The pathogenesis of a COVID-19 respiratory infection, in a major way, is related to what is referred to as the cytokine storm [cytokine storm syndrome (CSS, hypercytokinemia, etc.], i.e., it is a hyper-inflammatory response. During this response, an explosive production of proinflammatory cytokines such as TNF-? IL-1?, and others occurs, greatly exaggerating the generation of molecule-damaging reactive oxygen species (free radicals) . In severe cases, the cytokine storm is responsible for the most obvious signs of a COVID-19 infection including fever, lung injury which causes cough and shortness of breath (and the long-term complication, lung fibrosis) and in death.
A causative factor related to the hyper-inflammatory state of immune cells is their ability to dramatically change their metabolism. Similar to cancer cells in many solid tumors, immune cells such as macrophages/monocytes under inflammatory conditions abandon mitochondrial oxidative phosphorylation for ATP production in favor of cytosolic aerobic glycolysis (also known as the Warburg effect) . This switch is driven by the transcription factor HIF-1? (hypoxia inducible factor-1? and the serine/threonine kinase, mTOR (mammalian target of rapamycin) and other proteins The change to aerobic glycolysis allows immune cells to become highly phagocytic, accelerate ATP production, intensify their oxidative burst and to provide the abundant metabolic precursors required for enhanced cellular proliferation and increased synthesis and release of cytokines (Fig. 1 ).
New York City health officials reported zero deaths related to the novel coronavirus four months after the state's first official death was recorded on March 11.
According to initial data reported by the NYC Department of Health and Mental Hygiene, no one died from the virus in New York City on July 11. Officials recorded no confirmed deaths the day before as well, but did have two probable deaths.
The department's data shows there hasn't been a day without a coronavirus-related death since March 13, two days after the first reported death.
Each sign of progress in New York has come in the shadow of an ever-growing national spike that continues to plague the U.S. crisis. On Sunday, Florida reported more than 15,000 positive cases of the virus. It's the highest single-day number for any state and cleared the record previously set in New York back in April.
As coronavirus rages out of control in other parts of the U.S., New York is offering an example after taming the nations deadliest outbreak this spring while also trying to prepare in case another surge comes.
New Yorks early experience is a ready-made blueprint for states now finding themselves swamped by the disease. It could also come in handy at home, as the region readies for a potential second wave of infection that experts predict will likely come at some point.
Gov. Andrew Cuomo has offered advice, ventilators, masks, gowns and medicine to states dealing with spikes in cases and hospitalizations and, in some places, rising deaths. Some health care workers are heading to other states to help fight the virus, reciprocating the influx that gave New York hospitals some much-needed relief just months ago.
At the same time, the Democratic governor has ordered travelers from more than a dozen states to quarantine for 14 days, while urging New Yorkers not to let up on wearing masks or social distancing.
Yet with the virus tearing through the South and West, Cuomo warned Friday it would eventually rear up again in New York.
States Grapple With New Hotspots and COVID Spikes
Infection rates are increasing, straining hospitals and resources in states that are now being called hotspots for the coronavirus. Arizona, California, Texas and Florida are dealing with surges in cases.
Were doing everything we can, he told WAMC radio, but I can feel it coming.
A widely cited University of Washington model doesnt project spikes at least through its Nov. 1 time frame in New York, New Jersey or Connecticut, whose Democratic governors have coordinated on traveler quarantines and, earlier, some shutdown policies. But that doesnt mean the densely populated tri-state area is in the clear.
We expect the virus to return in all of those states, said Dr. Christopher Murray, head of the universitys Institute for Health Metrics and Evaluation. The question is one of timing.
As cases spiked in March and April, New York became the nations coronavirus nightmare, with New York City at the crux of it. Statewide, over 18,000 COVID-19 patients were in hospitals at one point in April. Daily deaths peaked at 799 in April, and have totaled over 24,000.
Now, as states from Florida to Texas to California see new confirmed cases soar, hospitals fill up and daily death tolls hit new records, numbers have dropped precipitously in the tri-state region. New York reported five new deaths statewide Sunday, when hospitals were caring for a total of about 800 coronavirus patients.
While New York has been gradually reopening, it also has been quietly preparing to handle another surge if it comes.
