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This is the surge

Charts showing rapid rise in both Covid-19 cases and deaths in Massachusetts and Boston.

Total cases and deaths. State in blue; Boston in red.

With more than 38,000 confirmed Covid-19 cases- and with more than 130 people a day dying from the virus (146 reported today), Massachusetts is now into its expected surge that Gov. Baker had been warning us about. Even the White House is paying attention to us now.

Dr. Robin Schoenthaler, an oncologist at Mass. General - which now has the state's largest census of Covid-19 patients in general and in the ICU in particular - reported yesterday:

The hospitals are brimming over with COVID patients. Seven times as many critically ill patients are at MGH as usual, 349 COVID-positive patients there right now. The hospitals have stopped all but the most critical of surgeries - unless you are an abject emergency there are almost no operations (MGH is using 7 of their 70 ORs), no colonoscopies, no mammograms, no hip replacements - it's all-Covid-all-the-time.

All the hospitals have increased their number of ICU beds, some hugely. On March 13, MGH had 18 COVID ICU beds; now they have 206.

She adds the importance of everybody writing down key contact info and of filling out a health-care proxy form that lets doctors know who they can ask if you're unconscious and unable to make medical decisions:

This exhausted ER doctor wrote: "Bring multiple cards with your family’s name/number…especially for those who are demented, don’t speak English, are in terrible respiratory distress, etc. We do our best to communicate with families….. but please if you have a meaningful relationship with someone like this, please try to have this hard conversation before I have to have it, shouted under an N-95 mask, with an interpreter on an iPad they can’t hear, while they are gasping for breath.“

Nuff said. PLEASE talk to your family members about what you and they would want done if you or they were to get super sick and need a ventilator. TALK TO YOUR PEOPLE.

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when all the people who were out today catch it.

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Not impossible, but difficult.

Restaurants, conferences, trains, buses, very doable. Outside, especially with some distance and lots of masks, very hard.

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Masks and distance, you say? I gather you haven't been to Jamaica Pond recently.

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Was close today, but not quite that far from home.

But even walking by people doesn't appear to be a major form of transmission. From what the experts are saying sounds like evaporation and UV take their toll, but as we all learn new terms, viral load seems to be a necessary variable. TBD, but most of the major transmission routes seem to be indoors.

Personally not taking chances but not that concerned about walking around. Would appreciate the joggers and millennials respecting the 6 feet recommendation.

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How old do you think millennials are? I’m a young millennial and I’m almost 30. We are trying to convince our boomer parents to stay home with us! We’re not the ones playing beer pong at our buddies’ houses. That’s Gen Z.

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I ride on the perimeter of Franklin Arboretum n Jamaica pond and all are brimming with people

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What is the source of your alleged information?

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...by the time this is over, everyone on Uhub will be given an honorary medical degree in doctoring from Harvard. If they haven't gone broke.

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If they haven't gone broke.

Or insane.. I'm on the edge some days. Some days its so bad, I just shutdown.. like today.

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Hang in there. These are hard times and it’s okay to not feel good,but you’ll pull through. You will.

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I realized how bad I am at self-care, so I made a punch list for things to do everyday. 1. showered and dressed before 9am. 2. Found my address book and send one card/letter/postcard per day to someone I've lost track of. 3. Listen to an entire album on Spotify from any band I used to like back in the day. 4. Clean/organize one small corner of my world. and 5. Like Mister Rogers said, "Look for the helpers." so I find one organization that's making this better (or at least not so bad) and send a couple of $$, even small money helps. So I've got a routine, things to look forward to and, if I can do this one more week, my wife says she'll let me out of the basement.

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Some day like today, I have all I can do it get out of bed and walk over to the computer to work.

I'm glad I am working from home, otherwise I would be out a lot.

Just crushing every single day now.

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I was in the process of getting transferred when all hell broke loose, so my old department is learning to live without me and my new department doesn't know for sure what I'm supposed to be doing yet, so I have to monitor my email all day without having more than a couple of tasks to do. And my attention span is far too shattered to try to do anything other than press the Twitter refresh button like the exact opposite of a patient calling for more morphine.

Just trying to hold it together for a day, an hour, 10 minutes at a time.

