Top pick of the day: Thursday

The ‘first wave’ of coronavirus isn’t over — and it’s getting worse

Article by Ruth Reader published online at FastCompany, June 25, 2020.

Last week, Vice President Pence misleadingly claimed there is no “second wave”. It’s misleading because there can’t be a second wave until the first one is over. This article reviews what most epidemiologists (including me) have been saying for weeks: the initial ‘wave’ of the epidemic in the U.S. is still going strong, few states are doing what is needed to bring it under control, and there is widespread misunderstanding of what an epidemic wave even is. Many people still wish that this would be a sprint when its clearer everyday that it is a marathon.

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.

Daily COVID-19 Briefing: Thursday

Top news, reports and insights for today:

  1. Daily deadline summaries for Thursday:
  • President Trump’s administration is ending support for 13 coronavirus testing sites including 7 in Texas just as that state reports an all-time daily high in cases (The Hill)
  • California sets record daily high of more than 6,600 cases sparking fears the epidemic is out of control in that state (Los Angeles Times)
  • Alarming resurgence of COVID-19 cases seen in Europe across 11 countries as countries reopen, mirroring trend in the U.S. (BBC News)
  • The national weekly average daily incidence of new cases is now nearly as high as it was at the initial peak on April 10 (STAT News, see graph below)
  1. U.S. cases explode, new record daily high reported. Things are really crazy in Arizona
    On Wednesday, a record high 37,915 new COVID-19 U.S. cases were reported eclipsing the previous daily high set April 24. This further clarifies two important facts: 1) reopening has led to wide-spread transmission intensification; 2) the “first wave” is still in progress (see today’s Top Pick). The surge in cases nationally is the result of significant increases in new cases in 17 states throughout the south, midwest and west. The lower chart shows where the new case growth is most intensive. As has been true over the past 10 days, Arizona is “off the charts” now reporting more than 37 new daily cases per 100,000 population, a number in excess of what has been seen in any state since April 1. Arizona’s total increased by almost 20,000 last week, a 47% surge, indicating cases are doubling every 2 weeks. The incidence rate has risen almost 900% in the last 2 months. COVID-19 hospitalizations and patients in the ICU have both doubled there since April 24. Big rises in new cases (>8 daily cases per 100,000) are also being reported in California, Idaho, Nevada, Utah, Iowa, Oklahoma and 10 of 13 states in the South, where only Kentucky and West Virginia are below the 5 cases benchmark. Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas are all higher than 10 new cases per 100,000. The surge in cases in the warmest states clarifies that the epidemic is not curtailed by heat and humidity.
  1. The big mystery of the moment: Why are deaths not rising
    Disease detectives are driven by the prospect of solving puzzles and unraveling mysteries. A big mystery is coming into clearer focus. Have a look at this graph showing daily deaths. Cases have clearly been on the rise since June 10. The trend in deaths however is quite different. The 7-day average continues to trend downward. While new daily cases are now back to where they were at peak, deaths are at 600 a day, a third of what they were at peak over 2,000 on April 24. This is a big mystery. Why have deaths not surged as cases have? There are many possible explanations, but the 4 most likely are listed below. In coming blog posts, I will try to unravel this mystery.
    1. Cases have risen as a function of more testing, that has not translated to deaths. I will comment on this in Point 4 below.
    2. The time lag between infection, symptoms, a positive test and death is longer than we thought. Deaths will rise soon.
    3. COVID-19 deaths are being hidden for political reasons.
    4. COVID-19 is becoming more infectious (especially among younger people), less lethal or both.
  1. Increased testing does not explain the spike in cases
    President Trump believes testing is a bad thing because it finds too many cases. Don’t get me started. Some governors have blamed surging case numbers on increases in testing. Let’s look at some data. The first thing I went to is the overall shape of the epidemic curve in testing. Like the daily case and death totals we saw above, we can learn important things by looking at the overall shape of global testing intensity. Using data from the invaluable COVID Tracking Project, the graph below shows what the pattern in global testing looks like since March 15. The blue area describes the steady rise in daily testing over the course of the U.S. outbreak. It shows, in my opinion, four phases. First, there was rapid acceleration of daily testing from mid-March till the end of April. Next, we saw linear growth that stalled out by April 20. This was followed by steady linear increase until the end of May (Memorial day). Since June 1, the increase has been slower that the previous period. Daily testing, now at about half a million a day, has doubled since the beginning of May. However, the period of greatest interest, when U.S. daily cases changed direction and began a steady rise, starts around June 9. During that period, testing rose modestly from about 425,000 a day to just over 500,000. Similarly, the test positivity rate, has been declining steadily, dropping by half since April 22. Strikingly, that decline has stalled at around 7% over the last week.
    What this means: If the surge in cases has been caused by a rise of testing, we would expect to see something different than we do. Testing rose more rapidly before Memorial day, when cases were falling. There is no visible bounce in testing that would explain the June surge. If anything, the absence of any big shift in the TPR tells us that the overall testing regime has been business as usual for most of May and June. I believe this chart provides solid evidence that the surge in cases is being driven by the virus, and not by increased testing.

