surge when the DoPH updates again at 4pm). Twelve states and all the territories remain unaffected.

Cancellations: Today's byline is in honor of MIT's closure. Citizenry has a list of college-level closures. Last night, Philadelphia cancelled its St. Patrick's Day parade (via Facebook). DC has "postponed" theirs. Italy, of course, remains closed.

Plague Ships: The saga of Germ Boat #6 floats on: The Mercury News reports that less than half of the passengers had disembarked by last night. Two days apparently only sufficed to remove the ill, Californians, Canadians, and 100 Brits. The fate of the "mostly international" crew is the most in doubt; one plan that's been floated is quarantining them aboard the otherwise empty ship off the coast. The case count for the current cruise as unexpectedly announced by the Vice President was 19 crew and 2 passengers; there seem to have been no updates since then.

Recall that Germ Boat #6 was brought to you by a now-deceased Placer County (CA) man who apparently acquired COVID-19 though community spread, then took the Grand Princess's previous cruise to Mexico (February 11th-21st) on which he infected some fellow passengers and crew. Some of the crew remained aboard for the current cruise to Hawaii, though others moved to other ships, eventually causing the shunning of Germ Boats #8 and #10. The count for the cruise to Mexico is still growing and is now at 14 cases and the one death.

Germ Boat #11 is an unnamed Nile cruise ship quarantined Saturday in Luxor with 45 positive cases (later reduced to 20 after more testing). Once again, the situation was identified through a tourist who returned home after a previous cruise and tested positive there (in this case, a Taiwanese American who returned to Taiwan). Today all remaining foreigners (46 French and American passengers, plus 18 Indians), were released and flown home. Domestic cases may still be quarantined.

P.S. Lawful Masses has an informative video about the Grand Princess lawsuit.

P.P.S. Here on the other germ coast, the Commonwealth of Massachusetts has announced 3 new cases. Also, the CDC has deigned to confirm 5 more of our cases, bringing their total up to 6 out of 95. Biogen cases have increased to 77 out of the 95 (4 more than the new cases for today), so some old cases must have been traced to them.

P.P.P.S. The methanol death count in Iran has risen to 44. Colleges and universities continued to announce closures throughout the day. Also, for a touch of Italy, the governor of New York locked down the New Rochelle cluster with the help of the National Guard.

P.P.P.P.S. There's been some misreporting of Daniele Rugani (Juventus/IT) as the first or second (after Timo Hubers of Hannover 96/DE) soccer player to fall ill. PlagueBlog readers know he's at best the third down; the first soccer player victim was Elham Sheikhi, late of the Iran national women's futsal team.

P.P.P.P.P.S. Italy has closed for business except for pharmacies and grocery stores.

P.P.P.P.P.P.S. There were five new deaths in Washington State. CNN reports that the NBA suspended their season in the middle of a Utah Jazz game tonight, due to an infected player.

Day 39: Don't Come Back

Coronavirus cases have now exceeded 116,000, with over 4,000 dead and 64,000 recovered. Italy now leads the non-Chinese pack at over 9,000 cases with 463 dead, and has suspended mortgage payments. Next up is Iran with over 8,000 cases, while South Korea is only slightly above 7,500. Spain is over 1,600, France 1,400, and Germany 1,200. Austria (157 cases) has restricted public gatherings.

For the US, Johns Hopkins calls us at 761 cases now (BNO says 717), with 27 deaths (2 in California, 2 in Florida, and the remainder in Washington State). Testing is ongoing at the Life Care Center of Kirkland, WA, which once had 120 residents (13 to 19 of whom died from coronavirus, depending on who's counting and how recently) but now has less than 60. Of the residents, 31 tested positive, 1 negative, 3 inconclusive, and 20 are pending. Uninfected residents will be moved elsewhere. Apparently there aren't enough test kits for the 65 symptomatic staff members.

