Wednesday COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Wednesday:
  • Researchers combined information from 32 studies of COVID-19 risk in children, finding that children and adolescents had 44% lower odds of secondary infection with SARS-CoV-2 compared with adults (JAMA Pediatrics)
  • Moderna CEO says its coronavirus vaccine won’t be ready until spring of next year (CBS News)
  • The White House coronavirus task force again this week strongly recommending mask usage in some states like Iowa and Georgia that still do not have statewide mask mandates (CNN Politics)
  • Hospitals feel the squeeze as cases spike in upper Midwest states Wisconsin, North Dakota (ABC News)
  • Facebook removes 38 versions of Trump campaign ads claiming (without evidence) that admitting refugees increases COVID-19 risk (NBC News)
  • Largest study yet of COVID-19 transmission in India published in Science highlights the role of super-spreaders, a small subset responsible for a high percentage of infections. Study also finds that children transmit the disease as easily as adults (Los Angeles Times)
  • Remember how COVID-19 exploded on a cruise ship? The Trump administration has again over-ruled the CDC recommendation to extend the “no-sail” order on cruise ships to next year (ARS Technica)
  1. U.S. passes 7 million lab-confirmed COVID-19 cases. Last million cases added in 26 days
     Let’s start with the big picture today. Over the weekend, based on the Wikipedia data, the U.S. passed 7 million cases (See Figure A). On average, the U.S. has added a half million cases every 12 days. We went from 6.5 to 7 million in exactly 12 days. On average, each million cases has been accruing every 26 days. The jump from 6 to 7 million was just that (26 days). That’s a million cases a month. The more important idea here is that the COVID-19 outbreak is now steady-as-she-goes in terms of the pace of growth. On a big picture basis, the epidemic is locked in to an oddly consistent, even robust degree. Seasonality has been less than expected, surges and falls have been less steep than might have been predicted, and overall, the epidemic curve looks more like an endemic than a pandemic.
    What does this mean: Buckle up for the long hall because SARS-CoV-2 is not going away.
Figure A
  1. U.S. daily cases holding largely steady. Transmission intensity highest in the Midwest, growing fastest in the West
     Figure B shows daily cases; the 7-day average remains just over 40,000 a day. We are now adding cases about twice as fast as the nadir of the epidemic in the first week of June. Today, I wanted to point out how different ways of looking at the same data are needed to address different questions. What questions? First, where are infections being generated most intensively right now? Second, where is the rate of new infections growing the fastest? Sometimes the answers will be the same. But, if a particular state has high sustained transmission intensity for a long time, the rate of growth of new cases will be very low. Conversely, a state with very low transmission intensity might be growing the fastest through regression to the mean in a natural cycle of change.
     Take a look at Figure C showing new daily cases per 100,000 residents by state over the last week. Let’s remind ourselves that the benchmarks we care about are a) less than 5 indicating “low” transmission intensity, and b) greater than 20, or 4-fold higher, indicating “high” transmission intensity. As has been consistently true for weeks, the Northeast is in the best shape with 5 states in the low category and only Delaware is over ten. The South is, thankfully, also relatively quiet with only Arkansas reporting high spread. The region that is clearly most hot is the Midwest with eight of thirteen states in the red zone. Three stand out in particular: North Dakota (54) is 10x higher than the “low” benchmark, while South Dakota (45) and Wisconsin (39) are surging at a white hot pace. Michigan (9.6) and Ohio (7.8) are the only “warm” states below 10. Iowa (29), Kansas (32), Missouri (22), Nebraska (24) and Oklahoma (26) are all hot. In the West, while Arizona remains coolish, Idaho (25), Montana (27) and Utah (32) are all hot.
     So what about the second question? Have a look at Figure D showing 7-day growth factors in cases. The picture is different. Intensity is low in the Northeast, but growth in new cases is strong with five states seeing a week-over-week increase of 10% or more: Delaware, Massachussetts, New Jersey, New York and Pennsylvania. New cases are falling in nine of thirteen states in the South. The region where the most growth is occurring is the West. Cases are rising fastest in New Mexico (+58%), Wyoming (+53%), Nevada (+46%), Washington (+41%), Alaska (+39%), and Montana (+39%) in that order. Whereas transmission intensity is highest in the Midwest, case growth is over 20% in only Michigan (+21%), South Dakota (+28%), and Wisconsin (+23%). Let’s take special notice of the states that pop out of both figures. Montana, South Dakota and Wisconsin, all regionally propinquitous, all have both high intensity and rapid growth.
     Bottom line: Something big and scary is going on in the upper midwest plains states!
Figure B
Figure C
Figure D
  1. Quirky Qorner: Republic of Kazakhstan social influencer Borat tweets praise for U.S. coronavirus handling: “Because of Trump, 350 million Americans still alive”
     If rumors are correct, the long awaited followup to Borat is on its way to Amazon Prime Video sometime soon. According to this piece in Vanity Fair, twitter was shaken by a video appearing just before the first debate, handle @KazakhstanGovt, congratulating “Premier Trump” for his handling of the crisis. Very Nizzzze!