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I was slated to go to a 3 week vacation extravaganza after being on the road for months for work. I was forced to go, per my boss. And even when I cancelled all the arrangements on March 4th.. a few days before I was suppose to go, I still had to go on vacation

So I sat home, shopped, and prepped to be home for weeks. In that 3 weeks time, work moved to work from home. I came back, my boss had a emergency for one week, and now she is very sick herself (C19 related). I literally have had no direction for weeks. I have tasks to work on but just lost all interest in doing so, and many of my projects were cancelled due to them being all on site visits.

Attention span is horrible right now. I thought it was only me but coworkers are also stating this fact so I am not alone. It's just so hard to even continue at this point.. kind don't see much of the point anymore. I just feel like we're done.. and we are just waiting for the end now.

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You are not alone. I am lucky enough to be working from home, but my attention span many days is zero. And it's hard to care about work in general, when there's a pandemic happening. Who cares about reports and budgets when that's happening??

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I know. Being employed right now is about the only thing keeping it together, but some days like today. I just can't even work from home. I'm useless if I am despondent and not replying.

But I try to remember that I have a job, where I can work from home and isn't suffering much of a business loss because of it. In fact, we've had lots of up sells lately because our product is useful right now (cyber security related).. not sure how long it will last but we were told "we look good".

Especially when so many of my service workers friends are out of work now. Trying to share the wealth as much as I can while I still have it. I even gave orange FF's blood money check away, others needed it more than I did.

I'm trying to be thankful but it is hard.

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Listen to an entire album on Spotify from any band I used to like back in the day.

Over the weekend, I started creating an "Early MTV" playlist for no particular reason than getting a few songs stuck in my head, but now both my wife and I find it really soothing to listen to. I'm still tweaking as certain songs trigger memories of other songs.

Even songs that I didn't particularly care for way back when seem to work. As my wife said, it may have been f-ed up back then, but not as f-ed up as it is now.

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Many years ago I subscribed to Billboard Magazine online for the sole reason to look at Billboard archival lists.

I printed Billboards' Top 100 lists from 1975 to 1991. Then proceeded to acquire every single song on those lists.There are some real gems that I forgot about. It's made the days better somewhat. But I've listened to them all by now.

And yeah I stopped in 1991 because it just got so bad music wise. Those were my high school years and love a lot of it but ughhhh .

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It's a terrific show on WMBR (88.1). Every Saturday morning from 6-8am they pick a top 40 playlist from some radio station in the US or other English language country from the 1940s to 1980s and play their list from bottom to top.

It's like a musical time capsule and in the case of the 50s and 60s, fun to hear how different the playlists where depending on where in the country the station was localed. Back then the stations actually selected their music locally. Imagine that?

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I have a calendar just for this type of stuff... radio shows to listen to live.

Mostly different stations that air reruns of Casey Kasem's America's Top 40 . It's always nice to hear what was popular the week of April 15, 1984 .

Then again this is also the same person who's TV watching lately is reduced to those reels of commercials from the 1980s, searching for "wbz/wcvb/wnev 80s" and watching whatever comes up. Been enjoying the Evening Magazine reruns and WNEV's newscasts from the late 80s.

Its been very comforting lately hearing JD Saul's voice again. (along with Liz's on wbz reruns)

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And in the 60s and early 70s the legendary local DJ Dick Summer used to read poetry on the air on his "Lovin' Touch" program, first on WBZ AM and later on WMEX AM. I've even got one of the "Lovin' Touch" poetry books he put out back then.

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Welcome, comrade.

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This is a real good list. I think I'll steal it.

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Actually, my concern was for Harvard.

We're all getting free money from the government.

The solution...be Irish.

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The only reason we’re not reading stories in Boston like they did in Italy and Spain is because of the way the hospitals planned in advance for the surge. I’ve never been so proud of working in healthcare in Boston. Talking to the people who organized this and who’s planning means that there hasn’t been any rationing of care is humbling. They have achieved so much in such a short time.

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but I also think that to some extent we are not seeing the same catastrophe here because we read those stories about Italy and Spain and it defined for us how bad things could get. The only model Italy and Spain had was Wuhan, and it turns out that dictatorships aren't useful models for democracies during pandemics.

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Kudos to everyone who gets to see it in hindsight. This new normal is going to fray and wither a lot of social, cultural, and political outlets, refuges, and pressure valves.

