Weekend COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Saturday/Sunday:
  • Epidemiologists issue stark warnings and predictions about where the U.S. COVID-19 outbreak is headed over the holiday period. Is anyone listening (CNN)?
  • With COVID-19 cases at record levels topping 180,000 on Friday, states including New Mexico, North Dakota and Oregon are rolling out new restrictions (VOX).
  • Student athletes who contracted COVID-19 had their hearts imaged in a recent study. Over a third had heart abnormalities that could later cause serious problems. Most in the study had few or no symptoms. The American College of Cardiology says student athletes should be followed. This is one more example of how SARS-CoV-2 effects everyone (INVERSE).
  • As COVID-19 surges, a vaccine looms and ‘lockdown fatigue’ deepens, a new Ohio State University national survey shows that 38% of Americans plan to attend a Thanksgiving gathering of 10 or more and a third would not ask others to wear masks at holiday gatherings (VOX).
  • This week an outbreak of COVID-19 occurred in the Minnesota State Senate, linked to a Republican senator who tested positive after attending a recent party caucus. As a measure of how deeply politicized the pandemic has become, State Republican leaders urgently warned Republican colleagues about the outbreak. State Democrats, who shared the same spaces, were not told anything (Huffington Post).
  • As concerns rise about the start of flu season, the U.S. Surgeon General Dr. Jerome Adams told NPR there is one sure sign you have COVID-19 rather than influenza: loss or alteration of taste (ageusia/dysgeusia) and/or loss of smell (anosmia) (Eat This, Not That).
  • Grocery stores nationwide re-impose purchase limits on toilet paper, soap and other essentials in response to fears that consumers will overstock as cases surge (Newsweek).
  • A small study of patients hospitalized with COVID-19 between March and July suggests that aspirin may lower risk of being put on a ventilator, admitted to the ICU and in-hospital mortality. Combined with growing understanding of the importance of inflammation and blood clots, this study shows aspirin should be further investigated (Anesthesia & Analgesia).
  1. U.S. cases shoot through the roof. Every Midwest state now white hot
    Friday set a new record as more than 166,000 U.S. COVID-19 were reported (See Figure A). Is it all about rising testing? The answer is a qualified no. Figure B shows that since the trough on September 11, daily testing has doubled from 774,000 a day to over 1.4 million a day (blue line). At the same time, cases jumped 4-fold from 34,000 a day to over 141,000 averaged over a week (red line). It’s not just cases that are through the roof. Figure C shows the U.S. figures for currently hospitalized (light blue) and daily deaths (black). The three peak periods of the U.S. outbreak are clearly visible in Figures B and C. Hospitalizations are now higher than either the April or July peaks, while deaths are now higher than July but lower than April. How long will that last depends on what happens in the next month.
     The overall U.S. situation is rough just about everywhere. COVID Act Now classifies all but 10 states as critical (uncontrolled spread). My analysis suggests it is currently substantially worse in the Midwest region (Figure D). Transmission rates (new daily cases per 100,000 people last week) are above 40 in all 13 Midwest states and over 80 in Iowa (144), Illinois (96), Indiana (83), Kansas (88), Minnesota (101), North Dakota (181), Nebraska (107), South Dakota (150) and Wisconsin (106). No states in the South or Northeast are currently above 80; three Western states are: Montana (93), Utah (93) and Wyoming (116). I continue to believe that cold temperatures accelerate transmission increases based on these numbers.
    Bottom line: Overall, the U.S. outbreak continues to break previous records. While testing doubled in the last 6 weeks, cases have risen 4-fold, a signal that this surge is very real. Deaths are now rising with daily mortality now above the July peak but not yet as high as the nightmare we experienced in April. Hospitalizations are now higher than either of the previous peaks with no end in sight. While a few states have started to take action, I believe there is little reason to think that deaths, hospitalizations and cases will do anything but continue to explode unimpeded.
Figure A
Figure B. From COVID Tracking Project
Figure C. COVID Tracking Project
Figure D.
  1. The BIG picture: New U.S. cases pass 10 million, rate of increase doubles this month. The U.S. is the only developed wealthy nation that still has not stopped the first wave and now has the worst COVID-19 trajectory on the planet
     You have seen the headlines. Cases are still exploding in the U.S. as well as other nations. Let’s step back and see the bigger picture. It took 2 weeks to go from 8 million cumulative cases on October 19 to 9 million on November 2. Since then, the rate of new cases has doubled, rising to 10 million in just 8 days (See Figure E). The word doubling is the key. Obviously the total number of cases didn’t double in a week, but the rate at which cases are rising doubled. The result is we have seen the shortest interval between each million cases by far. We are back to the exponential rate of increase not seen since June.
     The headlines also tell us we are not the only country facing a fall surge. Cases are also spiking in Brazil, Italy, Germany, the U.K., Poland, Russia and Spain (among others). Almost way you compare countries though, the U.S. stands out as the worst. Here are two cases in point. Figure F shows new daily cases from the 10 most impacted nations using Johns Hopkins data. Multiple nations are seeing cases rise, but none has the consistency and rate of climb seen here. The last figure is really big picture – based on log-log plots of the overall trajectories of the entire outbreak in the 15 countries with the highest cumulative cases in the world. I’ll make three points about Figure G, which I made using Aatish Bhatia’s fantastic site. First, the straight dotted reference line shows what we would see in a country doubling cases every 7 days. That’s uncontrolled exponential growth. The U.S. trajectory is the closest overall to that reference line meaning that overall, COVID-19 is growing fastest in this country. Secondly, until April 7, we are the only country that actually saw the outbreak grow even faster than 7-day doubling. Thirdly, the 3 big peaks of the epidemic are clearly visible as humps in the red U.S. trajectory. It is however a mistake (made by many) to call these three separate waves. It is one continuous wave with three peaks. As I have said before, an epidemic transmission wave is over when the log-log plot shows a nose dive resulting in a period of vertical decline signalling a cessation in exponential growth and a shift to additive growth. Of the 15 hardest-hit countries, the first wave ended (if only briefly) in France, Germany, Italy, Spain, the U.K., South Africa, and Peru. In the rest (Mexico, Russia, Brazil, Iran, Columbia, Argentina, and the U.S.) the end of the first wave never happened. That means the U.S. (although one could argue also Russia) is the only highly developed nation that has not been able to control the outbreak sufficient to end the first wave.
    Bottom Line: Things are bad in several countries, but none worse than the U.S. A third peak is in full swing in the never-ending first wave of the U.S. coronavirus outbreak. Meanwhile, the President and the White house have completely dropped out of the game now that the election is “over”. The nation and its leaders waits for a vaccine to save the day, even though that is months from making a difference. Add to this colder weather more favorable to the virus, American’s shifting indoors, the approach of Thanksgiving, and a nation sick and tired of locking down and masking up. The perfect storm gathers.
Figure E
Figure F. Source: https://coronavirus.jhu.edu/data/new-cases, Captured November 14
Figure G: Source: https://aatishb.com/covidtrends/?doublingtime=7&location=Argentina&location=Brazil&location=Colombia&location=France&location=Germany&location=Iran&location=Italy&location=Mexico&location=Peru&location=Russia&location=South+Africa&location=Spain&location=US&location=United+Kingdom


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