Wednesday COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Wednesday:
  • At least 1,707 new COVID-19 deaths were reported Tuesday, the highest daily death toll since May 14 (CNN)
  • The vaccine being developed by Pfizer and German biotechnology firm BioNTech is 95 percent effective at preventing disease, according to an analysis after the trial reached its endpoint. The vaccine trial also reached a safety milestone, with two months of follow-up on half of the participants, and Pfizer will submit an application for emergency authorization “within days,” according to a news release (Washington Post).
  • Moderna’s vaccine also found to be 95 percent effective in trial involving 30,000. The company will apply to regulators in the coming weeks, expects to have 20 million doses available. Unlike the Pfizer vaccine, this one does not require ultra-cold storage (BBC, See Figure A).
  • U.S. hospitals report record high COVID-19 patient load over 73,000. City and state leaders scramble to institute new restrictions to curb the virus (CBS News)
  • As hospitals fill up, now 22 percent don’t have enough staff according to new data just released by the Department of Health and Human Services (The Atlantic)
  • Despite higher risk among American Indian and Alaskan Native populations, the Navajo Nation in Oklahoma has been a hidden success story. How did they do it? They followed the science, instituting a mask mandate in the Spring, free drive-through testing, hospitals well-stocked with PPE and intensive contact tracing using an army of public health officers fully supported by tribal leadership (STATNews).
  • Dr. Anthony Fauci is urging Americans to “think twice” about traveling and having indoor gatherings for the holidays (USA Today).
Figure A:
  1. Attention shifts to rising deaths
     U.S. COVID-19 cases continue to soar higher as daily cases cross 150,000 on the 7-day average (red) curve (See Figure B). Average daily cases have more than doubled since the previous peak in mid-July. Meanwhile, a record high 76,830 hospitalizations were reported yesterday by the COVID Tracking Project (Figure C). That is not double the previous peak but the expectations are that hospitalization rates will continue to climb for several weeks despite growing signs that hospitals are reaching capacity and short on staff.
     While the rise in cases and hospitalizations is alarming, the big story today is the spike in daily COVID-19 deaths (Figure D). The trend toward rising deaths began a month ago when daily deaths were averaging about 685. In main point 3 below, I have a look at the lag between cases and deaths. Yesterday, 1,510 deaths were reported, a higher death toll than at any point during the summer peak and one not matched since May 20th.
    Where are deaths spiking? See Figure E for that. As always, states with small numbers of deaths have gridded bars to indicate unstable estimates of growth factors (the ratio of deaths this week to the week before). For the first time since spring, weekly deaths doubled or more in seven states, three out West (Alaska, Hawaii and Wyoming), Nebraska in the Midwest, Virginia in the South and Delaware and Maine in the Northeast. Increases of 50% or more were seen in Michigan (+75%), Minnesota (+50%), Missouri (+77%), West Virginia (+60%), Maryland (+77%), New Hampshire (unstable), and New Jersey (+79%). Thankfully, weekly deaths were trending down 10% or more in California, Nevada, Kansas, Oklahoma, Arkansas, North Carolina and Washington DC. Some states where deaths are spiking still have significant hospital bed and ICU capacity. For example, in my home state of Maryland, deaths rose 77% from 52 to 74 last week while the state retains three-quarters of its available ICU bed capacity. Nebraska, on the other hand, jumped 94% but are now using 72% of their ICU beds. Several states, including Montana, Oklahoma and South Dakota, are reporting that all ICU beds are full.
    Bottom line: U.S. cases continue to rise at a rapid pace. We will have to wait for the rest of the week’s data to see if there is any sign of a slow-down. Meanwhile, the attention shifts to a sharp spike in deaths yesterday. As hospitals and ICU beds fill up, and staffing shortages mount, we will have to monitor things closely for signs that health care systems are not keeping up. Remember that overall death rates have come way down since the spring peak thanks to the work being done in the health care sector. As hospitals become overwhelmed, deaths will skyrocket and those gains will be erased.
Figure B
Figure C
Figure D
Figure E.
  1. Lag analysis: how long after cases and hospitalizations rise to deaths surge?
     I want to talk about lags. Lag is the time gap between different features of an epidemic. Understanding the dynamics of any outbreak is all about these lags. There is the lag between exposure to the virus and infection (that we call the incubation period). Then there is the lag between infection and symptoms, the lag between symptoms and seeing a doctor, the lag till seeking a test, the lag in receiving test results, and the lag till hospitalization and ultimately to recovery of full health. Another critical lag is the time between inflection points in test results (our proxy measure of cases), hospitalizations and deaths. I decided to go back into the data and look carefully at two such lags. There are lots of details here, and my analysis is not perfect, but I’ll cut to the chase and show you 5 graphs in Figure F that explain what I found. The first 4 represent the lag (days) between the inflection point in cases (when cases bottom out and shift upward) in the second and third peak for the whole country and for 3 regions. For the entire country, the lag between cases rising and deaths rising was 26 days for the second peak and 34 days for the third (Figure F1). In the South, there was no second peak inflection point, but the 3rd peak lag was 33 days (Figure F2). In the Midwest, the 2nd peak lag was 29 days (Figure F3), while the lags were longest in the West at 46 and 31 days respectively (Figure F4). We would expect the lag between hospitalizations and deaths to be shorter; they are at 16 and 14 days (Figure F5).
    Bottom Line: Looking at lag times is useful for lots of reasons. In the U.S., the pattern is pretty clear and consistent. Once cases bottom out between peaks and start to rise again, then deaths will start to rise about a month later (median of 6 observed lags was 32 days). The lag between rising hospital admissions and deaths is about half as long or two weeks. Next week I will look instead at the lag between the peak of cases and the peak of deaths.
  1. Quirky Qorner: COVID-19 denier Elon Musk has apparently contracted the virus. That was enough to get him banned from the launch of the Crew Dragon spacecraft. Musk is not happy.
     Elon Musk, the controversial head and founder of SpaceX announced on Twitter that at least one of the COVID-19 tests he took was positive. How inconvenient for the billionaire mogul who has been a skeptic of the disease for months. According to a story in Fatherly, Musk has only cold-like symptoms but the timing could not have been worse. NASA and SpaceX were scheduled to launch their jointly developed rocket ship to the international space station on Monday (which they did) and Musk had intended to attend. Apparently he wasn’t happy when NASA administrators blocked him from doing so for obvious reasons (see photo below).

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