April | 2020 | Thomas A. Glass, Ph.D.

Top news, reports and insights for today:

Daily headlines for Thursday:

At least 31 states will reopen in the coming days as stay-at-home orders expire across the U.S. (CNN)
As states move to re-open, none has met federal criteria: 14-day drop in cases (NBC News).
L.A. County becomes first in California to offer testing to all residents as cases surge in the city (Los Angeles Times).
Dr. Anthony Fauci (America’s Uncle Tony) says that a viable coronavirus vaccine is possible by January (NBC News).
Georgia reopening: an experiment with lives at stake, puts working-class in the cross-hairs of the pandemic (The Atlantic)

States that never issued stay-at-home orders, and those that did so late, have steeper epidemic curves
On April 19 I posted a graph that shows how states compared in the rate of case growth since the day of the 100th case comparing three groups of states among those with moderate-sized outbreaks. This compares the pace of the epidemic in states that issued stay-at-home (SAH) orders early, vs. late vs. never. Today I present an update on that graph after 10 more days of data (see below). It’s a busy graph, but contains I think very compelling evidence that SAH orders have been effective. The black line is the average growth across all states and DC. States below that line are below average growth in cases, states above that line have more rapid growth. All states start on the day they reached 100 cases. There are 3 big take home messages here.
1. All states that adopted SAH restrictions before March 30 (solid lines) are growing cases slower than the national average. Wisconsin was above the black line until day 26 but has since remained below the US average.
2. All states that adopted SAH orders after March 30 had more rapid growth than the US average except South Carolina and Nevada.
3. Among states that never adopted SAH orders (dotted lines), 3 have seen dramatic acceleration of their curves. I have marked Nebraska, Arkansas and Iowa. In those states, on different days, their curves turned dramatically upward after a period of slower growth. This pattern is not seen in any state that adopted early. Utah’s inflection is less severe but still evident at day 35.
The bottom line: These data suggest that stay-at-home restrictions have slowed the epidemic generally, that early adopting states have done better, and that states that never adopted have been vulnerable to dramatic periods of accelerated growth. This provides a template for looking over time at what happens as these restrictions are lifted.

U.S. deaths spike again to second highest daily total, new cases remain flat
On Wednesday, reported COVID-19 deaths spiked again to the second highest daily total of 2,549, a rise of 5%. While the 7-day moving average, had showed a trend toward decline since April 21, the last two days have adjusted the trend back in the direction of rising deaths (top graph). Nine states matched or set new record high deaths, including 5 in the midwest (Iowa (12), Indiana (63), Nebraska (13), Ohio (138), and South Dakota (2)). In the Northeast, records were set in DC (15), Massachussetts (252) and Pennsylvania (479). New cases in the U.S. have passed 1 million rising by 3% on Wednesday by more than 25,000 (bottom graph). The 7-day moving average has been trending flat over the last week, however it remains unclear if this is flat case growth or flat testing capacity.
What this means? The disconnect between the push from states to reopen and the story the data are telling is more striking every day. Neither deaths nor new cases show sustained declines. The White House continues to say we are on the cusp of getting past this epidemic. I have no idea where they get that assessment.

Brazil ranks second yesterday in new cases (behind U.S) raising concerns about South America as temperatures there fall
On Wednesday, Brazil reported the second highest new case totals (6,462), a 1-day rise of 9%. The graph below from WORLDOMETER shows that new cases and active cases have been rising exponentially over the last two weeks. Brazil joins Peru, Chile and Mexico as nations in the top 25 in new cases. Of further concern, Brazil has tested only 1,600 per million, suggesting that these case totals may be severely under-estimated.
Bottom line: So far, few have paid much attention to Latin America. This may soon change. As temperatures begin to fall in the southern hemisphere, all eyes will be on South America and Africa to see what happens when COVID-19 collides with an entire season of “normal” respiratory illnesses. Brazil is an especially important country to watch due to high population density, intense tourism and substantial areas of poverty. Brazil is also in the midst of a severe recession.

Thomas A. Glass, Ph.D.

An epidemiologist’s perspective on the COVID-19 pandemic

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