COVID-19 - Facts and Information Only Topic

[Hapless Bills Fan]

FDA authorizes first saliva test for diagnostic use under EUA from Rutgers University.  Will be available initially through hospitals and clinics associated with Rutgers:

https://www.nbcnewyork.com/news/national-international/us-clears-first-saliva-test-to-help-diagnose-new-virus/2372424/
https://www.rutgers.edu/news/new-rutgers-saliva-test-coronavirus-gets-fda-approval

 

This is huge, because anyone can collect a saliva sample from themselves.  The current regimen which requires a HCW to push a throat swab deep in your nasopharynx (no one can get it deep enough on their own).  The HCW must wear protective clothing since they're up-close-and-personal with your possibly virus containing schnoz, and proper isolation protocol requires a change of that clothing between tests to avoid potentially contaminating the next patient. 

 

In many places but especially right now the NYC area, the supply of protective gowns, masks, and special swabs limits the amount of testing performed.

It sounds as though the Rutgers group is going to try to work with large testing companies that have high throughput or rapid tests:
 

"Soon after the Rutgers-ADL team received notification from the FDA on Saturday, the White House’s COVID-19 testing task force called Brooks to offer congratulations and support and to ask about any specific hurdles to expanding testing and enabling other laboratories to benefit from the accomplishment.
 

Shortly after the White House call, the research team was contacted by chief executive officers of some of the world’s largest life sciences companies that are involved in COVID-19 testing.
 

“I have spoken with these companies’ leadership to not only share knowledge but to create opportunities for continuing to help innovate during this crisis,” Brooks said. “We will work closely with these new partners, the FDA and the White House task force to leverage everything Rutgers has to offer to not only help our community but also make a global impact.”

The University of Washington SCAN (Seattle Area Coronavirus Assessment Network) project has also been using at-home nasal swab testing under EUA for surveillance of covid-19 in the population.

 

15 hours ago, meazza said:

Wasn’t there already tests developed that didn’t require the swab? Abbott labs comes to mind.

 

As far as I know, the Abbott labs test just runs a nasal swab sample on its "ID Now" system, but if you have any links that's be great

 

7 hours ago, Nervous Guy said:

"The Abbott RealTime SARS-CoV-2 assay is a real-time (rt) reverse transcriptase (RT) polymerase chain reaction (PCR) test intended for the qualitative detection of nucleic acid from the SARS-CoV-2 in nasal swabs, self-collected at health care location or collected by a healthcare worker, nasopharyngeal (NP) and oropharyngeal (OP) swabs collected by a healthcare worker, from patients suspected of COVID-19 by their health care provider. "

 

https://www.molecular.abbott/us/en/products/infectious-disease/RealTime-SARS-CoV-2-Assay

 

Fair enough, but to my understanding, the FDA was not allowing nasal swabs with it here (in USA).  Nasopharangeal collected by a HCW or nothing was their view, with minor exceptions like the Seattle SCAN surveillance project.

 

The point is: allowing a saliva sample is big for testing scale up, assuming it works well.  (Even allowing a self-collected nasal swab would be big for testing scale up - again, assuming it works)

 

[Hapless Bills Fan]

Chinese study of covid-19 on items in hospital ward.  https://wwwnc.cdc.gov/eid/article/26/7/20-0885_article

 

Spoiler alert: a lot of covid-19 falls to the floor and gets tracked all over by shoes of staff working on covid-19 wards:
The rate of positivity was relatively high for floor swab samples (ICU 7/10, 70%; GW 2/13, 15.4%), perhaps because of gravity and air flow causing most virus droplets to float to the ground. In addition, as medical staff walk around the ward, the virus can be tracked all over the floor, as indicated by the 100% rate of positivity from the floor in the pharmacy, where there were no patients. Furthermore, half of the samples from the soles of the ICU medical staff shoes tested positive. Therefore, the soles of medical staff shoes might function as carriers

 

Also anything touched by staff hands:
The rate of positivity was also relatively high for the surface of the objects that were frequently touched by medical staff or patients (Tables 1, 2). The highest rates were for computer mice (ICU 6/8, 75%; GW 1/5, 20%), followed by trash cans (ICU 3/5, 60%; GW 0/8), sickbed handrails (ICU 6/14, 42.9%; GW 0/12), and doorknobs (GW 1/12, 8.3%). Sporadic positive results were obtained from sleeve cuffs and gloves of medical staff. These results suggest that medical staff should perform hand hygiene practices immediately after patient contact.

