I thought you might enjoy listening to this first and then come back to read this email. I love the words and the concept. "Does anybody have a map? Anybody happen to know how the hell to do this? I'm flyin' blind and I'm making this up as I go." This is from Dear Evan Hansen; the Broadway show about a lonely boy's life complicated by social media. Those of you who know me well have heard that this is my favorite all-time show. Sometimes life feels like this. But as you have seen, slowly, our plan, our map, is being fine-tuned every day and is working. That's how it works with plans. Plans need constant revision and sometimes it does feel like we are flying blind. Why am I mentioning this? Well, very soon you will see our Government roll out a plan for opening up the country.

Paraphrased from Rolf Dobelli The Art of the Good Life:

You are sitting on a plane from London to New York. How much of the time is it sticking to the flight path, do you think? 90% of the time? 80% of the time? 70% of the time? The correct answer is never. Thousands of times per second the autopilot recalculates the gap between where the plane is and where it should be, and issues corrective instructions.

There is no perfect business strategy, no optimal stock portfolio, no one right job. They are all myths. The truth is that you begin with one set up and then constantly adjust it. The more complicated the world becomes, the less important your starting point is.

The numbers:

US:        639,664 cases     30,985 deaths    4.8% fatality rate (up)

Maryland: 10,784 cases        392 deaths     3.6% fatality rate (up)  

Yes, these fatality rates look scary. Understand however, we have only tested 1% of the population (3.2M Americans). I suspect that at least 10% of the population has been infected with at least 50% of those asymptomatically. If that is true, the fatality rate significantly drops.

In NYC, they continue to stabilize. In fact, NY is re-locating ventilators to hot spots outside of NY.

Locally, HCGH remains stable. Yet, we are remaining in the ready position should a surge occur. We should not and will not let our guard down.

Yesterday I mentioned that a newly identified risk for a severe COVID-19 infection is obesity. Why? When you are at an unhealthy weight, you have extra fat. The most dangerous fat is called visceral fat which is inside your belly and around your organs. It is also sometimes in the liver; we call that fatty liver disease, also known as Non-Alcoholic Fatty Liver Disease (NAFLD). We can see this fat on scans and it can elevate liver function tests. Fat is an organ all to itself and it produces inflammatory substances that weaken the immune system. How do we counteract this? First and foremost, eat well; strive for 5 to 7 servings of fruits and vegetables every day. Eat whole grains and beans. Be careful with too much animal products including meats, dairy, ice cream, yogurts, etc. A plant-based diet means that most of your plate is filled with plants! Stay tuned for more information about boosting your immune system at a later date.

Diagnostics and Therapeutics: 

·     The innovative Israeli company, Redhill, has a remedy that looks promising, an oral drug that may decrease the likelihood of developing COVID-19 induced respiratory failure. 

·     JAMA published a summary article on the state of therapeutics on April 13, 2020. There was general agreement that there is not an emerging clear-cut reliable treatment.

·     Scientists and physicians require clinical trials of reasonable size with strict application of the scientific method using randomized, double-blinded trials to find a reliable efficacious treatment. This is a challenge in critically ill patients who worsen, thus requiring throwing everything at them to potentially save their lives. These obstacles open the opportunity for innovation and a can-do attitude to save lives and make a difference. My group's drug fits in the anti-cytokine and immunomodulatory category (the same as Redhill showed success above). We are very hopeful for an opportunity to present this to the FDA soon. We appreciate the help and leads you have provided.

·     Now this is very intriguing: in some countries (not the US), people are routinely given a vaccination intended to decrease the likelihood of tuberculosis. It is called the BCG vaccination and it is somewhat effective. There are 10M cases of tuberculosis in the world each year and it is in the top ten causes of death in developing nations. It turns out that people who get the BCG vaccination may be more resistant to some viral infections--including COVID-19. I suspect that it will be shown that the vaccination enhances innate immunity. Time will tell.

On a musical note:

This Is Me from The Greatest Showman

Just a note to all of you - when I listen to music, particularly when times are tough and challenging, songs like this make me feel anything is possible! I am hoping you can feel that spirit and that it works for you too.

I found this quote from Plato that says it all:

"Music gives a soul to the universe, wings to the mind, flight to the imagination and life to everything."

And on a lighter note: (thank you MR)