Friday COVID-19 Briefing

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Top news, reports and insights for today:

1. Daily headline summaries for Friday:

• U.S. Coronavirus hotspots are improving after a very tough summer (Axios, see Figure A)
• Germany, Spain record highest daily coronavirus infection rate since April as cases surge across Europe (CNBC)
• Updated CDC guidance for schools suggests “common-sense” strategies for dealing with outbreaks among students, including partial closures (Bloomberg)
• Trump administration declares teachers “essential workers” amid push to reopen schools. While the ruling is “advisory” it means teachers are now considered “critical infrastructure” like doctors and police. One implication is that infected teachers can now return to the classroom as long as they are asymptomatic (Axios)
• Top doc “Uncle Tony” Fauci says there is not much utility in taking temperatures to fight coronavirus because they are unreliable. He suggests questioning people about their overall symptoms instead (The Hill)
• School outbreaks break out at University of North Carolina, Notre Dame, Ole Miss, Purdue, Cherokee County Ga, and others wreck President Trump’s plan to return to normal (Politico)
• Masks in the bathroom? Study in physics journal says using and flushing urinals in restrooms can generate an “alarming upward flow” of virus-laden particles (USA Today)

Figure A: Screen grab from Axios.com, August 20, 2020

2. U.S. daily cases have peaked, declines seen in the South and West
    I am happy to report that daily COVID-19 cases now appear to be on a steady trajectory of decline (See Figure B). Last week, 313,629 new cases were reported, a rise of 6% in the cumulative total. That’s a substantial drop from the 411,000 weekly cases seen on August 3. So, let’s look at the state situation to see where the fall is occurring. Clever disease detectives (as always) want to see two things. First, where are weekly cases rising and falling across states? We look at growth factors for that (Figure C). That tells us about relative change in new cases. For absolute change, we also need to see new cases per 100,000 people per day (Figure D).
    First, the growth factors: the good news here (and it is quite good) is that new cases are falling (relative to the previous week) in 12 of 13 states in the South. The odd-man-out there is Texas, where an astonishing 48,900 new cases were reported, a 6% rise. New weekly cases fell by 25% or more in Alabama (-26%), Arkansas (-37%), Florida (-32%), Louisiana (-34%), and South Carolina (-26%). Cases are also falling in 10 of 13 states in the West. Wyoming is an exception where 313 new cases were reported last week, a 76% spike. Arizona (-23%), California (-18%), Colorado (-21%), Idaho (-23%), and New Mexico (-21%) reported substantial drops. So where are the next hot spots going to be? Cases are rising in the Midwest in Iowa (+16%), Illinois (+16%), Kansas (+16%), and South Dakota (+16%). Concerning increasing trends are also noted in 4 Northeastern states (Connecticut, Delaware, Maine and Vermont).
    Turning to new case rates (Figure D), our eyes are drawn in different directions. While cases are dropping relatively, we continue to see new daily cases per 100,000 of 20 or more in 5 Southern states (Florida, Georgia, Mississippi, Tennessee and Texas). It will take time for things to move closer to the bench-mark target of 5 or fewer new cases per 100,000. Currently, Colorado is the only state in the West, Midwest or South meeting that target. Texas and Kansas are the most troubling states right now as they are trending poorly in both graphs (high new case rates and rising weekly cases).
    The bottom line: The decline in new cases is a welcome development. The hot-spot states in the South are finally falling, but new cases remain troublingly high. I am concerned the epidemic may be moving back toward the Northeast and Midwest in the next few weeks.

Figure B

Figure C

Figure D

3. U.S. passes 160,000 deaths, daily death toll stable at 1000+
    Yesterday, another 1,122 deaths were recorded in this country from the SARS-CoV-2 virus. On Tuesday, the total was 1,205 Americans, a figure that put the total number of U.S. citizens who have died at over 160,000 for the first time. Despite the sagging of daily cases, the number of deaths per day remains fairly stable at just over 1,000 (Figure E).
    The national picture is stable, but as disease detectives, we ask the next question: where are deaths rising and where are they falling? The good news is that weekly deaths are falling or stable in 10 states in the South (Figure F). Contrary to that trend, weekly deaths spiked in Kentucky (+69%) and Tennessee (+38%). Texas reported an alarming 1,504 deaths last week to lead the nation, a slight rise of 9% compared to the previous week. Sadly, new cases continue to surge in that state as well. In the Northeast, deaths declined in general but jumped by 9% in New York. The region of greatest concern this week is the Midwest which is looking increasingly like the next hot zone. Weekly deaths rose 20% or more in Michigan (+88%), Minnesota (+22%), Missouri (104%), Ohio (+27%), Oklahoma (+58%) and Wisconsin (+23%). Out West, declines in weekly deaths in California (-6%) and Arizona (-21%) were off-set by substantial jumps in Idaho (+68%), Utah (+22%) and Washington (+22%).
    What it means: The decline in daily cases has not yet translated to falling deaths. The overall picture suggests that deaths may have peaked in most Southern states just as the numbers are again surging in the Midwest. It’s more whack-a-mole.