[Hapless Bills Fan]

6 hours ago, OldTimeAFLGuy said:

..Hap, how does your industry and similar scientific types deal with reports surfacing about multiple COVID-19 strains and mutations, with some purportedly more aggressive and more resistant than others?.....if this is the case, what do you folks concentrate on?......perhaps a BAD example, but the annual flu vaccine cannot cover ALL strains (not sure what the percentage is).....so do you concentrate on the more prevalent?......

 

The thing to understand about an RNA virus is that by its nature, it mutates constantly.  That's just the nature of the beast - RNA polymerase makes more errors than DNA polymerase (my shorthand is to say "RNA viruses are slobs").  That's the  way genomic epidemiology traces the virus around the world and figures out how long it's been circulating - by the mutations.  SARS-CoV2, the virus that causes covid-19 disease, has been tracked to mutate about 2x/month.   

Here's one of the tree maps produced by studying viral mutations:

 

Here's the Motherload:

https://nextstrain.org/ncov/global?f_country=USA

 

Here's a figure from a recent scientific paper that uses a phylogenetic tree of 160 of the 3957 genomes sequenced to date to identify 3 principle subtypes, A, B, and C.  The A and C subtypes are circulating in the Americas and Europe while the B subtype is more restricted to Asia (per paper).  Would their phylogenetic tree look less clear and show more subtypes if they included more than 5% of the current genomes?    The point is all the little dots (and all the little branches on the above trees) represent a different mutation, do you call them all strains?    ?‍♀️

 

Until/unless one identifies a functional difference (more virulent/ less virulent, more infectious/less infectious), it's clear as crystal mud.  Mutations that affect function are called "adaptive mutations" and so far we don't seem to be seeing them.

I don't know what is meant by "resistant" in this context.  One usually speaks of "resistant" in the context of resistance to therapeutic drugs, since we don't have drug therapies, hard to have resistance.

 

It's possible that the virus from some areas causes more severe disease but I don't think there's any clear evidence of that - difference in mortality seems so far more linked to demographics and presence of preexisting conditions like high blood pressure, diabetes, and so forth - as well as whether or not the hospitals are able to provide good care or are overwhelmed.  It's certainly possible but there hasn't been anything that's stuck out so far.

 

As far as vaccine development, there's a bit upthread of commentary from epidemiologist Trevor Bedford.  Fundamentally vaccines target the coat proteins - the spikey sticky-out bits.  Bedford points out that there are a handful of identified mutations in them.  So it would be necessary to ensure that antibodies against one coat protein cross-react against the variants of the coat protein.  This should be straightforward to test. 

 

If they don't cross-react, the usual strategy is to include different strains in the vaccine - Prevnar 13, the pneumoccocal conjugate vaccine, contains components to work against 13 different strains.  If that sounds like a much tougher development project, you're right.

A typical flu vaccine is trivalent (3 strains) or quadravalent (4 strains).  So if need be, a vaccine could encompass more than one strain of covid-19.

[Deranged Rhino]

 

[plenzmd1]

Maybe some hope for a therputic

 

https://www.usatoday.com/story/money/2020/04/17/remdesivir-coronavirus-drug-gilead-sciences-covid-19-treatment/5150793002/

[Edit: report on compassionate use of remdesevir outcomes in New England Journal of Medicine.  In contrast to some reports on other drugs, these were very sick people - 65% on ventilators or receiving ECMO.  Partial data read out from ongoing clinical trial in Chicago.]

[Hapless Bills Fan]

27 minutes ago, plenzmd1 said:

Hey @Hapless Bills Fan, help me out here if you will.

 

Testing aboard the Roosevelt implies about a 13% infected rate(600 out of 4800) , with 60% of those cases as of now being completely asymptomatic. I find that to be a good thing no? Implies many more may have had the infection, and if we can get massive anti body tests may help us fully open up sooner?

 

Am I looking at the wrong?

 

https://justthenews.com/politics-policy/coronavirus/uss-theodore-roosevelt-coronavirus-numbers-imply-higher-infection-rate

 

If 60% are fully asymptomatic, that would be a terrible thing as far as containment of the disease without really effective, thorough contact tracing and testing.

 

The ideal disease from a public health containment viewpoint, is one where people don't become infectious until they show symptoms, and when someone shows symptoms it knocks them flat so they stop running around making other people sick. 