The CPAC super-contacter came into contact with but did not infect the President's chief of staff, who is self-quarantining anyway. On the other end of the social spectrum, Fox News reports the city of Detroit is turning the water back on for some non-payers for a $25 fee (possibly waived) and $25 a month, in order to encourage hand washing. PlagueBlog wonders how much the non-payers owe that that plan sounded reasonable to someone, and how it is that people are allowed to live on the books in homes that are unfit for occupancy.

Here in Massachusetts, the gift of the Biogen conference just keeps on giving. If you know where to look, you can get our real case count (41, as of yesterday) broken down by Biogen-did-it, sex, hospitalization status, and county. For those of you unfamiliar with this cesspool of germs the area, Middlesex, Norfolk, and Suffolk County are the Greater Boston area and account for 35 of the cases.) We're currently at 32 Biogen cases, 4 travel-related cases (I'm guessing the one Chinese student and 3 ex Italy), and 5 that they're still investigating (maybe-Biogen-did-it).

On the Plague Ship front, the Straits Times reports on Germ Boat #9, the Costa Fortuna, which successfully docked in Singapore and passengers were allowed off, after having been refused at several Asian ports along their itinerary and having prompted Malaysia to ban cruise ships (apparently due to some healthy Italian passengers). Its next cruise, set to end in Italy, has been cancelled.

Time reports on a new one, Germ Boat #10, another Princess Cruises ship, the Caribbean Princess, also with crew off an infected ship (two of them, presumably off the previous cruise of the Grand Princess, though the papers seem to be having trouble keeping track). The CDC got involved and issued a no-sail order; the passengers are trapped aboard for the moment. The Grand Princess herself (#6) safely docked in Oakland, CA yesterday, though not all passengers disembarked then. Today's news is that passengers are already suing from aboard ship. (PlagueBlog recommends that you disembark from the death trap first, then sue.)

A 24-year-old Vietnamese woman (not to be confused with the jet-setting infected Vietnamese fashion model) returned to Vietnam after being refused testing in London. She tested positive there, becoming Vietnam's "Patient 32". It's not clear she's ex London, though, because she probably caught it from "Patient 17", another Vietnamese visitor to London who had also visited Italy and France (and quite possibly the jet setter or her equally-infected sister).

Local cancellations: Yesterday, Amherst College led the Mass pack by announcing they're going online-only after spring break. (The other four colleges announced plans to keep tabs on the situation, except for UMass Amherst, which says it formed a task force.) Today Harvard joined in. BIDA dances are cancelled through March. Balkan Music Night is also cancelled.

P.S. Channel 10 reports that Dunkies will no longer be refilling reusable coffee cups. PlagueBlog awaits Starbucks' announcement that they'll be creaming your coffee themselves like a real coffee shop, so you don't have to touch the same cream pitcher every other yuppie in town has touched today.

P.P.S. Our governor came home from vacation to declare a state of emergency (or, as PlagueBlog prefers to put it, a Commonwealth of Emergency), perhaps due to our 51 new cases, for a total of 92, 70 from Biogen alone (see this MSN article for details of the dinner and two conferences involved), and 18 untraced. Rhode Island (which is actually a state) and Ohio declared theirs yesterday.

P.P.P.S. The US has hit 1,000 cases, with 30 deaths. The extra deaths are the first New Jersey death, a travel-related case/death in South Dakota, and more deaths in Washington State. Also, MIT has cancelled school for the remainder of the year starting Monday and is sending all students home this coming weekend unless they can prove their home country is more of a basket-case than ours. Facebook and Google have ordered all their North American employees to work from home.

Day 38: Closing Schools Like It's 1918

ABC reports from the governor's mouth that New York State has jumped to 142 cases, 19 in the eponymous city. Kansas has reported its first case today. Connecticut reported its first case yesterday, apparently ex California. Washington State has stealthily reported 3 more deaths in their ever-increasing case counts, bringing the US to 22 deaths among 551 cases.

A JAMA paper from 2007 has been making the Internet rounds lately, Nonpharmaceutical Interventions Implemented by US Cities During the 1918-1919 Influenza Pandemic. The interventions were school closings, isolation/quarantine (isolation for the actually ill, and quarantining of their contacts), and banning of public gatherings:

Public gathering bans typically meant the closure of saloons, public entertainment venues, sporting events, and indoor gatherings were banned or moved outdoors; outdoor gatherings were not always canceled during this period (eg, Liberty bond parades); there were no recorded bans on shopping in grocery and drug stores.