Figure E

Figure F

4. Quirky corner: Texas skydiving team uses their bodies to paint a picture of the coronavirus in this video
    Check out the video from The Macon Telegraph about a team of 40 skydivers from Dallas who managed to build a true-color replica of the SARS-CoV-2 virus in the sky. The team included two videographers who wore gloves and face shields and managed to capture the scene.

Screen capture from: https://www.macon.com/news/nation-world/national/article245016585.html

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Top pick of the day: Tuesday

Seven months later, what we know about Covid-19 — and the pressing questions that remain

Health Article by Andrew Joseph. Helen Branswell, and Elizabeth Cooney, online at StatNews, August 17, 2020.

StatNews has been a valuable and trustworthy source of information and analysis throughout this epidemic. Here, three of their top health reporters team up to offer a big-picture overview of what we know and what we still need to know. Topics covered include: COVID-19 in kids, safe vs. dangerous settings, symptom persistence and “long haulers”, the race for a vaccine, asymptomatic spread, viral mutation, the reinfection question, how long does immunity last and how many infections have occurred.

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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.

Sunday COVID-19 Briefing

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Top news, reports and insights for today:

Update notice: I thank alert reader James S. who spotted an error in my Sunday update. I entered death data wrong for Saturday August 15 that made it appear that record high daily deaths had occurred in 15 states. I sincerely apologize for the error. I modified point 3 to reflect this change. The error did not impact the accuracy of Figure D.

1. Daily headline summaries for Sunday:

• CDC says that while children make up only 7% of U.S. COVID-19 cases, rates have been “steadily increasing” in young people from March to July (CNN)
• A school district near Phoenix Arizona will not reopen as planned on August 17 because so many teachers refuse to come to work over safety concerns (Axios)
• The U.S. CARES Act, signed into law in March, requires the Food and Drug Administration maintain a publicly available list of equipment and supplies that are in shortage. Five months later, FDA has just put out that list containing 20 items including gowns, gloves and other critical PPE (Axios)
• White House task force warns COVID-19 is “widespread and expanding” in Georgia, which now has the 5th highest number of cases. Against this backdrop, the state reopened many of its schools including in Cherokee County which now has at least 110 confirmed school cases resulting in over 1,600 students and staff in quarantine (NBC News)
• USC researchers studied the order that COVID-19 symptoms appear, finding that fever most often occurs first, followed by cough, and muscle pain with a host of other symptoms coming later (Ladders)
• The FDA authorized a new fast, cheap saliva test developed by researchers at Yale. This potentially groundbreaking test could be a game-changer, dramatically increasing our ability to test and track. More testing is needed first and it’s being done in NBA players (Wall Street Journal)

2. New cases continue at 54,000+ a day. There is something wrong with this picture.
    The SARS-CoV-2 epidemic keeps chugging along (See Figure A). As a disease detective, I am scratching my head. Most infectious disease epidemics have a given shape. It works a bit like a fire. Energy, oxygen and fuel. Quantities that exist in given amounts at a particular forest or building or fireplace. Plotted over time, the fire will shift and change as fuel runs out relative to the energy, oxygen and burn rate. The shape is constrained by higher-order laws. It’s physics to some extent. What goes up (in flames) must come down.
    This virus isn’t acting right. Every day I show you the epidemic curve. We know what is suppose to happen. There is a rise, it accelerates, the fuel (susceptible hosts) starts to run out, the peak is reached, then a shift, a downward drift. Eventually, not enough fuel or oxygen and the fire wanes and expires. We had a peak in April. Then a waning. Then another big rise, past the earlier peak. Then a new peak in mid-July, followed by an apparent decline. But now, we are stuck in neutral. It’s been a fairly constant 53,000ish cases a day since August 2. Is there another peak coming? Will the decline be apparent when the clog in test processing clears? I don’t know. I’m not sure anyone does. At this point, the data is a frothy bitter-tasting cocktail of what the virus is doing, what our testing isn’t doing with a good dose of political shenanigans thrown in. The picture that we see in this graph is not the picture we should be seeing. I scratch my head and wait for the smoke of confusion to clear.

Figure A

3. Another day, another 1,200 American souls lost. Are we getting getting numb?
    We are getting numb aren’t we (See Point 4)? It’s hard to grasp the reality reflected in this pink graph everyday. On Saturday, 1,190 new COVID-19 deaths were recorded (see Figure D). We know that we are capturing about 60% of the real death toll. We also know the book-keeping is sloppy, delayed and error-prone. But in the real world, where you and I live, about 2,000 American citizens got sick, suffered and died yesterday. They all had names, parents, stories, dreams, regrets, and favorite ice cream flavors. Many died miserably, often without loved ones, with front-line doctors and nurses, exhausted, desperate to keep them alive, hoping for the virus to pass. Two thousand sheets pulled over real people.

Figure D

4. Need some perspective? Stare at this for a moment
    The U.S. has now recorded 158,069 deaths (according to Wikipedia) from the SARS-CoV-2 virus in just five and a half months. Are we losing perspective? That is more American lives lost than were recorded in:
   1. The first SARS-CoV outbreak (aka SARS)
   2. The Gulf war
   3. The September 11 terrorist attacks
   4. The Swine Flu H1N1 pandemic of 2009-10
   5. The Korean War
   6. The Vietnam war
   7. All deaths from influenza in the U.S. for the 6 years prior to this year
   8. And World War I
      
      Combined.