 

As far as people being sick...let's say for example that 13% of the population of the US is infected right now (this is probably unrealistic, as an aircraft carrier is like the worst situation for spreading a contageous disease, and the population is selected to be young and healthy and less likely to show symptoms, but work with me). 

 

We are going to test everyone with an antibody test that has 95% specificity, meaning 95% of those tested are correctly identified as immune, and 5% have the test reacting to something else (a medication, antibodies to a different coronavirus, whatever).  This happens to be the reported specificity of the recent FDA-approved antibody test. 

 

Let's do some math.  13% of the US will test positive - 43 million people.

286 million people are negative.  But of those, 14 million will test positive even though they are not immune. 

57 million positive results, of which 43M are correct, and 14M are incorrect.

 

That means that if you or I are tested, and the test is positive, there's a 3 out of 4 chance that's a correct result, and a 1 in 4 chance that it's a false positive

There are also still 286 million susceptible people.

 

So I would say....probably not as good news as one might think. 

 

We still need to #testtraceisolate for actual success to contain the disease.

 

5 minutes ago, Gray Beard said:

Supposedly most young kids who get the virus are asymptomatic. Do you think the fact that the crew on a Navy ship consists largely of 20 year olds has something to do with the high percentage of asymptomatic cases?

 

as usual, thanks for your inputs, and I won’t be offended if you delete this comment.

 

I do think the age and the general health of the crew of a Navy ship has an influence on the number of asymptomatic cases.

Overall in the population S. Korea is now saying 20-25% asymptomatic - and they are doing a large amount of contact tracing and testing.

 

There are some studies that say higher though - Iceland I think tested everyone and says 50% asymptomatic.  I think one of the cruise ships was similar.

 

 

 

 

[Hapless Bills Fan]

On 4/13/2020 at 2:11 PM, Hapless Bills Fan said:

https://threadreaderapp.com/thread/1247609734896607232.html

 

Discussion by "my boi" virologist Trevor Bedford on estimating population prevalence of covid-19.  (I quote him a lot, because he kind of knows his stuff, and he puts it out there so that others can weigh in and correct if need be).

 

The "dream state" would be 50% of the population has actually had covid-19, in which case Jackpot! that's herd immunity.  Bottom line, Bedford doesn't think we're there, and here's why

 

Here's a report by the MRC estimating prevalence in Europe:

https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-13-europe-npi-impact/ (summary)
https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020-03-30-COVID19-Report-13.pdf (full thing)

 

Table from the above (note the error estimates):

 

Currently, the US has 560,891 cases of covid-19.

Bedford estimates

(note he uses the words "I guess", but the guess of a trained epidemiologist on his topic of expertise is not the same as my guess or your guess.  It would be more like the trained eye of a football scout estimating the foot speed of a prospect by eye vs. me doing it)

 

So Bedford's estimate would mean between 5.6M and 11.2M people in the US are actually infected: 1.7 - 3.4% of the population.

 

That's way short of what's needed for herd immunity.

 

Initial serology study of 3,000 people in Santa Clara, CA

https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1

 

"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. "

 

Note that their estimate of population prevalence 2.5-4.2%  is not that far off Bedford's estimate 1.7-3.4% or the Imperial College estimates for most of Europe in the table above.

 

Again, this is far short of the ~50% of the population infected one needs for herd immunity.
 

18 hours ago, snafu said:

Are you looking at that in a nationwide sense?

What about *the* hotspot of NYC and surroundings?

Wouldnt that be better news for those folks, and not so much for areas of the country no so hard hit yet?

 

Nationwide sense.

Hotspot of NYC area: If you look at the Imperial College estimates for Spain and Italy, I would predict NYC would more closely resemble them with 10-15% estimate prevalence.   The Imperial College numbers give a huge range though (3.7% - 41%)

[Hapless Bills Fan]

6 minutes ago, snafu said:

Are you looking at that in a nationwide sense?

What about *the* hotspot of NYC and surroundings?

Wouldnt that be better news for those folks, and not so much for areas of the country no so hard hit yet?

 

Nationwide sense.

Hotspot of NYC area: If you look at the Imperial College estimates for Spain and Italy, I would predict NYC would more closely resemble them with 10-15% estimate prevalence.   The Imperial College numbers give a huge range though (3.7% - 41%)

[Magox]

20 minutes ago, Hapless Bills Fan said:

 

Initial serology study of 3,000 people in Santa Clara, CA

https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1

 

"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. "

 

Note that their estimate of population prevalence 2.5-4.2%  is not that far off Bedford's estimate 1.7-3.4% or the Imperial College estimates for most of Europe in the table above.