While people were still susceptible to flu after (or during) these interventions, they did have some benefits, namely,

[...]delaying the temporal effect of a pandemic; reducing the overall and peak attack rate; and reducing the number of cumulative deaths. Such measures could potentially provide valuable time for production and distribution of pandemic-strain vaccine and antiviral medication. Optimally, appropriate implementation of nonpharmaceutical interventions would decrease the burden on health care services and critical infrastructure.

It's a good read, but the tl;dr conclusion is:

These findings contrast with the conventional wisdom that the 1918 pandemic rapidly spread through each community killing everyone in its path. Although these urban communities had neither effective vaccines nor antivirals, cities that were able to organize and execute a suite of classic public health interventions before the pandemic swept fully through the city appeared to have an associated mitigated epidemic experience.

It would be nice if we learned from the past, but we seem to forget instead. New York City was a model of public health promptness a hundred years ago, while Boston took a long time to react and suffered for it (see Table 1). Nevertheless, a few Massachusetts schools have closed for the moment: The Stratton School in Arlington was closed by the city due to a Biogen parent's symptomatic kid.

Individual schools in Boston, Malden, Plainville, Plymouth, Wellesley, and Worcester have closed for Friday or Monday, often for far less reason (e.g., in Worcester it's a contact of a relative of a staffer) in conjunction with a wiping-down-the-school effort and a planned reopening after the scrub. This is hardly a unified public health intervention. At least Boston University is planning for remote learning, though in an abundance-of-caution way rather than a do-it-yesterday way.

Education Week has a map of coronavirus-related school closures, though several recent Massachusetts cases seem to be misreported at ongoing closures rather than cleaning days. (Wellesley has already reopened.) New York and New Jersey have several district closures. In Seattle, whose response time wasn't too bad in 1918, many schools have already reopened.

Cancellations: Never mind those scrub-by-night school cancellations; NEFFA has been cancelled.

P.S. The New York Post reports the head of the Port Authority was among today’s cases. Though he’s been in contact with the governor, he’s not getting tested.

P.P.S. Five more deaths, four in Washington and one through community spread in Santa Clara County, California, have brought the US death count to 27. Santa Clara County has cancelled "mass" gatherings (of a thousand people) for three weeks. Italy has banned gatherings and restricted movement across the country.

P.P.P.S. Following in Ireland's footsteps, Boston has cancelled our St. Patrick's Day parade. Chicago has not.

Day 37: The Band Plays On

The Associated Press reports on our elderly presidential contenders campaigning on, including a quote from a Bernie Sis who thinks coronavirus is just "to distract people." In other news, Oregon has declared a state of emergency, presumably to distract people, and Twitter reports two more retroactive deaths at the Life Care Center of Kirkland, WA. The total case count for the US is 475.

Massachusetts insurers will be fully covering coronavirus testing, but then they're used to paying for the weird stuff. YMMV if you live elsewhere in the US. It's a good thing, too, because our Department of Public Health has announced 15 new presumptive cases (all from Biogen's battiness), increasing our count to 28 (with 23 directly linked to Biogen).

New Jersey is up to 6 cases. Vermont announced its first case yesterday. The New York Times now has a US case map.

The US State Department joins PlagueBlog in recommending against cruise ship travel. Though their purview is international travel, their advice is surprisingly unqualified:

U.S. citizens, particularly travelers with underlying health conditions, should not travel by cruise ship.

Speaking of plague ships, Germ Boat #8, the Regal Princess, is currently pacing back and forth off South Florida after being refused docking in Fort Lauderdale pending testing of two crew members formerly of Germ Boat #6, the Grand Princess.

Israel (with a case count of 39, only one untraced) is quarantining all arrivals, while Micronesia has closed its borders completely. France has banned public gatherings of more than 1,000 people, except for protests. (It's unclear whether this is a civil rights exception or a final solution to France's protest problems.)

