20200517u Day 138: Some US States have 6x Higher CFR – Hydroxychloroquine?

20200517u Santa Cruz, CA: I’m curious about the almost 5-9x difference in case fatality rate (CFR) between the US states with the lowest CFR and the US states with the highest CFR. As of today, the CFR for the United States is 5.96% (275 deathsPerM divided by 4615 casesPerM).

The four best states have a CFR near 1%:

  1. Wyoming: 1.07% (14 deathsPerM / 1303 casesPerM)
  2. Utah: 1.11% (25 deathsPerM / 2258 casesPerM)
  3. South Dakota: 1.11% (50 deathsPerM / 4507 casesPerM)
  4. Nebraska: 1.20% (64 deathsPerM / 5349 casesPerM)

The seven worst states have a CFR over 6%:

  1. Michigan: 9.57% (490 deathsPerM / 5121 casesPerM)
  2. Connecticut: 9.11% (956 deathsPerM / 10495 casesPerM)
  3. New York: 7.85% (1456 deathsPerM / 18498 casesPerM)
  4. Louisiana: 7.24% (536 deathsPerM / 7407 casesPerM)
  5. New Jersey: 6.99% (1167 deathsPerM / 16685 casesPerM)
  6. Pennsylvania: 6.85% (352 deathsPerM / 5141 casesPerM)
  7. Massachusetts: 6.74% (841 deathsPerM / 12479 casesPerM)

Timeline of Hydroxychloroquine related actions in the US States above. In reviewing these, I thought I might notice that some states were treating with hydroxychloroquine and others were not. If this is going on, I think doctors and pharmacists are keeping this information to themselves due to the politics surrounding hydroxychloroquine.

  1. March 4, 2020: From Nebraska UNMC, Clinical trial begins for COVID-19 medication, a video of Andre Kalil, MD, leading a COVID-19 Clinical Trial
  2. March 7, 2020: New York Executive Order restricts dispensing hydroxychloroquined
  3. March 17, 2020: Nebraska Medicine post recommendations for Hydroxychloroquine treatment: COVID-19 Antiviral and Pharmacotherapy Recommendations
  4. March 21, 2020: President Trump Tweet that ““HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine.”
  5. March 23, 2020: No. 202.10: Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency, an executive order from Andrew Cuomo, Governor of the State of New York, which included the following: “No pharmacist shall dispense hydroxychloroquine or chloroquine except when written as prescribed for an FDA-approved indication; or as part of a state approved clinical trial related to COVID-19 for a patient who has tested positive for COVID-19, with such test result documented as part of the prescription. No other experimental or prophylactic use shall be permitted, and any permitted prescription is limited to one fourteen day prescription with no refills.”
  6. March 25, 2020: Notice of Designation of Scarce Materials or Threatened Materials Subject to COVID-19 Hoarding Prevention Measures Under Executive Order 13910 and Section 102 of the Defense Production Act of 1950, which specifically identifies “Drug product with active ingredient chloroquine phosphate or hydroxychloroquine HCl”
  7. March 27, 2020: Utah Medical Association Email, which included the statement ”

    recommending that providers use a long-standing medication to treat COVID-19. This medication, Hydroxychloroquine, Hydroxychloroquine/zinc compound or Chloroquine/zinc is showing some promising data for affecting the course of COVID-19.” This was followed by an email the next day that said “The UDOH has withdrawn its guidance on hydroxychloroquine from March 27. They are instead endorsing the launching of the clinical studies and urging patients to participate in the trial to get access to the investigative drugs in a controlled environment with gathering of data.”

  8. March 28, 2020: FDA Emergency Authorization for use of Hydroxychloroquine
  9. March 29, 2020: Limitations on Prescribing and Dispensing of Medications for Treatment of COVID-19, New Jersey order for limiting hydroxychloroquine prescriptions
  10. April 6, 2020: Penn researchers assess hydroxychloroquine for Covid-19
  11. April 13, 2020: South Dakota launched the nation’s first statewide clinical research study to investigate hydroxychloroquine: Sanford Health to lead clinical trial for COVID-19 treatment
  12. April 13, 2020 (last updated):  COVID-19: Hydroxychloroquine, Chloroquine, and Azithromycin has different state policies on hydroxychloroquine
  13. April 16, 2020: Federal, state authorities step up efforts to prevent hoarding of chloroquine, hydroxychloroquine
  14. April 24, 2020: FDA Safety Warning on use of Hydroxychloroquine
  15. April 27, 2020: Boards of pharmacy and other actions relating to COVID-19 prescribing:

    “The A.M.A. is calling for a stop to any inappropriate prescribing and ordering of medications, including

    chloroquine or hydroxychloroquine, and appealing to physicians and all health care professionals to follow the highest standards of professionalism and ethics,” said AMA President Patrice A. Harris, MD.