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It needed to happen, and it could have been a lot easier than it is.

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Which is good. More for other places that might need it.


Meanwhile, the Navy aid ships might be freeing up.

They were there in case things got really insanely bad. They are a really reassuring sight.

"As of Friday, 71 of the USNS Comfort’s 500 beds were occupied.
During a White House briefing Friday, President Donald Trump said the lack of patients on the ship showed that New York City was healing.
“They didn’t need it, that’s a good thing. That’s such a good thing. I think that shows that New York’s making progress,” Trump said."

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"Tapering off" to me means the end of the curve, where the number of new cases are dropping to soon be a small number. What we are seeing in New York and elsewhere is huge numbers of new cases every day, but not significantly more than the previous day. That's not the tail of the curve, the "tapering off". That's... maybe we'll hit a peak soon, with social distancing measures in place?

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The ship was only for non-COVID-19 patients and there were so many restrictions on who could go there that it ended up being virtually useless. It wasn't for lack of need.

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...that may have been the case at first, but the ship was quickly converted to accommodate COVID patients - not sure if it was due to the initial backlash or because a crew member came down with the virus - but it was converted.

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The worst of the 1918 pandemic was from a second surge after people let up, thinking the bad days were behind them and they could return to normal.

We need to be smart about the new normal untill we can test and vaccinate.

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....but the outbreak of a new more virulent & deadly mutation of the flu virus and first seen in returning troops quarantined at the Commonwealth Pier Receiving Station. The first cases appeared in late August. Within two weeks, 2,000 officers and men were infected and the Chelsea Naval Hospital was overwhelmed. Camp Devens experienced an outbreak at about the same time. A “Win the War” parade in early September including soldiers and sailors from the Receiving Station, plus Navy Yard and shipyard employees, became the vector for rapid and widespread transmission in Boston. By the end of September, there were 1,000 cases in the city. Many who survived the first wave contracted the mutation, including, if I remember correctly, Babe Ruth. There was a third Influenza wave, which gets very little attention because the outbreak was brief and much less lethal.

PBS’s The American Experience” had a great segment devoted to the pandemic. I’d be surprised if it wasn’t streaming somewhere. John Barry’s The Great Influenza ( general history of the pandemic) and Gina Kolata’s Flu (history, plus a deeper dive into the epidemiology and the research into the nature of the virus itself) are the two best books I’ve read on 1918.

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And has been like a bible during all this.

Just. Stay. Home.

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I recall some of the stories from those books, read years ago. For instance: Young nurse, healthy in the morning, goes to work. By noon she is coughing. By three in the afternoon she is dead.

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Life is short but the smartest thing to do is write off your summer plans for this year.

The parade in Philly happened not out of defiance to some perceived grievance against a global shadow deep state of satan worshipping Democrats but because it was out of simple ignorance and to financially prepare the country for WW1.

They just didn't know how bad it could get.

We do know how bad it could get and need to heed those warnings.

Past is prologue and the meek shall inherit he earth.

Have fun at your covid rallies, Trümpettes.

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The health care proxy form wants two witnesses, and the person named as a proxy can't be a witness.

That's a good rule, in general, but I don't see a safe way to do this, for myself or a lot of other people. I can't ask my spouse to be both the proxy and a witness, and nobody else lives with us. There are three people living upstairs, but two of them are school-age children. Do I fill out the form now, and keep it handy so I can ask the EMTs or ER staff to witness? Look for two friends or neighbors who can come over and witness my signature from six feet away?

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They can witness from a distance, then approach and sign the paper—wearing a mask, and cleaning their hands afterwards.

I don't think you want to risk waiting until EMTs show up; there would be a lot happening then, and it would be extremely easy to forget. Also, if you're not conscious, they wouldn't be able to witness.

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You can scan/photo and email someone, have them print it out and sign it, and then scan/photo and send it back to you.

Legal contracts are handled that way all the time these days.

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DocuSign might be good for this and they offer a free trial.

1. Create an account + setup your signature
2. Upload your file & add the fields to fill in the blanks
3. Send your file to 2 people, have them sign up
4. File will be returned to you, just print out the entire thing (or save to PDF), just make sure you include the paper that shows the electronic paper trail
5. And you're done

even if you don't keep the account, it should be sufficient for this purpose.