Day 36 Retrospective

Day 36 (yesterday) was an exciting day for the Northeast and US Germ Boats. New York’s caseload jumped to 76, prompting the governor to declare a state of emergency. Acela service between NYC and DC was cancelled until late May. Bloomberg reports bad times for our lobster industry, what with the bottom falling out of the Asian giant edible spider import market.

The Commonwealth of Massachusetts now has our own tracker, which still lists yesterday’s stats of 13 cases. An infectious disease conference in Boston (CROI) was moved online, because apparently not everyone in the biotech sector here is completely insane.

Vice President Pence accidentally announced 21 confirmed cases aboard Germ Boat #6, the Grand Princess. Also, a Germ Boat #7 was christened when a “medical matter” (that is, a suspected coronavirus case) trapped passengers aboard the Carnival Panorama in Long Beach, CA, until a negative test result could be obtained. (The following cruise was shortened by one day.) PlagueBlog recommends against taking cruises at this (or any) time. At least one more death has been recorded for #2, the Diamond Princess, as well, bringing the official total to 7.

Another LAX screener was diagnosed. The US hit 19 deaths and Brazil hit 17 cases (two in Rio). MasterCard closed its offices in NYC and São Paulo due to a coronaviral connection between the two. The SXSW conference that several tech companies pulled out of earlier in the week has been cancelled.

A relatively new Chinese hotel in Quanzhou housing quarantined case contacts collapsed, killing at least 10. The Pope started streaming to keep crowds from gathering to see him, and the Vatican confirmed its first case.

Poland’s sixth case apparently caught it from the first case on a bus. The leader of the Italian Democratic Party fell ill. A cluster of 60 cases in Spain was linked to a funeral. The Netherlands reported their first death and a total of 182 cases.

Day 35: 100,000 Strong

Today the worldwide case count hit 100,000, with over 55,000 recovered and almost 3,400 dead. PlagueBlog will be at an inadvisable public gathering on the NH/MA border this weekend and will be unable to provide our usual level of gory detail. Just one note: Biogen maintains that its three infected employees are all out of state, even though they seem to have infected one another here in Massachusetts, meaning that the ex Italy case in their county is not an employee. PlagueBlog reserves judgement for the moment.

One other point of information: you may have heard about two strains, L and S, one nastier than the other, of SARS-Cov-2. The paper the media picked this up from is pretty baseless and has already been debunked in the literature, so ignore.

P.S. Channel 4 reports 3 Massachusetts cases from Biogen’s what-were-you-thinking conference last week, and 2 more out-of-state cases.

Day 34: Ex Boston

Channel 5 reports that we may have exported coronavirus to Tennessee in the person of a Williamson County (TN) man who flew from Nashville to Logan and back. Channel 10 reports he came to Boston for an international meeting "at Biogen" in Cambridge [reddit speculates this meeting was actually at the Boston Marriott Copley Square in the heart of Boston] last week, from which attendees took home both flu and COVID-19 (three positives so far). Our third Massachusetts case, also in Middlesex County (location of both Cambridge and yours truly) has been reported by the state as ex Italy but by NBC as ex Biogen, is awaiting confirmation by the CDC. PlagueBlog would like to thank you now for reading, because posting may come to an abrupt and possibly permanent halt at any time now.

Boston.com reports that the wayward New Hampshire medical worker "is now complying" with quarantine after exposing a bunch of Dartmouth Tuck Business School students at a mixer. One Tuck student "estimated that about a hundred business school students attended, along with 30 or 40 resident physicians associated with Dartmouth-Hitchcock, an academic medical center located near Dartmouth College."

In other local news, Governor Cuomo tweets that there are 5 new confirmed cases in New Rochelle, a couple in their 40's with three children who were friends of the previous family. There are also two untraced cases in New York City. New Jersey has two presumptive cases.