Top pick of the day: Monday

How Long After Exposure To Covid-19 Coronavirus Should You Get Tested?

Article by Bruce Y. Lee, senior contributor and professor, published online at Forbes September 26, 2020.

A friend of mine called me in a panic the other day and said he thought he had been exposed to COVID-19 and wasn’t sure what to do. Amidst the groundhog day monotony of life in the time of coronavirus, it’s easy to forget that people are still getting sick and exposing others. Here is a handy go-to guide written by a former colleague who walks you through the process. The bottom line: if you think you have been exposed to SARS-CoV-2, quarantine yourself and seek a diagnostic test.

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.

Image captured from

Weekend COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Saturday/Sunday:
  • Two studies suggest that declining ICU utilization and mortality rates from COVID-19 may be due to falling viral load (the amount of circulating viral particles resulting from replication in the body) as the epidemic evolves from month to month (CIDRAP, See main point 3).
  • The vaccine maker Novavax said Thursday that it would begin the final stages of testing its coronavirus vaccine in the United Kingdom and that another large trial was scheduled to begin next month in the United States. It is the fifth late-stage trial from a company supported by Operation Warp Speed, the federal effort to speed a coronavirus vaccine to market, and one of 11 worldwide to reach this pivotal stage (New York Times)
  • In an ironic twist, President Trump attacks FDA plan for tougher standards on emergency vaccine approval as a ‘political move’ (Washington Post)
  • The extent to which COVID-19 is dangerous for pregnant women and their babies remains unknown. Evidence is growing that SARS-CoV-2 is less risky in pregnancy than either SARS or MERS before it. A new study from Sweden yields overall good news. They compared women in labor with and without COVID-19 and found a higher likelihood of preeclampsia (elevated blood pressure in pregnancy), but no evidence of other problems or with worse birth outcomes in the baby (JAMA)
  • Researchers at Vanderbilt studied the change over two months in anti-coronavirus antibodies in health care workers. They found that all those who were positive for SARS-CoV-2 infection at baseline showed declining antibodies at 60 days. Their key finding was that just over half of those who were positive were seronegative (no sign of prior exposure) at 2 months. This implies a shorter window to donate convalescent plasma and complicates the picture for using antibody tests to determine who has and has not been exposed (JAMA)
  • In India, the first randomized clinical trial to test the efficacy of convalescent plasma to introduce antibodies from those who have recovered from COVID-19 failed to show any benefit (Nature News)
  • Google maps now show you where COVID-19 cases are spiking. Find the “covid-19 info” option under the layers button in the top right hand corner on the phone app (MIT Technology Review)
  1. U.S. daily cases and deaths both rising slowly. Hotspots drifting West
     On September 13, we had seen a steady downward trend in new daily U.S. cases that had been sustained since the national peak of July 23 (See Figure A). The last half of September has seen that trend reverse, as new weekly cases have risen to just under 300,000 (compared to a weekly total of 234,000 on September 11). It seems certain the U.S. will pass seven million cumulative cases in the coming days, the most of any country, and 22% of all global cases. Among nations with 250,000 cases or more, the U.S. now has the 4th highest incidence rate (confirmed cases per 1 million population) at 631 behind Peru (972), Chile (657) and Brazil (664).
     State and regional patterns vary somewhat from my last briefing (Figure B). Today, I am showing you the 7-day growth factors for cases. What jumps out to me is the clear trend toward significant growth in cases in the West. Where more Midwestern states were growing last week, now 10 of 13 Western states are seeing new cases rise. Among those, seven saw weekly cases grow by 30% or more including Idaho (+47%), Montana (+41%), New Mexico (+39%), Nevada (+34%), Oregon (+37%), Washington (+33%), and Wyoming (+43%). New infections fell substantially only in Arizona (-40%). In the Midwest, Michigan (+28%), Minnesota (+35%), and South Dakota (+34%) also saw big surges. Seven Southern states declined but Texas stood out for a big surge, however the 47,370 new cases last week included about 15,000 “old cases” just included. Weekly growth factors were generally low in the Northeast but new cases surged in the last 3 days in Maryland and Massachussetts. On Saturday New Jersey saw over 750 cases (a one day jump of 220) while New York was over 1,000 for the first time since June 6.
