Over the last week, I’ve found the Hopkins map to be a steaming pile of buggy um stuff. It’s not updated properly, information appears and then disappears. Completely unreliable. It currently shows CA with zero cases.
The Spanish government has declared a nationwide state of emergency. This gives powers to the government to carry out mandatory evacuations, Force the closure of territories, take control of essential industries and more. It appears that the military has been tasked to help keep order, and also that they were asked to be ready to set up field hospitals if needed.
After the declaration of the state of emergency, the Catalan regional government ordered the closure of the whole region and stopped transportation, although they said that airports were responsibility of the central government and it was up to them to order their closure.
All shops except for food stores, pharmacies and shops selling essential things are to be closed.
Madrid has half the cases in the country; there the regional government took control of all the health services (both public and private) to put them all under a unified chain of command. Hotels (many of them empty) were asked to volunteer to be converted into temporary hospitals. At least two hotel chains appear to have agreed to it.
In stupider, facepalmier and more selfish news, there were rumors that The whole of Madrid was going to be put in quarantine and sealed off from the rest of Spain. This led to a lot of people running away from Madrid to go elsewhere in Spain; many new cases of COVID-19 in other regions of Spain have been linked to people from Madrid getting the hell out of there {{{RAGE}}}
Right now Spain has the highest amount of cases in Europe after Italy. A friend of mine in Madrid apparently caught COVID-19 from coworkers; she is waiting for the definitive results of the test 
My family in Spain was medical and I know many people who work in that field right now. They are overwhelmed and the whole Spanish health system is under huge strain. They want to avoid at all costs a situation like the one in the north of Italy, where doctors had no option but to do triage of new patients due to sheer lack of resources.
sigh
Stay at home.
The Catholic schools in San Antonio are closed until April 6th. They may stay closed for longer, but that is the current target date.
Students start remote-learning on March 23rd.
Sophia is upset as this cancels the Senior retreat and the State Latin tournament in Houston. She yelled yesterday “I’M SO SICK OF HEARING ABOUT THE CORONAVIRUS!” to which I responded “Only someone too young to have heard the names Lorena Bobbitt, Susan Smith, or Casey Anthony can say such a thing.” 
Here’s an illustration of what “flatten the curve” means.
Good news, Oklahomans: Oklahoma used half its daily tests on NBA team! Who says wealth doesn’t buy you privilege, eh?
That means that up to 57 people in Oklahoma might still be able to be tested!
Her play got canceled as well.
Also, Fordham said it will be another two weeks before they announced Fall acceptances. They were scheduled for today, but the University was one of the first ones to close, so I can’t say I’m shocked.
There’s no spiffy map but the World O Meter site is the best running right now. That’s where I get the numbers I post every evening.
My snarky commentary deserves clarification; on that day, Oklahoma could have run tests on another 42 people, apparently.
I am a general pediatrician. These conversations have been large parts of my recent days. They are actually quite easy ones. Much easier than many others I have! Parents have been very relieved that across the world very few kids have been getting sick enough to be diagnosed at least, and that so far, very much unlike influenza, there is no evidence of it spreading from kids to adults, only the other way around. I am very clear that I suspect it will be seen to some degree and that protecting higher risk adults from exposure to a child even mildly ill with anything is still prudent. The parents I have had contact with anyway want the schools open and have been dreading the announcement just made that schools in our state are to be closed for two weeks minimally.
We DO know that while it is POSSIBLE to spread while presymptomatic most are at low levels of infectivity at that time. Peak infectivity is in the first few days of symptoms with fever, cough, etc., and then drops off. We have no evidence that those who are asymptomatic are infective at all. And we know that even in the relatively highly tested South Korean population they are not seeing examples of the disease moving from a child to an adult. I am sure with a big enough n we will see some cases of such, but what we have is more than enough to conclude that this is very different than influenza epidemiology and that children are minimally not significant drivers of the infection spreading and not getting very ill themselves in large numbers.
Surprises the heck out of me but it seems to be the case.
We do not know how many kids have gotten mildly ill and recovered, and how many adults have. We don’t know its true infection fatality rate. We don’t know if it will go relatively dormant as the weather gets nice only hit its real peak concurrent with influenza season, or rise and fall now never to return as anything virulent again, and if so over what time course. We don’t know how long-lasting immunity is or how fast the bug will mutate and into what. We don’t even really know that closing schools is effective as a control measure in the face of influenza, which does get spread by kids and does have significant morbidity for them, even though we have good reason to guess it would.
Lots we don’t know, despite all the reports claiming to know, usually stating end of the world level numbers. Taking reasoned actions in the face of that uncertainty, and in the knowledge that our hospital systems are not built to withstand more than a 2017-18 influenza level event, is completely prudent and justified.
But that kids generally minimally are not getting very sick with it, and are not a major driver of its spread in communities to date (unlike influenza) … that much we know.
