Top pick of the day

U.S. deaths soared in early weeks of pandemic, far exceeding number attributed to covid-19

Washington Post article by Emma Brown, Andrew Ba Tran, Beth Reinhard and Monica Ulmanu, posted April 27, 2020 at 11:11 AM

How well are we doing at counting COVID-19 deaths? Studies in Europe have focused not on official mortality statistics which we believe are undercounting, but rather at tracking excess deaths above average seasonal trends. Here is one of the first attempts to do this in the U.S. based on a collaboration between Epidemiologists at Yale and the Washington Post. Similar to Spain, this study suggests there may be twice as many deaths than official counts indicate.

Today’s bite-sized, handpicked selection of important news, information or science for all who want to know where this epidemic is going and what we should do.

Screen capture from Washingtonpost.com: https://www.washingtonpost.com/investigations/2020/04/27/covid-19-death-toll-undercounted/?arc404=true

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Daily COVID-19 Briefing: 4/27/20

Top news, reports and insights for today:

1. Top headlines for Monday:

• New Washington Post/Yale University collaborative study shows that U.S. COVID-19 death total may be double current estimates (Washington Post).
• Colleges and universities wrestle with prospects of re-opening next fall (The Atlantic).
• California sees serious car crashes fall by half due to social distancing (Wired).
• University of Maryland studies anonymized cell phone data, finds evidence of “quarantine fatigue” as adherence to social distancing falls by 3% (NBC News).
• New York City starts using “self-swab tests” reducing risk to health workers. New testing protocol introduces saliva testing as well (Vice).
• National Bureau of Economic Research working paper argues that New York city subway system may be key to understanding why that city’s outbreak was so explosive (NBER Working paper by Jeffrey Harris)
• Japanese Island of Hokkaido lifted social distance restrictions too soon and was hit hard with second wave of infections, offering reality check to U.S. states (Time magazine)

2. New U.S. deaths drop Sunday to levels not seen in two weeks
   In a hopeful sign, new U.S. COVID-19 deaths rose just 2% on Sunday with 1,168 reported deaths. This is the lowest daily mortality numbers seen since April 5. These numbers as compiled by Wikipedia from state health departments do not include growing numbers of ‘probable’ COVID-19 deaths. Estimates from sites that do include such numbers, such as WORLDOMETER, posts 56,139 deaths now. Also, because we have seen a consistent lag in weekend death reporting, we need to remain cautious about the magnitude of this decline. The U.S. continues to report the highest global death toll, with double the deaths in Italy, which ranks second. Nevertheless, the 7-day trend shows a decline in new deaths, which indicates we may be at or near peak. Minnesota was the only state to set a new record high death count at 28. New Mexico, Minnesota, Nebraska and Alabama all saw total COVID-19 deaths double in the last week.
   What this means? The drop in new deaths is welcome news. I remain concerned about a possible rebound on Tuesday as death reporting from the weekend catches up. The larger trend is toward a decline in new deaths, which may indicate we are at or near peak deaths in the U.S.. The mid-west remains an area where mortality continues to rise.

3. Numerous states move to re-open despite insufficient evidence of peak in new cases
   Last week I explained how important it is to wait until new case growth has peaked before states re-open. I also argued that the best way to see the peak is in a special type of graph that compares last week’s new cases to total cases, both on the log scale. The graph below comes from Aatish Bhatia’s site and is based on the latest data in the 13 states that are now moving toward re-opening. The inflection point we are looking for signals the end of exponential growth and the slowing of linear growth. It shows up on this graph as a sharp pivot from an upward angle to a straight line pointing down. Here we see three patterns. The first is states that do evidence post-peak curves. That includes states with small outbreaks (Alaska and Montana) and just one state that has had a moderate outbreak (Ohio). These data support relaxation of social distancing in these states. New York started to look like it had peaked, but that state’s curve turned this last week, so it’s a special case. A second group of states shows a flat curve, indicating that community transmission is still occurring, but on a linear scale. That includes New Jersey, Oklahoma, South Carolina, Florida and Georgia (the state that has moved most aggressively to re-open). A third group of states is still experiencing rapid growth in new cases (including California, Colorado, Tennessee, and Minnesota).
   That this means? Beaches were crowded in parts of California over the weekend, even as new cases rise precipitously in that state. States with flat curves are at risk of re-igniting exponential transmission by withdrawing social distancing measures, an effect that would not be seen for 1-2 weeks. These data suggest that fewer states should be re-opening.

Link to this image taken by screen capture on 4/26/20: https://aatishb.com/covidtrends/?region=US&location=Alaska&location=California&location=Colorado&location=Florida&location=Georgia&location=Minnesota&location=Montana&location=New+Jersey&location=New+York&location=Ohio&location=Oklahoma&location=South+Carolina&location=Tennessee

Daily COVID-19 Briefing: 4/26/20

Top news, reports and insights for today:

1. Daily headlines for Sunday:

• Dr. Michael Osterholm, a must-watch expert, says COVID-19 testing is in crisis right now (NBC News, Meet the press)
• CDC finally expands case definition, adding 6 new symptoms. This should have been done in early March. (USA Today)
• All eyes are again on Italy as it starts to re-open. Is it too soon? (Wall Street Journal)
• New study of 5700 hospitalized COVID-19 patients in New York City shows only 30% had fever on admission (JAMA Network)
• Young people with COVID-19 are having strokes, suggesting the virus may be causing dangerous blood clots (Washington Post)

2. U.S. Cases trending upward, nearing 1 million. Midwest states surging
   The new case graph below shows that infections in the U.S. are trending upward, based on the 7-day moving average curve. Nearly 35,000 new cases were reported yesterday, a cumulative rise of 4%. I’ve tweaked the graph so that Sunday and Monday reports are a darker shade, to emphasize a pattern I pointed out earlier in the week about lagged reporting over the weekend. That is why the 7-day focus is preferred since it balances out weekly variation in ascertainment. It is likely the U.S. will be the first country to pass 1 million cases next week. Globally, the U.S. has more than 3 times more cases than Spain, which ranks second in the world. However, in terms of prevalence (proportion of the population infected) the U.S. at 2,948 per 1 million population ranks behind Spain (4,847), Belgium (3,981), Ireland (3,901), Switzerland (3,358), and Italy (3,269). However, keep in mind that U.S. testing remains lower than most nations (except Belgium and Spain). Seroprevalence studies remind us that there may be 10-times more infections than we are now aware of. The bottom graph shows 1-week growth in cases by state and region. Two midwestern states (Iowa and Nebraska) have doubled cases in that time. Substantial increases were also seen in Kansas (+71%), Minnesota (+56%) and Ohio (+52%), making the Midwest the latest apparent regional hot spot. Notable rises were also seen in the South (Arkansas and Virginia) and the Northeast (Massachussetts, Maryland and Rhode Island). Growth in new cases was less than 20% in New York, Maine and Vermont.