     U.S. daily deaths have also been slowly rising (Figure C), as 5,180 new deaths were reported last week. Most data sources have the nation’s death tally at over 200,000 now, but the Wikipedia source I use has not yet reached that mark. I am digging into why that is and will report my findings in a coming posting. Meanwhile, deaths continue to zigzag with numbers rising in Washington state (1.37 growth factor), Indiana (1.12), Michigan (1.13), Missouri (3.03), Oklahoma (1.39), Wisconsin (1.25), Arkansas (1.63), Maryland (1.23) and Pennsylvania (1.24).
     What it means: The data are telling us the fall is trending toward higher transmission intensity with the possibility of a Western swing in the areas of greatest concern.
Figure A
Figure B
Figure C
  1. A look at incidence rates by state for cases and deaths brings some surprises
     Every few weeks I like to zoom in on state-level variation in incidence rates of COVID-19. Remember back in the spring when many were convinced that infections and deaths were out of control in New York, New Jersey and a handful of other Northeast states, that it looked like the coronavirus outbreak in this country was going to be largely a problem for the greater “Big Apple” region? New York’s incidence rate was so much higher than any other state that it seemed nobody would catch up. Have a look at Figure D showing current numbers for states and regions. Currently in the Northeast, only DC, New Jersey, New York and Rhode Island are above the national average (red dashed line) and not by much. Fourteen states are now higher than New York, nine of which are in the South. On a regional basis, the South has an aggregate incidence rate of 2,606 per 100,000, nearly 800 higher than the Northeast. It’s a dead heat between the Northeast and the West (1,860) with the Midwest just a smidgen below (1,810). The highest infection rates in the nation are in Louisiana (3,526), Florida (3,252) and Mississippi (3,248), all above 3,000 per 100,000. These states have higher infection rates than countries with the highest national rates like Panama (2,542), Peru (2,419), Brazil (2,216). All three are more than 1,000 cases per 100,000 higher than the national average.
     Figure E shows the same information for death rates. Here the picture is quite different. New Jersey now has the highest at 161 deaths per 100,000 population, more than 100 greater than the national average (red dashed line). Three other Northeast states are above 120 including Connecticut, Massachussetts and New York. Across the nation, the only state outside the northeast above 100 is Louisiana (118). Most states above the average had extensive outbreaks in large cities early on like Illinois (Chicago), Michigan (Detroit) and Louisiana (New Orleans). Arizona is an exception at 77 deaths per 100,000, where the outbreak didn’t get started till the summer. California (39) and Washington (28), two states hit hard early on, remain well below the national average.
     What it means: In terms of cases, past was no prologue. New York, New Jersey and the rest of the Northeast have faded into the background as summer brought big surges across the South and Midwest. The story on death rates remains very different and points to the fact that COVID-19 may have been more lethal in the initial waves that hit the Northeast (see Headline 1). It remains to be seen whether this discrepancy is related to the virus itself or whether medical interventions have improved or some additional set of factors in combination.
Figure D
  1. Quirky Qorner: What I have learned during this pandemic: toilet paper is funny.
     This blog requires me to spend many, many hours hunting and browsing the inter-webs for COVID-19 related material. Sometimes, I get silly and distracted and I come across articles like this one, or these at bored panda that make me chuckle. It’s worth remembering that memes are information viruses that replicate and “survive” based on the same processes as virus. Bon Apetit.