The UK government - and the devolved governments within the UK - seem to be taking a remarkably pragmatic approach. The assumption is that most of the population is going to end up catching the thing at some point anyway, so there’s no point in being all performative about “SHUT DOWN EVERYTHING!”.
How long are you planning on keeping your country/state/municipality/town/village on lockdown? How long do you think you can sensibly sustain it? This thing is now uncontained - until a mass-produced and reliable vaccine is available in a year or so there’s a certain inevitability about what happens next. The UK isn’t going to go full draconian until the real peak arrives in June/July.
So google doesn’t know what Trump is talking about.
Contrary to what we were told today, they are not building a website for the virus.
Great post, thank you. However 
I don’t think that we do know this. A recent German study says:
“The researchers found very high levels of virus emitted from the throat of patients from the earliest point in their illness —when people are generally still going about their daily routines. Viral shedding dropped after day 5 in all but two of the patients, who had more serious illness. The two, who developed early signs of pneumonia, continued to shed high levels of virus from the throat until about day 10 or 11.”
Link to the story in STAT.
Kind of a minor difference but I don’t want people to think that they are not able to spread the virus if they aren’t “sick”.
Now here is a website to obsess over. COVID-19 Tracker.
It is attempting to list on a state by state basis the number of COVID-19 tests completed.
“We attempt to include positive and negative results, pending tests, and total people tested for each state or district currently reporting that data.”
I can’t vouch for accuracy at all.
Here is a link to the introductory page, the numbers are found on “Take me to the data”
All right, so since much of the advice is “Avoid hospitals if you are sick, if you can,” what’s the DIY remedy for Covid-19, other than the usual (sleep more, vitamin C, drink fluids, etc.?)
A great post from DSeid who eloquently and succinctly summarized the situation; “Nobody knows anything”.
It is prudent to be cautious to a degree. “An overabundance of caution” does not always send the right message. In the absence of evidence that closing schools and travel bans are effective long after the initial cases, what precedents are being unintentionally set here? Especially with the preliminary information on pediatric transmission apparently being a smaller factor than for many other outbreaks? I understand the desire to avoid litigation and not be seen doing too little.
Balancing prudence and optimism is not always easy. The enormous lack of testing is unhelpful, but testing people mainly since they have a privileged access to tests is probably unwise.
Canada has a meagre 12.9 ICU beds per 100,000 people. Some emergencies essentially operate above capacity and are improperly staffed even in the absence of outbreaks. The system creaks along at best due to many exceptional efforts, which are rarely respected, even within the medical community.
Though my heart goes out to those severely affected, the number of cases needing hospitalization is much more important than inaccurate estimates due to limited testing. There is much we don’t know, so caution is reasonable. Stoking fear should be avoided while encouraging people to take appropriate steps and follow local advice. Whatever Mike Pence’s strengths, his medical knowledge is probably limited. Canada is in somewhat more seasoned hands, but tests are still too hard to access and when you are in charge of a potentially big problem, one is tempted to overreact as a form of ass-coverage in the face of zealous media reports. Too little will change once this ends, but there will be much future overabundance of caution.
As for advice, most transmission occurs if within one metre (39 inches) of an affected person. Maintain a bit more space. Wash your hands frequently. Try to avoid touching your face, which is very hard. If you develop a cough, maybe wear a mask in public. Throw used tissues away. Eat healthy foods and drink lots of fluid. You want to say your prayers or take a multivitamin, be my guest. See your doctor if breathing is at all difficult. The current advice is to self-quarantine for 14 days if needed. I’d be curious to see if there is any evidence this time frame is optimal, though.
Gargling with salt water and some aspirin.
guaifenesin
humidifier
maybe those zinc pills that maybe help with colds
(I am not a doctor.)
I thought that was how long to quarantine to see if you get sick after having been infected. There is data backing that up.
(I don’t think that has a paywall. But it refers to a couple of studies, and says most people get sick about 5 days after exposure, some as soon as 2 days, rarely as long as 27 days, but 97.5% of those who develop symptoms will do so within 11.5 days of exposure)
I understand the above sounds mundane. The evidence for zinc, echinacea, vitamin C, vitamin D, etc. is marginal at best. Drinking enough, exercising, reducing smoking and eating reasonably well likely makes a bigger difference.
Hopefully lessons are learned from this and the money being put into new research pays dividends. After all, breakthroughs in medicine tend to be widely and universally adopted. The average period for this widespread adoption to occur tends to be (no fooling!):
about 20 years
And my heart goes out to anyone put in the unenviable position of what to do about school X or event Y. These decisions are very hard. The fact I would have done it differently does not make me right nor mean decisions were unreasonable. But they will have future effects and it is easy to imitate monkeys, so to speak.
There is evidence people have seen others use 14 days, and evidence this seems to be enough in this case. This is a little different from optimal time, though. Especially if there is later recurrence.