Texas has three new cases, two of them in Harris County (i.e., Houston). California is lousy with cases, but a notable one is one of the medical screeners from LAX. The CDC state-by-state map is updating daily again, possibly due to agitation from reddit. In less official but more accurate news-based counting, the US is up to 221 cases and 12 deaths.

An eight-month-old baby is a new Australian case, ex Iran. South Africa's first case is ex Italy.

On the bright side, the Diamond Princess has been downgraded to 696 cases and 6 deaths, due to some double-counting of cases.

P.S. Germ Boat #6 is another Princess Cruises ship, the Grand Princess. The story is similar to that of previous Germ Boats: passengers on a prior cruise later tested positive (including one death; these are some of the California mainland cases), so the current passengers have been condemned to a slow death by quarantine off the coast near San Francisco. Test kits are being flown in by helicopter.

Day 33: Biden Our Time

Iran has leapt ahead of Italy, with 2,922 cases (including 23 members of parliament) and 92 deaths. The Ayatollah was seen wearing gloves. Germany and France have each exceeded 200 cases and Spain is not far behind. Case counts are rising across Europe, with notable jumps in the UK, Switzerland, Norway, and the Netherlands. Portugal now has five cases (the fifth ex Italy, and the third and fourth connected to the initial two). Poland, famed for its resistance to the Black Death, has reported its first case.

Here in the New World, Canada is up to 33 cases, with several new cases ex Iran, while Mexico is holding at 5 and Brazil at 2. (The low case count in South America is the only thing between us and the WHO declaring this a pandemic.) The US has reached 132 cases, with 9 deaths (all in Washington State). CNN is tracking cases state-by-state. Most of today's new cases are in California and associated with travel, though at least one is untraced.

Governor Cuomo announced that many suspected New York State cases, including those in Buffalo and Oneida, tested negative. On the downside, the 50-year-old Westchester County case managed to super-spread the virus to his wife, a son (20), a daughter (14), and a neighbor. The children's schools (including Yeshiva University) will be closed today. He also announced that SUNY/CUNY students studying abroad in certain countries will be flown home and quarantined.

Day 32: Don't Lick the Shrine

The official case count is now over 92,000 cases. While Italy has exceeded 2,000 cases and South Korea 5,000, Iran (2,336) continues to be the most infectious, with almost as many new cases per day (835 today) as South Korea and the only significant death rate (11 today) outside of China (33 today). Notable figures in society continue to fall ill; the head of emergency services is now a confirmed case, and Mohammad Mirmohammadi, member of the Expediency Council and advisor to Khamenei, reportedly died of COVID-19 yesterday. The situation in Iran may have something to do with the government's failure to keep people from licking shrines—or, more likely, the very fact that they needed to tell people not to lick shrines in the first place. PlagueBlog also recommends you don't lick the shrine.

Back on the home front, Boston.com reports some more details about the first Rhode Island case, a school administrator. The second official case is one of the students from that trip to Italy. The article mentions that another chaperone is a suspected case; this suspected case may be Massachusetts' second case, a 27-year-old Cohasset woman who was on the same school trip. Whether a Massachusetts school was involved is still unclear.

Two cases have been confirmed in New York state. The first, a 39-year-old NYC health care worker, was ex Iran, but the second one is suspected local, untraced transmission to a Westchester County man in his 50's over whom not one but two local schools have already closed. Governor Kemp of Georgia reported two confirmed cases there ex Italy.

An unspecified foreigner in his 30's is the 706th case confirmed (yesterday) aboard the Diamond Princess. It's apparently a crew member, not the food blogger, who has escaped confinement (though not Japan) and is still food blogging while waiting to be readmitted to the US.

In non-humanitarian news, a stowaway cat at the port of Chennai is facing deportation over coronavirus fears. PETA India is concerned about its fate if returned to China and has offered to adopt it out.

Cancellations: The Louvre apparently remained closed today, though whether solely through worker action or now officially is unclear. The Japanese government is planning to cancel the annual Fukushima Memorial. The Chicago Tribune reports a major local trade show cancellation as well as other cancellations and postponements across the country. Twitter, Facebook, and Intel have pulled out of the SXSW conference in Austin.