Maybe setup a Zoom to do it all over camera (and record the meeting!) and send the document while on the meeting if you are that paranoid, but DocuSign should be enough

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The most important question associated with COVID-19 is how many people have become infected??

That is a vastly different question than how many people have been tested for the SARS-COV-2 virus, the causative agent for COVID-19 disease, and found to have a positive test result.

We know that for the vast majority of people whose nasal and other respiratory and oral samples are tested for the presence of the virus, the test shows no detectable level of the virus.

Most recent and some earlier MA data*1:

  1. April 19: Total Tests (TT) 5,435 Confirmed Cases (CC) 1,705 (+%) = 31%
  2. Cumulative: (TT) = 162,241 CC = 38,077 (+%) = 23%
  3. Cum thr Apr 1: (TT)=51738 (CC)= 7738 (+%) = 15%
  4. Cum thr Mar 24: (TT)= 13749 (CC)= 1159 (+%) =8%

Now the Census Bureau, July 1, 2019, (V2019) estimates that 6,892,503 people live in MA*2
So to date looking at the raw numbers:
We've tested 2.5% of the population and if the current rate of positives (+%=31) is prevalent within the whole population -- then some 2,136,676 people have or had the COVID-19 in MA.

However, the simple fact is that we don't know -- it could be, although extremely unlikely, that we've tested the entire population who have or had the COVID-19. It's also possible that the entire untested population of MA has or had COVID-19 and we've yet to encounter and test them. Or any other possible rate in between. All of this of course assumes that each of the:

  1. testing systems used is equally well characterized in terms of false positive and false negative results
  2. samples is collected with the same degree of care and skill
  3. tests are conducted with equal degrees of care and skill including contamination control
  4. samples is collected under the same protocol and the local interpretation of the protocol*3
  5. etc.

But -- Ignoring all of the data issues -- all of the tests were looking for the presence of a measurable amount of virus in nasal and oral a samples. We don't have any data as yet to look for the presence of antibodies to the SARS-COV2 virus in blood samples -- the typical "Gold Standard" for viral epidemiological studies.

And then came the not-yet prime-time release of the "Stanford Study" *4-- which attempted to ascertain how many people in Santa Clara County [aka Silicon Valley] were carrying the antibody to the virus. It is much criticized on various blogs and by pundits most of whom have no knowledge of any of the technical terms used in the paper.

The key findings of the study [my highlights in Bold]:

The unadjusted prevalence of antibodies to SARS-CoV-2 in Santa Clara County was 1.5% (exact binomial 95CI 1.11-1.97%), and the population-weighted prevalence was 2.81% (95CI 2.24-3.37%). Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%).
These prevalence estimates represent a range between 48,000 and 81,000 people infected in Santa Clara County by early April, 50-85-fold more than the number of confirmed cases.
The population prevalence of SARS-CoV-2 antibodies in Santa Clara County implies that the infection is much more widespread than indicated by the number of confirmed cases. Population prevalence estimates can now be used to calibrate epidemic and mortality projections.*4

In the discussion the authors of the Stanford Study mention some additional serological [blood antibody] tests in localities in Europe [# are the references in the Stanford Study]:

Several teams worldwide have started testing population samples for SARS CoV-2 antibodies, with preliminary findings consistent with a large under-ascertainment of SARS CoV-2 infections.
Reports from the town of Robbio, Italy, where the entire population was tested, suggest at least 10% seropositivity;24 and data from Gangelt, a highly affected area in Germany,25 point to 14% seropositivity. *4

There are at least three other situations which could be used to measure the prevalence and spread of the COVID-19 in close quarters [aka inside social distancing]:

  1. one is the Pacific Diamond the Cruise Ship which was tied to the pier in Yokohama Japan and for which essentially everyone was tested*5:
    1. 3,711 passengers and crew on board:
      1. Feb 5: [TT] = 31 TT Cum [TTC] = 31 [CC] = 10 CC Cum [CCC] =10
      2. Feb 13: TT= 221 TTC = 713 CC = 44 CCC= 218
      3. Feb 20: TT= 52 TTC= 3,063 CC= 13 CCC= 634 %+ = 21%
    2. Everyone who had not been removed disembarked on Feb 20
    3. Final results of the testing
      1. Cumulative 634 tested positive including those tested on Feb 20:
        1. 52 of whom 13 tested positive [+% 25]
        2. and of whom 7 showed symptoms
        3. 6 were asymptomatic
      2. Overall of the 634 CCC 320 were Cumulatively asymptomatic
      3. Note that if these folks were in the general population they would not be eligible for being tested and hence their COVID-19 disease would not be counted
  2. the Biogen Conference??? *6,*7
    1. How a premier U.S. drug company became a coronavirus ‘super spreader’
      Biogen's annual leadership meeting in early March was one of the earliest examples in the U.S. of what epidemiologists call “superspreading events” of COVID-19.*6

      Biogen employees, most feeling healthy, boarded planes full of passengers. They drove home to their families. And they carried the virus to at least six states, the District of Columbia and three countries, outstripping the ability of local public health officials to trace the spread.....

      The official count of those sickened— 99, including employees and their contacts, according to the Massachusetts Department of Public Health — includes only those who live in that state. The true number across the United States is certainly higher. The first two cases in Indiana were Biogen executives. So was the first known case in Tennessee, and six of the earliest cases in North Carolina.....

      At least two of the company’s senior executives have tested positive....

      Although some other companies canceled international meetings around that time, Biogen never discussed doing so. The outbreak was raging in China but had not yet been declared a worldwide pandemic. As of Feb. 21, the Friday before the meeting, the United States had only 30 confirmed cases... Biogen executives in Germany, Switzerland and Italy — where there were just 20 known cases — packed their bags.

      On the first night, about 175 executives gathered for a buffet dinner and cocktails at the Marriott Long Wharf overlooking Boston Harbor. Colleagues who hadn’t seen one another in a year shook hands and vied for face time with bosses. Europeans gave customary kisses on both cheeks.....

      Two days later, the senior executives returned to their offices. One drove to a manufacturing center in North Carolina. Others flew back to Europe.

      Peter Bergethon, the head of digital and quantitative medicine at Biogen, went home to his wife, an infectious-disease doctor.

      A Biogen vice president in the Alzheimer’s franchise and her husband attended a party the following Saturday night at a friend’s home in Princeton, New Jersey, with about 45 other people....

      That night, Allana Taranto, a photographer who covered the leadership meeting for Biogen, celebrated her 42nd birthday with her boyfriend and another couple.

      Over that weekend, though, some people in the company had already started feeling sick.

      Jie Li, a 37-year-old biostatistician who worked on the Alzheimer’s drug team, had chills, a cough and aches. She was too junior to attend the company’s leadership conference, but her boss went, and showed up at the office afterward...

      Still, that same day, the company’s four top executives attended a huge health care conference hosted by the investment firm Cowen. At another Marriott in Boston....

      Later, investors were informed that two of the four Biogen executives at the conference tested positive for the virus....

      The next day, confirmation of the worst arrived. Two Biogen executives who had returned home to Germany and Switzerland, where tests were more widely available, had tested positive....

      Yet on that same day, a Biogen executive visited the Washington office of Pharmaceutical Research and Manufacturers of America, or PhRMA, the industry’s top lobbying group. Soon after, that executive tested positive, prompting the group to close its headquarters for deep cleaning....

      Bergethon infected his wife, the infectious-disease specialist.....

      Taranto, the photographer who had been at Biogen’s leadership conference, unknowingly gave the illness to a friend at her birthday dinner. She had felt healthy at the time.

      Of the four dozen people who attended the party in New Jersey, at least 15 later tested positive, according to public health authorities.

      A Biogen executive, Chris Baumgartner, became the first COVID case in Tennessee. “I was patient zero,” he wrote on Facebook....

      The earliest cases in Indiana and North Carolina were tied to the company. One Biogen employee even carried the virus back to China.

      After falling ill with flulike symptoms, Li called an ambulance and was given a coronavirus test, according to a public health official in Belmont....But before she received the results, she booked a flight to Beijing, boarding a plane with her husband and son....

      Jie Li, a biostatistician at Biogen.....Li took medicine to conceal her symptoms, and revealed her health condition to flight attendants on board the flight, Air China and Beijing disease control officials said last month.