Tracking Coronavirus in Tri-State
How Many in Tri-State Tested Positive for Coronavirus? See Latest Cases by the Numbers
Timeline: Tracking the Spread of COVID-19 in Tri-State
After health workers in New York and elsewhere grappled with shortages of masks, gowns and other protective gear this spring, Cuomo said he would order hospitals to have a 90-day supply on hand. New York City Mayor Bill de Blasio said the city would build its own reserve of ventilators, protective equipment and coronavirus test kits, identifying local suppliers and manufacturers rather than looking to federal authorities or global markets.
Weve learned a tough lesson that we have to create, and we have to protect ourselves, said de Blasio, a Democrat, who also said the city would stockpile as many as 18 million shelf-stable meals.
Others are preparing, too.
Mount Sinai Hospital expanded from 94 intensive-care beds to 235 and converted an atrium and lobby into wards for less-critical patients at the height of the crisis. Now, its developing a coronavirus playbook of sorts, so clinicians will have how-tos immediately at hand, said Dr. Roopa Kohli-Seth, who oversees intensive care.
New Yorks nursing homes, which lost more than 6,400 residents to the virus, have set up wings to separate infected residents. Theyre now required to test staffers weekly and have at least a two-month supply of protective gear. And they are no longer accepting recovering COVID-19 patients from hospitals, as the state initially directed them to do. They admitted over 6,300 patients before Cuomo reversed the policy under pressure May 10.
We know how to fight this virus now. We have the resources, said Stephen Hanse, who heads an association of New York nursing homes.
The health care system overall is better prepared now, said Dr. W. Ian Lipkin, a Columbia University epidemiology professor.
The difference now is we know the capacity of this virus to rapidly spread to cause disease, its impact on the health care system and our needs in terms of testing, personal protective equipment, ventilators all the other things we didnt know six months ago, said Lipkin, who is working with the city to test hundreds of thousands of people a week.
New York has taken reopening relatively slowly and braked, postponing the resumption of indoor restaurant service in New York City, after cases began surging elsewhere. Thousands of contact tracers have been hired to try to keep the virus in check. And mask-wearing has been widespread in the nations biggest city since a city recommendation and subsequent state requirement in April, while some other states have only recently started telling residents to don masks in public.
Still, with more New Yorkers getting out and about and riding mass transit, and police taking a hands-off approach to enforcing mask and distancing rules after several violent clashes caught on video, experts worry its inevitable case numbers will spike.
Im not sure how long this progress is going to hold, said Dr. Irwin Redlener, the director of the Pandemic Resource and Response Initiative at Columbia University.
Rob Griffin, a professor of emergency management at the University of Albany, said the state needs to spell out rules for any future shutdowns, so you dont have to make a decision on the fly.
Some experts have said New York didnt move quickly enough early on. New York Citys massive public school system closed March 16, and a statewide stay-at-home order took effect March 22.
If such measures had been implemented by March 8, Columbia University researchers estimate about 17,500 lives could have been saved.
To New York Citys elected public advocate, Jumaane Williams, the city and state responses to the crisis were frustratingly blind to foreseeable inequities.
The citys Black and Hispanic residents were hospitalized and died of the virus at more than twice the rates of whites and Asians, and people from very poor neighborhoods at twice the rate of residents of wealthy areas.
Williams feels New Yorks shutdown was too slow and limited, leaving too many workers many of them people of color obliged to commute to jobs that might not have been able to provide protective equipment. That cant happen again, the Democrat said.
The big thing, for me, is to shut down swiftly, open up slowly and make sure theres an infrastructure for communities we know are going to be impacted the most, Williams said. We learned lessons that we didnt need to learn, and hopefully other people will, too.
Copyright NBC New York/Associated Press
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Today's manic dip-buying has seen Small-Caps go from most-hated to most-loved, Nasdaq give up some gains, and the S&P 500 pushed into the green for the year...
President Trump is hosting Mexican President Andrés Manuel López Obrador at the White House Wednesday to recognize the United States-Mexico-Canada Agreement (USMCA), which took effect earlier this month.
Mr. Trump's visit with López Obrador, which is their first, included a bilateral meeting in the Oval Office followed by the signing of a joint declaration at the Rose Garden. This evening, they will hold a working dinner and deliver a joint statement.
Speaking before the agreement was signed in the Rose Garden, Mr. Trump said that "the relationship between the United States and Mexico has never been closer." He praised López Obrador, calling him a "tough negotiator."
My comment: "calling him a "tough negotiator" ...I am guessing Obrador did not bring the check for the wall?
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