The news regarding corona virus is coming fast and from a variety of sources. It can be difficult to sort the wheat from the chaff particularly when it is so easy to let one’s political beliefs color the interpretations. I want to present my interpretation of where things stand right now. First, let me give you some credentials and you can judge whether my interpretations are worth your time. I have a long career as a molecular biologist running a biomedical research lab at a medical school. I have more than a passing knowledge of virology, clinical medicine, and drug development. I am part of a grant application that seeks to develop a new therapeutic approach to treat Covid-19 patients. I don’t post often but I’ve been on this board well before it was segregated into a free board and a pay board. The bottom line is that while we know a remarkable amount about a virus that we were unaware of just a short time ago, there remains more that we don’t know. Much of the molecular nature of the virus we know from studies on the corona virus that caused SARS. The current virus is related enough to that virus that it is officially named CoV-SARS-2. We know that two host, i.e. YOU, proteins, ACE2 and TMPRSS2 are required for viral entry. The viral SPIKE protein binds to the portion of the membrane bound ACE2 that sticks outside of the cell, often a cell that lines the surface of the lung alveoli. TMPRSS2 is a protease that clips the SPIKE protein, a processing step that is required for efficient viral entry. There are therapies being developed that are directed toward interfering with these processes. Now to address the bigger population-based questions that get at the thorny question of setting policy. Right now, anyone that operates from a political viewpoint first and foremost can find some data or some study that supports their stance. The real answer is that there are problems with what data there are and until a lot more proper testing is done, we won’t be able to make informed decisions. There are arguments over just what the real viral infection rate is in the population. Initial numbers were skewed by the fact that so few tests were available that by and large, only symptomatic people were being tested. In addition, in trying to speed the bottleneck, the CDC broke one of its own rules and there were problems with contamination in the early testing. The central government has waived some of the stringent rules regarding the development and vetting of test kits and this policy is causing a big issue currently in accurately assessing infection rates. The two recent studies from USC and Stanford (which, last I knew, had not been peer reviewed) used a test kit that had been released without FDA approval. The false positive rate of that kit is 1.7%. If one is saying that 2 to 4% of the population is showing evidence of prior infection you can see why a background like that makes those numbers dubious. Other interpretations of that data suggest that it could be ten-fold less. Testing in other countries does suggest that the circulating level of virus is in the double digits. One could use this to argue either side of open up or not. The virus has a lower mortality rate than initially thought due to the population testing bias but this also means it is more infectious than thought. Data will continue to be suspect until enough of the test kits have been properly screened by the FDA and used to evaluate a big enough sample of the population in different states. Nonetheless, I suspect that within a month we will have a reasonably good handle on the frequency of infected people in the population. No estimate I’ve seen gives numbers that approach what is needed for herd immunity. That percentage ranges from more than 60% up to 95% depending on the infectivity of the virus. A highly infectious virus, like measles, is 95%. I suspect CoV-SARS-2 will be toward the upper end of this number and that means the virus will continue to circulate with local hotspots until herd immunity is reached or a vaccine comes online. This virus is not like influenza. I’ve seen a lot of references to the H1N1 pandemic. Influenza viruses come in a lot of flavors and it is an educated guessing game to make a vaccine that will neutralize the right strains when you have to make decisions a year and more in advance. H1N1 represented a major antigenic shift so that the vaccines for that year were completely ineffective. H1N1 is actually less infectious than the predominant flu strains and older Americans had some immunity from an outbreak that had occurred years before. Younger people had not been exposed to H1 or N1 viruses so the flu hit them harder. Yes, flu kills a lot of people and yes, there has been a substantial effort to make a ‘universal’ flu vaccine. Yes, flu tends to kill those with underlying health problems, especially lung problems but the symptoms of Covid-19 are significantly worse than from flu as evidenced by the length of ICU stays, time on a ventilator, and overall length of hospital stays. The course of Covid-19 is unpredictable, a patient can be seeming to improve and then fall off a cliff. One issue is a cytokine storm that triggers a massive inflammatory response in the lungs which can completely compromise function. This can occur in someone who is otherwise completely healthy but it cannot be predicted, at this point, who will react that way. People exposed to particulates, farmers, some construction and industrial workers, for example, should be particularly careful since they may have a high baseline of inflammation or compromise of lung function already. I’ve been following the numbers of cases and deaths closely. While there has been a lot of argument on this board over the accuracy (or lack thereof) of predictions and numbers, there is enough of a trend that won’t make either open uppers or stay at homers happy. Both mortality and total cases for the US overall have continued at a pretty constant rate for a while now. In places the curve has begun to drop a bit but that is counterbalanced by places where numbers are increasing more than linearly. Nebraska has fared pretty well so far thanks to a low population density and few tourists bringing it in. There are a couple of worrying developments of hot spots e.g. Grand Island with the potential to cause problems for local hospitals. The difficulties faced by rural hospitals even without Covid-19 is a huge issue of national concern. Take home message: no peak but a steady ongoing course of infections and deaths averaged over the nation. Have stay at home orders worked? To a degree, yes. Two examples: Colorado had early outbreaks thanks to infected people coming into the state to ski. Early on it was number 4 or 5 in Covid-19 cases. Colorado’s governor instituted stay at home orders and closed many businesses. It now ranks 18th in total cases among states. A second example is seen by comparing Kentucky and Tennessee. Kentucky moved sooner with business closings and promoting social distancing and has less than half the number of cases as Tennessee. Now the bad news: as I said above, overall numbers aren’t going down. They have been holding pretty steady. With some notable exceptions, hospitals have not been overrun. I anticipate that the case rate and death rate will hold steady for the next month. That means we will have over 100,000 total Covid-related deaths in the US by June. I hope I’m wrong. (I thought I was wrong once, but I was mistaken- old joke, couldn’t resist). Reopening soon is inevitable. I wish it would hold off for another 3 or 4 weeks until we have firmer numbers on infection rates that would inform as to how best to go about a staggered reopening, but I am realistic enough to know that it isn’t going to happen. Wrong decisions will mean an upturn in cases and deaths and could actually wind up shutting down some industries more than helping them back on their feet. I am eager to get back to work. My colleagues and I are working on developing a very promising cancer drug and progress is currently at a standstill as we cannot go to the lab for anything but essential maintenance. However, I am going to be smart about it for some time yet. I will work at home insofar as possible. I am not going to travel, I am not going to go to restaurants, not even a damn microbrewery, I am going to continue wearing a mask when out in public. How you approach it is up to you. Just realize protection is for others even more so than yourself. If you are out in public in places that everyone has to use, like the grocery store and gas station, please wear a mask and gloves. You can make decisions for yourself to go to the gym or tattoo parlor but, when in places everyone has to use, if you choose not to use protection, you may be making a life or death decision on someone else. It is not an infringement of your liberties any more than not being allowed to yell, “Fire,” in a crowded theater when there is none is an infringement upon your 1st amendment rights. It is a minor inconvenience for a common courtesy. On a personal level, I do have a friend who died of Covid-19. I have a relative infected in a nursing home who should have died (multiple severe health problems) but somehow didn't even have symptoms. My daughter is an emergency room physician and is on the front lines.