Dr. Derrell Cox_04-10-2020

SARS-CoV-2 (COVID-19)
Pandemic In the US and
Oklahoma, Early First Wave,
April 2020

Maps, Information, and State of the Science on Possible Treatments

Derrell Cox PhD, Center for Applied Social Research, University of Oklahoma

https://phil.cdc.gov/
Details.aspx?pid=2
3312

Model of
COVID-19
(aka
coronavirus,
SARS-CoV-
2) virus
particle.

Cross sectional model of a coronavirus particle (Lipid)
https://www.scientificanimations.com/

https://www.niaid.nih.gov/di
seases-
conditions/coronaviruses

Image of COVID-19
virus particles
(color-enhanced)

https://coronavirus.jhu.edu/map.html

Total confirmed
COVID-19 cases,
worldwide
1,596,496
(April 9, 2020)

Total
confirmed
COVID-19
cases, US
462,135
(April 9, 2020)

https://www.nytimes.com/i
nteractive/2020/us/corona
virus-us-cases.html

https://www.nytimes.com/in
teractive/2020/us/oklahom
a-coronavirus-cases.html

Total confirmed
COVID-19 cases,
Oklahoma
1,684
(April 9, 2020)

https://coronavirus.jhu.e
du/map.html

Confirmed Active
COVID-19 cases in

the US
420,212
(April 09, 2020)

Total COVID-19
deaths in the US
16,513
(April 9, 2020)

https://www.nytimes.com/i
nteractive/2020/us/corona
virus-us-cases.html

Total COVID-
19 cases and
deaths in
Oklahoma
(April 9, 2020)

https://experience.arcgis.com/experience/0e8ccb659c804924b72ddc862ec0eadf

Total reported
cases per capita
in the US
(April 8, 2020)

https://www.nytimes.com/i
nteractive/2020/us/corona
virus-us-cases.html

https://www.nytimes.com/i
nteractive/2020/us/oklaho
ma-coronavirus-cases.html

Total reported
cases per capita
in Oklahoma
(April 8, 2020)

https://www.nytimes.c
om/interactive/2020/us
/coronavirus-us-
cases.html#states

Fastest rising
places of
confirmed
COVID-19
cases in the
US
(April 7, 2020)

https://www.nytimes.c
om/interactive/2020/us
/coronavirus-us-
cases.html#states

Fastest rising
places of
confirmed
COVID-19 cases
in the US
(April 08, 2020)

Rate of rising cases is
dropping in most of the US
due to social distancing (or
lack thereof).

https://www.nytimes.com/in
teractive/2020/us/oklahom
a-coronavirus-cases.html

Fastest rising
new COVID-19
cases in
Oklahoma
(April 7, 2020)

https://www.nytimes.com/in
teractive/2020/us/oklahom
a-coronavirus-cases.html

Fastest rising
new COVID-19
cases in
Oklahoma
(April 8, 2020)

Likewise, rates of rising
cases are dropping most
of Oklahoma resulting
from social distancing (or
lack thereof). Greer
County, home of
Magnum, OK has the
fastest rising cases and
highest death rate per
capita in the US.

https://www.nytimes.com/int
eractive/2020/04/03/us/coro
navirus-county-
epidemics.html?action=click
&module=Top%20Stories&p
gtype=Homepage;
https://cid.utexas.edu/sites/d
efault/files/cid/files/covid-
risk-
maps_counties_4.3.2020.pd
f?m=1585958755

Estimated

chance of

COVID-19

epidemic in the

US, by county

(April 3, 2020)

https://www.nytimes.com/in
teractive/2020/04/03/us/cor
onavirus-county-
epidemics.html?action=clic
k&module=Top%20Stories
&pgtype=Homepage

Estimated
chance of
COVID-19
epidemic in
Oklahoma, by
county
(April 3, 2020)

: Google tracking of movements

People in
Oklahoma
appeared
to be
congregating
in parks,
especially
during days of
nice weather.

https://www.gstatic.com/covid19/mobility/2020-03-29_US_Mobility_Report_en.pdf

Not only is Mobility Gradient Map by County
social
distancing Darker Shades = More Travel
important, Lighter Shades = Less Travel
but so is
mobility.
Watch the
change in
travel of
individuals
with mobile
phones in
Oklahoma
counties.

https://public.tableau.com/profile/fabio.baraghini#!/vizhome/CuebiqMobilityIndexAnalysis/MobilityIndexMarketArea

Mobility Gradient Map by County

Darker Shades = More Travel
Lighter Shades = Less Travel

https://public.tableau.com/profile/fabio.baraghini#!/vizhome/CuebiqMobilityIndexAnalysis/MobilityIndexMarketArea

Mobility Gradient Map by County

Darker Shades = More Travel
Lighter Shades = Less Travel

https://public.tableau.com/profile/fabio.baraghini#!/vizhome/CuebiqMobilityIndexAnalysis/MobilityIndexMarketArea

https://public.tableau
.com/profile/fabio.bar
aghini#!/vizhome/Cu
ebiqMobilityIndexAn
alysis/CBSAMobilityI
ndex

Movement
by income
status in
Oklahoma

Blue = Higher Income Travelers
Red = Lower Income Travelers

COVID-19 in Oklahoma

COVID-19 in Oklahoma COVID-19 Deaths

CASES 1800 54% 46%
1600
1400
1200
1000

800
600
400
200

0

Confirmed Cases DATE Deaths Female Male
Hospitalizations

Data source: OK State Department of Health; tables by author

COVID-19 in Oklahoma

COVID-19 Deaths COVID-19 Deaths/Confirmed Case,
Age Groups
2% 4%
14%

14% Age 12%

0-4 10%
5-17
18-35 8%
36-49
80% 50-64 6%
65+
4%

2%

0% 5-17 18-35 36-49 50-64 65+
0-4

Data source: OK State Department of Health; tables by author

Are some races/ethnicities more vulnerable to
severe COVID-19?