 

Again, this is far short of the ~50% of the population infected one needs for herd immunity.

 

Correct, however If accurate it would show a mortality rate well below what was initially believed to be.  This would show somewhere between a .09% -.14% mortality rate which would be not that far off from the common flu.  But the Risk of lethality of the Virus wouldn’t any longer be so much the mortality rate but rather the rate of contagion which if this study is to be believed would be many multiples more than the flu.   And that would be the greater risk.

 

Of course this is just one small study but it does fall in line with the antibody study recently done in Germany.   I don’t believe the 25-50% asymptomatic assumptions that some of the health experts were stating will hold up.

[GottaRun]

Is this new or already responded to theory?  Not yet peer reviewed

https://www.mirror.co.uk/science/coronavirus-outbreak-started-september-british-21882200

 

"Researchers from the University of Cambridge have investigated the virus’ origin to calculate the likely date of the initial outbreak.

Their findings indicate that the outbreak in Wuhan occurred between September 13 and December 7.

Peter Forster, who led the study, said: “The virus may have mutated into its final ‘human-efficient’ form months ago, but stayed inside a bat or other animal or even human for several months without infecting other individuals.

“Then, it started infecting and spreading among humans between September 13 and December 7.”

 

"In the study, which is yet to be peer-reviewed, the researchers analysed coronavirus strains using a mathematical algorithm.

 

While the virus originated in bats, the scientists found hundreds of mutations between the original Sars-CoV-2 and the one first found in Wuhan.

Typically, a coronavirus usually acquires one mutation per month."

"According to the researchers, this indicates that the virus may have quietly been spreading in animals and humans for years, before reaching the form we see today.

Dr Forster said: “If I am pressed for an answer, I would say the original spread started more likely in southern China than in Wuhan.

“But proof can only come from analysing more bats, possibly other potential host animals, and preserved tissue samples in Chinese hospitals stored between September and December.

“This kind of research project would help us understand how the transmission happened, and help us prevent similar instances in the future.”

[Foxx]

43 minutes ago, Hapless Bills Fan said:

 

Initial serology study of 3,000 people in Santa Clara, CA

https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1

 

"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. "

 

Note that their estimate of population prevalence 2.5-4.2%  is not that far off Bedford's estimate 1.7-3.4% or the Imperial College estimates for most of Europe in the table above.

 

Again, this is far short of the ~50% of the population infected one needs for herd immunity.

and if the virus mutates enough, herd immunity is out the window, correct?

[Hapless Bills Fan]

1 minute ago, Foxx said:

and if the virus mutates enough, herd immunity is out the window, correct?

 

Yes, but....

If outbreaks are occurring regularly during mutation, usually people retain enough immunity to keep the disease from being as serious, and to keep the transmission somewhat in check. 

 

With the observed mutation rate, the estimates I've seen are that a vaccine developed (similarly herd immunity) is expected to be good for several years.

[OldTimeAFLGuy]

1 minute ago, Hapless Bills Fan said:

 

Yes, but....

If outbreaks are occurring regularly during mutation, usually people retain enough immunity to keep the disease from being as serious, and to keep the transmission somewhat in check. 

 

With the observed mutation rate, the estimates I've seen are that a vaccine developed (similarly herd immunity) is expected to be good for several years.

 

...are the mutation rates similar to, below or above other similar viruses?..............

[Hapless Bills Fan]

2 minutes ago, OldTimeAFLGuy said:

 

...are the mutation rates similar to, below or above other similar viruses?..............

 

As I understand it, a couple orders of magnitudes less than influenza.  Similar to other coronaviruses (common cold).

Apparently coronaviruses have some proofreading capability in their RNA polymerase, which influenza viruses lack.

Or so I've been told.

[Foxx]

4 minutes ago, Hapless Bills Fan said:

 

Yes, but....

If outbreaks are occurring regularly during mutation, usually people retain enough immunity to keep the disease from being as serious, and to keep the transmission somewhat in check. 

 

With the observed mutation rate, the estimates I've seen are that a vaccine developed (similarly herd immunity) is expected to be good for several years.

i understand.

 

because the standard flu mutates greatly, this is why a new flu vaccine is developed each and every year, to cover the expected dominate strain for that year. also, while it is generally thought that this particular coronavirus, COVID - 19 is slow to mutate, it is still possible for an unexpected wild leap, as can happen with any virus. 

