The COVID-19 epidemic is moving faster in the U.S. than any peer nation The graph below comes from OurWorldInData.org and is based on data gathered from the European CDC. The graph compares the rate of growth of new cases in a number of countries by setting all nations to the day each arrives at it’s first 100 cases. It shows that the U.S. has the fastest pace of growth in confirmed cases through the 25 days since 100 cases. What does it mean? Other countries have been more aggressive with social distancing measures than the U.S.. Also, testing and preparation efforts were especially slow to get started in this country. The accelerated pace of the epidemic in the U.S. is partly the result of these trends. The rate of doubling of new cases has been between 2 and 3 days, although that may now be slowing (see point 2 below). Hopefully, social distancing measures will begin to slow the epidemic and put us closer to the average of other peer nations.
Growth in U.S. cases and deaths slows on Saturday Below are my versions of the epidemic curves in deaths and new cases in the U.S. up to March 27. Both show a slowing in the rate of new COVID-19 infections and deaths compared to recent trends. New cases rose by 20% on Saturday (20,102) and deaths by 28% (447). While both new cases and deaths set record daily highs, the rate of growth may now be slowing. Cases appear to be doubling every 4 days (rather than the 2 day doubling rate of the past week). Hot spots in deaths can be seen in every region, with substantial rises in Montana (+67%) and Colorado (+41%) in the West, Illinois (+38%) and Oklahoma (+82%) in the Midwest, Arkansas (+57%) and Mississippi (59%) in the South, and Delaware (+120%) and Pennsylvania (+53%) in the Northeast. What does it mean? We have seen growth rates slow in previous days only to see a quick return to faster growth. These data are, however cause for cautious optimism. It is possible that the slowing is a byproduct of saturation of our capacity to process new information. It is way too early to conclude that we are near peak in the U.S.. In the last week, national growth in new cases has been driven by skyrocketing cases in New York where 43% of all U.S. cases have occurred. However, that state saw a modest 17% rise in new cases on Saturday. As the epidemic begins to slow in New York, it is just starting in many other places.
Some now calling for widespread use of masks for the public Like many public health experts, I have urged people not to wear masks in public unless they are sick or caring for those who are. This is based on the idea that priority must go to health workers who don’t have adequate supply of masks, and the belief that wearing masks if you are not sick is unlikely to lower your risk of contracting the illness. It is widely believed that the main way the SARS-CoV-2 virus spreads is by respiratory droplets coughed or sneezed by those infected, which land on surfaces and are then transferred to a person’s airways by touching. Generally speaking, it is believed that the virus does not float in the air for long and therefore, a mask is not useful for keeping the virus out. This advice is still correct in my view. However, a growing number of experts are starting to question current guidance on masks. As reported in the New York Times, some are starting to urge the public to wear a cloth or paper mask in public. The reason for the shift is a growing understanding that masks may play a role in slowing the rate of infections by preventing the spread of infectious respiratory droplets from those who have no (or only mild) symptoms. That’s right, the case for masks is not about keeping the mask wearer safe, but rather in preventing those of us who are infected and don’t know it from passing the disease to others. In my view, it makes sense for people to cover their mouth and nose in public providing that doing so does not divert the scarce supply of medical masks and respirators from health workers who need them. It may be time to get out the sewing kit and make a cloth mask at home.
If you have any symptoms, consider taking my COVID-19 Symptom Checklist on line. It’s free and confidential and will help develop better screening tools.
America grapples with the staggering pace of exponential change The pace of change is nearly impossible to grasp. The rise in cases and deaths in the U.S. is doubling every 2-3 days. The three images below are taken from screen captures of the Johns Hopkins COVID-19 dashboard from February 29, March 9 and yesterday. We have not seen growth like this in an infectious disease outbreak in our lifetimes. This pace is likely to continue while some national leaders remain in a state of denial about what will unfold in the next few weeks. A new study posted online from the University of Washington’s Institute for Health Metrics and Evaluation (IHME) used a statistical model to forecast the demand for hospital and ICU beds. They anticipate the peak in demand will not occur until mid-April till the end of May depending on the state. A story in the Washington Post says that studies like this are being accused of being hoaxes intended to harm the President. Few expected the work of epidemiologists to be so politicized during an epidemic, but this shows that multiple narratives are playing out. The exponential pace of change is so bewildering that it is hard for experts to be heard. This will make it harder to maintain a commitment to social distancing in the near term.
U.S. deaths jump a record 432 on Friday; New York, Louisiana and Michigan hit hard As the graph below shows, the number of daily deaths nearly doubled from 253 on Thursday to 432 on Friday. This puts the number of total U.S. COVID-19 deaths at 1,584, a 38% jump in one day. Hospitals in numerous hard-hit states struggle to keep up amidst shortages of basic PPEs, long hours, heavy caseloads and the fear of contracting the disease on the job (see today’s top pick). New York state, which now has a third of all U.S. deaths from COVID-19, recorded 134 new deaths (a 35% jump). But New York is not the only hot spot. Kentucky saw it’s first 4 deaths in one day as cases there begin to mount. Massachusetts saw a 129% rise in total deaths with 20 recorded on Friday. Louisiana continues to battle a surge in cases, with 36 new deaths in one day (a 43% jump). Florida saw its first day of double-digit deaths with 18 (a 63% increase). With the nation’s attention is focused on New York and Louisiana, Michigan has seen a spike in deaths, adding 32, and becoming the state with the 5th highest mortality count (92), which is now higher than California’s.
Scapegoating begins as President announces he may impose ‘enforceable quarantine’ on New York, New Jersey and parts of Connecticut later today NBC News has just reported that President Trump announced today he is considering imposing an ‘enforceable quarantine’ on hard-hit areas including New York and sections of New Jersey and Connecticut. New York Governor Cuomo says the President didn’t mention this on an earlier phone call and does not know how such an order would be enforced. The federal government does have the power to impose binding quarantine in times of emergency, but that has rarely been done and any attempt to impose it now would surely lead to a court battle and widespread confusion. Meanwhile, the Florida governor announced that visitors from impacted areas must self-quarantine for 14 days when entering the state. Officials in Dare County North Carolina are setting up roadblocks to stop visitors from entering coastal beach communities. Why this matters? Throughout the history of epidemics, we have seen the frequent emergence of scapegoating. This involves blaming individuals, groups and communities for a health crisis. When people believe that things are spinning out of control, there is an impulse to search for someone to blame. Despite the evidence that the epidemic is moving freely throughout the nation, with hot spots breaking out in numerous places, the tendency to scapegoat particular regions where the epidemic is more advanced are likely to continue. This has potentially terrible consequences because internal travel restrictions are not likely to keep the epidemic from traveling and because such restrictions impose stigma on the hardest hit areas and make getting needed assistance and supplies to that area more difficult.