P.S. The AP reports three new deaths in Washington State. Two seem to be posthumous confirmation of deaths from last week, and the third may be yet another nursing home resident from the Life Care Center of Kirkland, WA.

P.P.S. There's a second case in New Hampshire, a close contact of the first patient, though apparently not a result of the first patient breaking quarantine on Friday to attend a social event.

Day 31: The Accusations Fly

The official case count is over 89,000 cases, with over 3,000 dead and over 45,000 recovered. PlagueBlog cannot vouch for the Chinese number, which exceeds 80,000 cases with 2,912 deaths. South Korea now has 4,335 cases with 26 deaths. Iran has surged to 1,501 cases with 66 deaths. Italy is still slightly ahead at 1,696 cases and 34 deaths. Germany has hit 150 cases, France 130, and Spain 120.

Portugal has finally reported cases, both males in Porto, though only one is ex Spain. The 60-year-old doctor vacationed in Italy, while the 33-year-old construction worker worked in Spain and had some connection to Valência. Scotland has also reported its first case, ex Italy.

The US now has 88 cases, but no new deaths since yesterday. CNBC and MSN report on doctors' and suspected patients' lack of access to COVID-19 tests, despite CDC claims to the contrary. The New York Times also links CDC testing restrictions to weeks of covert spread of the virus in the Pacific Northwest. In other news, the CDC once again accidentally released an infected quarantined evacuee in San Antonio, but the patient was quickly recaptured.

The Bangkok Post reports that Thailand's first death, a 35-year-old sales clerk who dealt with Chinese tourists and passed away on Saturday, did not actually have an underlying condition; his dengue fever was a misdiagnosis and his only known disease was COVID-19. He had been in hospital since January 27th, stopped testing positive for coronavirus on February 16th, and succumbed to multiple-organ failure on February 29th.

And lastly, a cool toy: Genomic epidemiology of novel coronavirus (HCoV-19)

P.S. Steve Wozniak theorizes on Twitter that he was the American Patient Zero.

P.P.S. The Washington State cluster has now brought the US death count to 6.

P.P.P.S. New Hampshire has confirmed a case, in a hospital employee, ex Italy. Rumor has it he's been working since he returned from Italy. The nationwide case count is up to 100 as of 9pm EST.

Day 30: Looking Fully Incubated Now

NBC News reports that yesterday's death in Washington State turned out to be not just a domestic case, but also another unsourced infection in a non-traveller. In more disturbing news (from the same source), the CDC is responding to "the first possible outbreak" in a long-term care facility, the Life Care Center of Kirkland, WA.

In local news, the first Rhode Island "presumptive" case has been confirmed, a man in his 40's who'd travelled to Italy in February. Forty of his contacts are being monitored and/or quarantined at home by the RI Department of Health, but the patient himself is in an undisclosed hospital "nearby".

The US stands at 73 cases with one death. Canada has 20 cases. Mexico has 4, the fourth is ex Italy. Italy has jumped to 1,694 cases, though only 34 deaths. Unfortunate neighbors Germany and France are at or above 100 cases. Spain is at 76, the UK at 35, and Sweden, Austria, Switzerland, and the Netherlands have at least 10 cases each.

Iran reported 11 new deaths today, bringing their total to 978 cases with 54 deaths. Kuwait and Bahrain are now in the 40's, although Bahrain has only a quarter the population of Singapore.

South Korea has 3,736 with 21 deaths. Japan has 241 cases with 5 deaths. Hong Kong and Singapore have at least 100 cases each. Thailand, currently at 42 cases, has reported their first death.

P.S. PlagueBlog neglected to mention a canine case identified on Thursday: a pet Pomeranian in Hong Kong tested positive for the disease after her owner, Yvonne Chow Hau Yee, fell ill. The dog initially showed no symptoms; PlagueBlog has been unable to find any updates on its disease status, but Hong Kong is now quarantining pets.

P.P.S. New York has reported a case, and Washington State a second death.

P.P.P.S. Another Washington State case is a postal worker. PlagueBlog will refrain from "going postal" puns.