  16. May 12, 2020 (last updated): NIH Treatment Guidelines “There are insufficient clinical data to recommend either for or against using chloroquine or hydroxychloroquine for the treatment of COVID-19″


20200425S Day 116: Everyone Must Wear a Face Mask

Farmers Markets in Santa Cruz, CA on April 25, 2020 – First day of Santa Cruz County order requiring the wearing of face masks while in public

Today, everyone was wearing masks at the Farmers Markets. There were one way lines with people separated by six feet. Later, in the afternoon, I rode up highway 1 and the cars were also social distancing at six feet between automobiles – it was packed! Since the park parking lots were closed, everyone was parking on the side of the road. It felt like the 4th of July. You could tell that everyone is done with sheltering in place and ready to return to normal activities, especially when they can head to a sunny beach. Everything is still feeling to me that I will be out of this pandemic wormhole by June 8th. I’m still curious how life will be different in the new universe I’m surfing to.

20200321S Day 81: Three to the Fourth Power is Eighty-One


I ran for the first time in a while. I’m trying to get back to one of the universes where I can run a few miles and do over 50 pushups. One of the things different about the set of universes I’m in is that I don’t own an Apple watch. Because of that, I don’t seem to run either. Today, I took my phone and listed to a doctor on the front-lines. I ran less than a mile but got some sun. As I was walking back and checking my twitter, I read a tweet about getting off social media and getting some sun. I then looked up and saw this heart shining through the trees. The Universe is amazing and amusing.

I believe that the current attention the world is putting onto the smallest, oldest, and most alien life forces on the planet has the potential to result in the whole of world society surfing to a different reality. As if we were going to get on a spaceship to Earth2, it’s time for everyone to start thinking about what we want to take to this new reality and what we want to leave behind. Imagine we are starting over on a new planet. Imagine that society can be created in any way we wish. Imagine that our higher selves will guide us and that together we will be successful in creating whatever it is we determine is best to create. Imagine that we embrace the changes and we have the skills to optimize as we move toward a common and achievable reality.

It is now a time for magic to be used in addition to science. Science is sometimes compared with magic (Clarke’s Third Law), so I’m not suggesting that now is not a time for science. What I believe is that we needed a more “sufficiently advanced technology” than we have now, and since from our technological standpoint that will look like “magic”, then we need “magic” now – not when science catches up and calls it science.

So for all those practicers of magic, the world needs your magic to enable us to move to another set of universes where we live in harmony with the Earth and are not fearful of pandemics.

Humans are plentiful on the Earth because of exponential growth. Coronaviruses are also plentiful on the Earth because of exponential growth. In many universes, SARS_CoV_2 is the fifth and most deadly coronavirus that is endemic in the world population. It took almost 4 billion years for SARS_CoV_2 to infect a single human. Since then, we have had the following exponential growth of confirmed cases of COVID-19:

  • 14 days to go from 1 to 10 cases by Dec 26, 2019
  • 14 days to go from 10 to 100 cases by Jan 9, 2020
  • 14 days to go from 100 to 1000 cases by Jan 23, 2020
  • 7 days to go from 1000 to 10000 cases by Jan 30, 2020
  • 35 days to go from 10000 to 100000 cases by Mar 5, 2020, as the coronavirus epidemic subsided in China and moved to the rest of the world
  • 14 days to go from 100k to 250k cases by Mar 19, 2020

In 2-3 more weeks, the math of exponential growth shows that there will be over 1 million confirmed cases of COVID-19 if it continues at the same growth as the last few weeks. And if we continue at this 10x/month rate for another month or two, the number of cases go to 10M after 1 month and 100M after 2 months. This is not to be alarmist – it is just math.

Math is a foundation science that exists whether we exist or not. Math exists whether the universe exists or not. Physics requires a Universe with universal constants like the one we have. Math requires nothing. Math is true any any and all universes. It may be possible to surf to a universe with different physics, but it’s beyond my insight to understand how one would surf to a universe with different math.

Thankfully, we can use math to help us with the COVID-19 pandemic. The social distancing going on now will reduce the spread from person to person and increase the case doubling time. If we can reduce the number of cases sufficiently, we can begin contact tracing again. If we can increase the ability to test for COVID-19, we can use this surveillance ability to keep the disease in check.