• Illinois

• Blacks/African Americans represented 27.9% of all COVID-19 cases—1.96 times their population proportion (14.23%)—and 42.6% of all COVID-19
deaths (2.99x).

• AIANs represented 0.08% of all COVID-19 cases—1/3 of their population proportion (0.25%)—and 0.38% of all COVID-19 deaths (1.52x).

• Michigan

• Blacks/African Americans represented 33% of all COVID-19 cases, 1.96 times their population proportion (13.81%), and 40% of all COVID-19 deaths.
• AIANs represented less than 1% of all COVID-19 cases—their population proportion is 0.53%—and less than 1% of all COVID-19 deaths.

• California

• Blacks/African Americans represented 6% of all COVID-19 cases—even with their population proportion (6%)—and 3% of all COVID-19 deaths (1/2x).
• AIANs represented 0.2% of all COVID-19 cases—2/5 of their population proportion (0.5%)—and 0.6% of all COVID-19 deaths (1.2x).

• Summary: While it is early in the pandemic, race/ethnicity alone does not appear to be a factor with COVID-19 cases,
severity or deaths, but it is a factor where Non-Whites experience higher rates of obesity, diabetes, cardiovascular and
pulmonary diseases, smoking/vaping, poverty, and being un- or under-insured, and having less access to healthcare,
inadequate housing, and other socioeconomic factors that result in greater vulnerability.

Treatments Being Tested in Clinical Trials
(410 studies worldwide, 73 in the US)

• Pre- and post- exposure prophylaxis (something that prevents disease)

• Most commonly known: Hydroxychloroquine and/or Azithromycin

• Antivirals (AVs)

• Reduces the number of virus particles during an infection and thus, severity of
infection

• Vaccinations

• Most important strategy for the long-term, which will allow society to return to
normal

• Other treatments

• Disease Modifying Anti-Rheumatic Drugs (DMARDs)

• Keeps the body’s immune system from over-responding
• Reduces inflammation from immune system response

Pre- and post- exposure prophylaxis (a drug or
action that prevents disease)

• Hydroxychloroquine (HCQ) and/or Azithromycin

• Whether used alone or in combination, are not miracle cures for COVID-19
• HCQ has been used to prevent malaria and to treat lupus and rheumatoid arthritis
• Patients taking must be closely monitored
• May be helpful, but have risks (including death) and some patients cannot take
• Azithromycin is a broad spectrum antibiotic

• Antibiotics do not treat viral infections, but may be used to treat secondary bacterial
infections that may result from or coincide with viral infections

• Both of these are being tested in combination with other treatments as well

Pre- and post- exposure prophylaxis (a drug or
action that prevents disease)

• Post-exposure Prophylaxis / Preemptive Therapy for SARS-
Coronavirus-2 (COVID-19 PEP) in Canada

• Hydroxychloroquine, possible results late April 2020

• Trials also being conducted in the US

• California, Utah, Texas, Pennsylvania, New Jersey

• And worldwide

• S. Korea, Germany, France, Spain, and others

• Many medical centers in the US are using these for in-hospital
patients with severe COVID-19

Antivirals (AVs)

• Remdesivir

• NIH clinical trial of remdesivir to treat COVID-19 begins in Nebraska
• Trial among severe COVID-19 patients in China to be reported soon (within a week)

• Early look at outcomes were not very promising, but study continues. ARVs are typically effective
at beginning of infections, not so much afterwards.

• Trial among mild to moderate COVID-19 patients in China to be reported later

• Trials also going on in California through Kaiser Permanente

• EIDD-2801 at Emory University in Atlanta
• Favipiravir in Italy

• Results expected in July 2020

• Many others in the US and worldwide

• E.g. lopinavir, ritonavir

Vaccinations

• The most important long-term strategy for addressing COVID-19
• A successful vaccine will allow society to return to normal
• NIH Clinical Trial of Investigational Vaccine for COVID-19 Begins

• mRNA-1273 vaccine being tested in Seattle area
• bacTRL-Spike vaccine being tested in Vancouver
• Recombinant novel coronavirus vaccine (adenovirus type 5 vector) in Wuhan,

China

• Many ways to approach vaccination development, including
development of antibody-based drugs:

• COVID-19-Recovered Specimen Collection Research Study

• Research examining immune response to COVID-19

Other treatments being tested

• Disease-modifying antirheumatic drugs (DMARDs)

• Immune system suppressors/modifiers
• Keeps the body’s immune system from over-responding to disease
• Conventional forms

• Hydroxychloroquine (as discussed before), etc.

• Biologics

• anakinra, baricitinib, ruxolitinib, sarilumab, siltuximab, tocilizumab, tetrandrine,
etc.

Other treatments being tested

• Anti-inflammatory/Anti-oxidant Oral Nutrition Supplements
(ONS)

• Eicosapentaenoic acid, gamma-linolenic acid, and antioxidants

• NSAIDS

• Naproxen

• Vasodilator

• Sildenafil

Prepared for the Cheyenne & Arapaho Tribal Health Board
April 2020

If you have any questions, comments, or concerns, please contact me at
[email protected]
© 2020 Derrell Cox, PhD and with thanks to Lori Sims-Cox, MS