Daily COVID-19 Briefing: Sunday

Top news, reports and insights for today:

  1. Daily deadline summaries for Sunday:
  • Florida reported 4,049 new COVID-19 cases on Saturday, another single-day record as the number of statewide infections has surged to at least 93,797 (CBS News)
  • Michael Osterhom (a trusted source) said on Meet the Press he does not think coronavirus is behaving like influenza and does not expect multiple waves, instead likening the epidemic to a forest fire that he believes will burn continuously through the summer and fall (Axios)
  • Despite everything that we know from the data, President Trump says COVID-19 is ‘dying out’. The President told the Wall Street Journal recently that testing was ‘overrated’ because it reveals large numbers of cases which ‘makes us look bad’. The federal attitude of dismissiveness will make it harder to further contain the epidemic which shows no sign of slowing (STATNEWS)
  1. U.S. daily cases spike to levels not seen since May 1, 10 states set new record highs in new cases
     The U.S. added more than 31,000 new COVID-19 cases yesterday, after a week in which 175,979 new cases were reported nationally, an increase of almost 20,000 compared to two weeks ago. On Friday and Saturday, new record high daily case totals were reported in Arizona (3,246), California (4,317), Nevada (445), Utah (643), Missouri (389), Florida (4,049), Georgia (1,800), South Carolina (1,148), Tennessee (1,188), and Texas (4,430). Records were broken on both days in Nevada, Utah, Florida and South Carolina. The leading edge of the 7-day moving average of daily cases has reached 25,000 daily cases for the first time since May 9. The overall surge in new cases is due to escalation of transmission intensity (percent growth in cumulative cases in last week of 15+ percent) in 20 states, most notably Arizona (+45%), California (+16%), Idaho (18%), Oregon (+22%), Utah (+22%), Oklahoma (+24%), Alabama (+20%), Arkansas (+25%), Florida (+28%), North Carolina (+20%), South Carolina (+32%), Tennessee (+17%) and Texas (+25%).
    The Bottom Line: The U.S. is trending back toward exponential growth at a pace not seen since early April. The White house is in complete denial. The rest of the world looks on in horror. U.S. deaths will begin following suit in the next two weeks.
  1. Change in U.S. State COVID-19 incidence rates vary astonishingly: some states rose 1,000%
     I thought it would be useful to take a look at overall trends in the incidence rates across U.S. states. That means confirmed COVID-19 cases per 100,000 population. Of course, we know those rates have been going up due in part to more testing but the shear spread in those rates and how much they have changed shocked even me. Have a look at the graph below. For each state, there are 2 bars; the dotted bar to the left is the COVID-19 case incidence rate 2 months ago on April 20; the solid bar is the rate as of yesterday. As expected, the incidence rates in the Northeast remain the highest, with 8 of 12 states over 1,000 cases per 100,000 population. New Jersey and New York stand at over 1,900, higher than any other country on earth with more than 100,000 total cases. You might think New York is way ahead of other Northeast states, but Connecticut, DC, Delaware, Massachussetts, Maryland and Rhode Island have closed the gap and are now at more than half the rate in New York. More importantly, while incidence rates doubled in the last two months in New Jersey, they rose more slowly in New York and Vermont. Maryland had the biggest rise in the northeast increasing 367%.
     I see at least 4 general patterns here. First there are a small number of states that saw their rates rise by less than 100%, including Hawaii, Montana, New York and Vermont. These are the states that should serve as models of best-practices. Second are states where rates roughly doubled, performing better than the national average. This includes Alaska, Colorado, Idaho, Washington, Wyoming, Michigan, Louisiana, Missouri, West Virginia, Connecticut, New Jersey, and Pennsylvania. Third are a group of states that did what the nation did as a whole, increasing 3 or 4-fold. Lets call that California, Nevada, New Mexico, Oregon, Utah, Illinois, Indiana, North Dakota, Ohio, Oklahoma, South Dakota, Wisconsin, Florida, Georgia, Kentucky, Mississippi, South Carolina, Tennessee, Texas, Delaware, Maryland, Maine, New Hampshire, and Rhode Island. Perhaps these are the states that performed about average. Finally, there are a group of states that saw rates rise from 500-1200% in two months. These low-performing states include Arizona (+883%), Iowa (+707%), Kansas (+507%), Minnesota (1,215%), Nebraska (+974%), Arkansas (+668%), North Carolina (+661%), and Virginia (+517%). These are states where we have seen large outbreaks at meat processing plants and prisons. Keep in mind that two months ago was late April, so there are no states that hadn’t had time to prepare and execute mitigation strategies. By April 20, all states had time to set up robust testing programs. It is shocking to think some states have seen more than 500% growth in cases in just 8 weeks. The northeast saw rates double overall, but both the West and South saw overall rates triple.
    Bottom line: Rates continue to vary wildly across states. The hardest-hit states in the U.S. now have rates of infection that exceed any country on earth. While some states have been effective at controlling the growth of infection rates, the lowest performing states have seen rates explode with Minnesota leading at more than a 1,200 percent rise. The West and South are now catching up to the extraordinary rates of infection seen in New York and New Jersey.