      After she landed in China, authorities placed her under investigation for “obstructing the prevention of infectious diseases,” a crime that reportedly carries a sentence of up to seven years in prison.

      In Beijing, the couple suffered from high fevers and lung infections and were hospitalized....

      It appears that all of Biogen’s employees who fell ill have recovered. Aside from Li, who was fired, all have returned to work, Caouette said....*6

    2. After 'superspreading' event, Biogen to build hub for COVID-19 patient data
      Jacob Bell
      April 16, 2020
      Biogen on Thursday announced plans to create a COVID-19 biobank, into which its employees, who were some of the first people in Massachusetts known to be infected with the new coronavirus, can contribute blood samples and other medical data.
      Employees who contracted the new coronavirus and later recovered from the disease it causes are eligible to contribute to the biobank. So too are their family members and close contacts, regardless of whether they had confirmed cases of COVID-19. The biobank will be run by a consortium that includes Brigham and Women’s Hospital and Massachusetts General Hospital. *7

  3. the USS Theodore Roosevelt ???
    1. The Navy's testing of the entire 4,800-member crew of the aircraft carrier - which is about 94% complete...As of Friday, some 660 sailors - nearly 14% of the crew - had tested positive for the coronavirus. The Navy has said that about 60% of those positive tests were among sailors who were symptom-free.*8
    2. WASHINGTON (Reuters) - The U.S. Navy said on Friday it will conduct antibody testing of sailors aboard the coronavirus-hit aircraft carrier Theodore Roosevelt to determine whether they were exposed to the virus as it spread through the ship.

      Sweeping testing for the coronavirus among the entire crew of the Roosevelt has already yielded a curious result: The majority of the positive cases so far are among sailors who are asymptomatic.*8

Conclusion we should at least double the number of cases confirmed by the existing testing regimen when ever we are discussing the COVID-19 incident -- and it could be much more prevalent even than that

Coronavirus Disease 2019 (COVID-19) Cases in MA
As of April 19, 2020
There were 5,435 new tests conducted for a total of 162,241.
There are 1,705 new cases for a total of 38,077.
also same reporting for:
As of April 1, 2020
As of March 24, 2020

US Census Bureau Massachusetts Population estimates, July 1, 2019, (V2019)

CDC COVID-19 testing protocol [current]

COVID-19 Antibody Seroprevalence in Santa Clara County, California

Eran Bendavid1, Bianca Mulaney2, Neeraj Sood3, Soleil Shah2, Emilia Ling2, Rebecca Bromley-Dulfano2,Cara Lai2, Zoe Weissberg2, Rodrigo Saavedra-Walker4, Jim Tedrow5, Dona Tversky6, Andrew Bogan7,
Thomas Kupiec8, Daniel Eichner9, Ribhav Gupta10, John P.A. Ioannidis1,10, Jay Bhattacharya1

April 11, 2020
medRxiv preprint doi: https://doi.org/10.1101/2020.04.14.20062463.
The copyright holder for this preprint (which was not peer-reviewed) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .


Pacific Diamond

Euro Surveill. 2020 Mar 12; 25(10): 2000180.
doi: 10.2807/1560-7917.ES.2020.25.10.2000180
PMCID: PMC7078829
PMID: 32183930
Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020
Kenji Mizumoto, 1 , 2 , 3 Katsushi Kagaya, 2 , 4 Alexander Zarebski, 5 and Gerardo Chowell 3
Author information Article notes Copyright and License information Disclaimer

Biogen Conference

Biogen Conference
After 'superspreading' event, Biogen to build hub for COVID-19 patient data

National Institute of Allergy and Infectious Diseases. (2020). "Novel Coronavirus SARS-CoV-2" [Image]. Retrieved from https://www.flickr.com/photos/nihgov/49565892277/in/album-72157713108522....

AUTHOR Jacob Bell
PUBLISHED April 16, 2020
Dive Brief:
Biogen on Thursday announced plans to create a COVID-19 biobank, into which its employees, who were some of the first people in Massachusetts known to be infected with the new coronavirus, can contribute blood samples and other medical data.

USS Theodore Roosevelt

Why did so many Theodore Roosevelt sailors not develop COVID-19 symptoms? Navy to test crew antibodies to help figure it out

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