Weekend COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Saturday/Sunday:
  • Top story: The U.S. FDA authorized a second vaccine (made by Moderna) under an Emergency Use Authorization (EUA). The company has begun distributing its vaccine to 3,700 locations as the U.S. vaccine distribution program begins to take shape (Reuters).
  • Twitter announced Wednesday that it would moderate, label and in some cases remove harmful misinformation about COVID-19 vaccines starting next week (CNBC).
  • Thousands of leaked directives show how China paid an army of internet trolls to make the coronavirus look less dangerous and its own response more competent than was true (ProPublica).
  • The WHO and the UK are working closely to monitor the emergence of a new variant of SARS-CoV-2 that might be spreading more efficiently. The new variant has been seen in the Netherlands, Denmark and Australia. Numerous countries are banning flights from the UK in response. There is no evidence yet that the new variant causes more severe disease or will respond differently to the vaccine. This story highlights what has been lost by the Trump administration’s ill-advised decision to withdraw from the WHO and why global coordination is so crucial going forward (BBC News).
  • The U.S. Equal Employment Opportunity Commission has determined that employers will be allowed to require employees to get a COVID-19 vaccine and block them from entering the workplace if they refuse (Huffington Post).
  • While older people make up 80 percent of COVID-19 deaths, many people falsely believe the virus is not impacting younger adults. A new study published in JAMA shows that from March to the end of July, U.S. adults aged 25-44 experienced almost 12,000 more deaths than were expected based on historical norms. Only a third of these excess deaths were officially attributed to COVID-19, suggesting that limitations in testing led to a severe undercounting of virus-related fatalities in younger adults. The chances of dying were more than double among young people in New York and New Jersey in this period (New York Times).
  • New study from Dallas TX adds to growing evidence that SARS-CoV-2 infection in pregnancy is not associated with adverse pregnancy outcomes (JAMA Open Network).
  • Newly released data shows nearly 900 out of 938 metropolitan areas and more than 2,000 out of 3,270 counties qualify as “sustained hotspots,” meaning they have “potentially higher risk for experiencing healthcare resource limitations.” (NPR, See Figure A).  
Figure A: From NPR (see above link), created from data released at https://healthdata.gov/blog/covid-19-open-data-–-our-data-your-data
  1. U.S. daily cases may be leveling but new transmission remains high in all but 9 states. Tennessee has gone ballistic. Hospitalizations have peaked in the Midwest but soar in 3 other regions.
      Friday broke the all-time daily record for most cases with 225,000 capping a 4-day stretch of over 190,000 cases a day (See Figure B). The 7-day moving average is hinting at a leveling trend, but as clever disease detectives, we wonder if this is a peak in cases or testing capacity. This week saw weekly new cases continue to fall in the Midwest, however the force of transmission intensity in that and all other regions remains exceptionally high as all but 9 states have new daily cases per 100,000 population of over 40 (Figure C). The benchmark for a state to have transmission intensity is just 5 (only Hawaii and Vermont are even close). A handful of states are again ‘white hot’ with transmission intensity over 75 including Arizona (90 cases per day per 100,000), California (104), Nevada (83), Utah (76), Indiana (81), Oklahoma (81), Arkansas (75), Delaware (77) and Rhode Island (94). Then there is Tennessee, which has gone ballistic this week, spiking to over 140 per 100,000, rising 48 percent week-over-week. That state this week became the 9th to record half a million cases after racking up 67,000+ in previous seven days.
     Reports continue to pour in about hospitals under stress and ICU beds and staff running short. The COVIDACTNOW site now lists more than 100 metropolitan counties and 88 non-metro counties where the ICU beds are 100% full. Figure D below from the COVID Tracking Project shows the moving average daily hospitalizations for four U.S. regions. In all but the Northeast, hospitalizations are now higher than they have been at any point during the pandemic. Nationally, we have about 110,000 people in hospitals compared to 60,000 during the two previous peaks. The only “good news” in this figure is that hospitalizations appear to have peaked in the Midwest, falling from a max of 29,000 on December 1, to 23,300 yesterday. The rate of increase in the three remaining regions is staggering.
    Bottom line: There may be signs that overall daily cases may be leveling, but transmission remains high in all regions and in all but 9 states. The situation continues to worsen in California, Arizona, Tennessee and Rhode Island. Hospitalizations are exploding at unprecedented levels in three regions, a warning sign that deaths will continue to soar for the next few weeks at least.
Figure B
Figure C.
Figure D
  1. Daily U.S. COVID-19 deaths pass 2,500 a day. Cumulative deaths to eclipse 300,000 tomorrow. Let’s compare state totals and rates
     On Wednesday, a new record for deaths was set in the U.S. with COVID-19 claiming the lives of 3,331 American citizens (Figure E). The daily trend continues to rise, passing 2,500 a day this week. Daily deaths have doubled since November 30 and, given the hospitalization data, are expected to continue to climb. If we look at total deaths by state (Figure F), the carnage looks especially lopsided, with just 9 states reporting 10,000 or more cumulative lab-confirmed COVID-19 deaths, including one out West (California), two in the Midwest (Illinois and Michigan), two in the South (Florida and Texas), and four in the Northeast (Massachussetts, New Jersey, New York and Pennsylvania). It’s a very basic tenet of epidemiology that we can’t compare states using the total numbers to determine which are doing better or worse at keeping citizens alive. COVID mortality is no exception; rather it is a rather apt illustration. We calculate COVID-19 death rates as total deaths divided by total population times 100,000 (Figure G). This picture looks completely different. California and Texas are ranked 2 and 3 in total deaths but have rates that are below the national average, shown here as the red dashed line. North and South Dakota have COVID-19 death rates over 150, the highest in the Midwest; that is triple the rates in California. In the South, Louisiana and Mississippi have rates above 140 per 100,000 but neither state has more than 6,700 total deaths. A handful of states have done dramatically better than average, keeping their death rates below 40, less than half the national average including Alaska (25), Hawaii (20), Oregon (32), Utah (36), Washington (40), Maine (22), and Vermont (18).
      Bottom Line: As 2020 comes to a close, we remain astonished at the wide range of COVID-19 death rates. The best and worst death rates vary by a factor of ten from Vermont (17.5) to New York (183.1). These disparities are further evidence of what happens in the absence of national leadership during a pandemic. The U.S. will pass 300,000 COVID-19 deaths today or tomorrow. That is the most of any nation by far and 19 percent of the world’s grand total death toll. We remain the world’s control group, showing what happens when the Federal government offer’s its people sugar pills, instead of real medicine.
Figure E
Figure F
Figure G

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