[OldTimeAFLGuy]

9 minutes ago, Hapless Bills Fan said:

 

As I understand it, a couple orders of magnitudes less than influenza.  Similar to other coronaviruses (common cold).

Apparently coronaviruses have some proofreading capability in their RNA polymerase, which influenza viruses lack.

Or so I've been told.

...thank you ..

11 minutes ago, Hapless Bills Fan said:

 

As I understand it, a couple orders of magnitudes less than influenza.  Similar to other coronaviruses (common cold).

Apparently coronaviruses have some proofreading capability in their RNA polymerase, which influenza viruses lack.

Or so I've been told.

 

...so then despite being less, this is far more destructive, contagious and/or potentially fatal versus influenza mutations, especially with no vaccines yet, albeit one that addresses a nominal percentage of strains as in our regular flu seasons?.....

[Hapless Bills Fan]

1 hour ago, OldTimeAFLGuy said:

...thank you ..

 

...so then despite being less, this is far more destructive, contagious and/or potentially fatal versus influenza mutations, especially with no vaccines yet, albeit one that addresses a nominal percentage of strains as in our regular flu seasons?.....

 

Well, the mutation rate of the virus really doesn't have to do with how infectious it is (how easily it spreads), its morbidity (how many people it makes ill) or its mortality (how many people it kills). 

 

 

 

 

[plenzmd1]

hmm, 30% infection rate in this random study..granted in a highly dense location...i know @Hapless Bills Fan has explained why this may not be a good thing...but to me means mobidity rate is way less than we think..and we are closer to getting that herd immunity. Hapless, what number is considered "herd immunity"? Thanks

 

https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/

 

33 minutes ago, Hapless Bills Fan said:

 

The number for "herd immunity" depends on the basic reproduction number, R0.  For R0=2, it's roughly 50%.  For R0=3, it's 60%. 

Early estimates for covid-19 R0 were 2.0-2.4 - I am searching for revised estimates based upon increasing learnings about # of asymptomatic patients.  It may be higher!

 

30% of folks walking around on the street, EXCLUDING anyone who had already tested positive by RT-PCR, is scary. 

Chelsea is a very densely populated area.  It's largely immigrants - 65% Latino - and many of them work in positions (health related fields) where they're considered essential and continuing to go to work (nursing home aides, cleaners in hospitals, stockers in grocery stores, that kind of thing) ?  I would assume those who were out walking about were disproportionately those who had to go someplace, like, to work........

 

Bear in mind that as the story points out, having a positive antibody response does not mean you are cured of the disease...many of these people may still be infectious.   

I don't understand why they did this: "To get Chelsea residents to participate in the study ― which included a questionnaire that was available in English, Spanish, and Portuguese — investigators allowed them to remain anonymous. But that meant none of the participants received the results of the blood tests."

 

Did the people really not WANT to know their results?  Or was this done because it was easier for the researchers?

[Hapless Bills Fan]

1 hour ago, plenzmd1 said:

hmm, 30% infection rate in this random study..granted in a highly dense location...i know @Hapless Bills Fan has explained why this may not be a good thing...but to me means mobidity rate is way less than we think..and we are closer to getting that herd immunity. Hapless, what number is considered "herd immunity"? Thanks

 

https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/

 

 

So here's another one saying "Whoaoa, this may be way more prevalent!"
https://www.boston25news.com/news/cdc-reviewing-stunning-universal-testing-results-boston-homeless-shelter/Z253TFBO6RG4HCUAARBO4YWO64/?fbclid=IwAR0uHANXzsg28A2ireFpmH-36ZXvX8DUljGcYsGugMJjpYE_hXo8BjyHn2g
 

The Centers for Disease Control and Prevention is now “actively looking into” results from universal COVID-19 testing at Pine Street Inn homeless shelter.

The broad-scale testing took place at the shelter in Boston’s South End a week and a half ago because of a small cluster of cases there (per this link, 1 person + tracing others) Of the 397 people tested, 146 people tested positive. Not a single one had any symptoms.

That's 36% not symptomatic at the time of test. (the testing was performed in response to a known positive test; some of those tested may develop symptoms, just as some of the 30% positive antibody tests walking around Chelsea might have or might develop symptoms,  There's also the reported false positive 10% with the Biomedomics test used.

But yes, plenzmd1, to your point - the original ~15% seriously (hospital needed) ill and ~3-5% critically ill" estimates were derived from situations where only people reporting symptoms (and sometimes only a subset of them) were being tested and the early estimates were 1-2% truly asymptomatic, so if 20-30% of people are truly asymptomatic, the morbidity estimates would most certainly drop.

 

If my back-of-the-envelope is correct, 25% asymptomatic (say) would mean the true "seriously ill" % would be more like 11%, the true "critically ill" % would be more like 2-4%.  35% asymptomatic would mean the true "seriously ill" % would be more like 10%, true "critically ill" % would be more like 2-3%.

[Edit: it was pointed out to me I should add, if 40-60% of the population contracts the disease almost all at once, those would still be huge, hospital-capacity overwhelming numbers - 40% infection and 10% seriously would mean 13 million people seriously ill, 40% infection and 3% critically would mean 3.9 million critically ill]

Very very interested to see how further antibody testing results play out (along with everyone else)

 

 

 

 

[Hapless Bills Fan]

On 4/14/2020 at 6:42 PM, Limeaid said:

Wyoming reports first death, last of the 50 states.

https://www.usatoday.com/story/news/nation/2020/04/13/coronavirus-wyoming-first-death-last-state-mark-gordon/2987542001/

 

 

I'll tag this on here.  I believe it's been suggested that Wyoming may be one of the first states to re-open.  It's had 1 death caused by covid-19:  last state for that

Has just over 300 total cases.

https://www.washingtonpost.com/nation/2020/04/17/wyoming-coronavirus-parties/

 

a group of protesters showed up at the state capitol building Wednesday to demand that Gov. Mark Gordon (R) release a plan to reopen the economy, believing the covid-19 curve had been sufficiently flattened, as the Wyoming Tribune Eagle reported.

 

But Gordon said this week that it was too soon to lift restrictions. Since Wyoming was late to the outbreak compared to other states, he said, it will probably be late to its peak, too.

“If we ease up and fail to adhere to the guidance currently in place, if we think that this will turn off like a switch, we may not be ready to relax any restrictions,” he said. “If anyone thinks that simply easing restrictions currently in place will lead to an immediate return to normal, they need to think again."

Example of the frustrations:  They're trying to contain several flaring outbreaks, including an outbreak at a psychiatric hospital "Wyoming Behavioral Institute"

Mayor Steve Freel of Casper, Wyo had just watched a Facebook video of a party that took place over the weekend showing partygoers “flat-out thumbing their noses” at public health guidelines, he said. And what’s worse: The party was attended by a health-care worker with a pending coronavirus test. The health-care worker’s roommate, an employee at the Wyoming Behavioral Institute — home to one of the largest clusters of cases in Wyoming — had tested positive for the virus last Friday. So, because of evident exposure, the unidentified health-care worker then sought a covid-19 test on that same day.  But despite a self-quarantine recommendation, the worker decided to go to a party on Friday night, Freel said. On Saturday, the worker went to another party.  And finally, on Monday, Freel said the health-care worker got the test results back: positive for coronavirus.

So now, Public health officials were left scrambling to locate all the partygoers to get them in isolation as quickly as possible.

The governor's point is while they're dealing with rich folks jetting into Jackson Hole and three large clusters of cases that are spreading into the community (see HCW story above), Public Health officials realize they are vulnerable to a flare-up, despite the overall low case count:
 

"Mark Dowell, the county’s health officer, said Wednesday that the low number of statewide and county cases is likely deceiving, warning that it may be “easy to think it’s not that big a deal when it hasn’t destroyed your community.” But signs of community transmission are growing, as officials monitor at least three large clusters of coronavirus cases statewide. “We have not flattened any curve at all,” Dowell said."

I personally think the same is true of many areas with low case counts.  If they are dealing with isolated cases, the chances are very high that there is unrecognized community spread both giving rise to those cases and resulting from them.  If they are dealing with a known infection cluster or two, all it takes is one or two ijits flouting social distancing to propagate that cluster into the community, and if there aren't any distancing restrictions in place to contain the spread, off we go.

This story has at its root, a clear ijit - what maroon gets a covid-19 test because of a known positive roomie, then decides it's a smart notion to attend 2 parties while they wait for the result? but the point is, the spread could have as easily occurred through someone who shopped or ate in a restaurant or waited for a bus with the roomie before he was known positive.  That's the root public health problem with a disease which is NBD for many of the people who contract it.