Weekend COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Saturday/Sunday:
  • Top Story: Anthony “Uncle Tony” Fauci, other experts warn of a post-Christmas “surge upon a surge” as U.S. braces for the worst period of the pandemic (Bloomberg).
  • Los Angeles County is in crisis, reporting a record high 148 new deaths on Thursday. Public Health official Barbara Ferrer told CNN “a person dies every ten minutes in L.A. Country from COVID-19” (CNN).
  • A new study in California shows that from March to August of this year, excess deaths among Hispanics and those without a high school degree or GED tripled. This is important further evidence of how the pandemic has posed the highest risk for low-wage essential workers (JAMA Internal Medicine).
  • Researchers scramble to understand the new variant of SARS-CoV-2 to emerge first in the U.K., now accounting for half of that country’s new cases. Some experts think the current vaccines will work against the new variant but nobody knows that until the studies are done (CIDRAP).
  • More than 1.9 million Americans have now received a COVID-19 vaccine (see Figure A). The Federal government says more than 9.5 million doses have been delivered to the states, but thus far, Illinois is the only state to have vaccinated more than 100,000 persons (New York Times).
Figure A: From https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html
  1. Christmas chaos in the daily data means we are again flying blind this week. U.S. hospitalizations now double the previous two peaks
     The daily tally of new lab-confirmed COVID-19 cases nose dived after December 23 when 206,000 new cases were logged (See Figure B). I am convinced the data is unreliable as a gauge of transmission intensity due to the reporting slow down associated with the Christmas break. Take note of the big dip in daily cases that occurred around Thanksgiving. It won’t be until the latter part of next week or the week after that we will be able to see where the case numbers are headed. It won’t be until the middle of January that we will see the impact of Christmas and New Years Eve as potential intensifier events. The best evidence that daily cases and deaths are downwardly biased can be seen in the daily hospitalization numbers (Figure C). While not immune to administrative sluggishness in reporting, the hospitalization numbers show no sign of a slow down. In fact, according to the data from COVID Tracking Project, Christmas eve saw a record broken for the highest daily COVID-19 hospitalization totals at over 120,000. That’s a significant number in part because it’s double the previous peak waves of hospitalizations seen in late April and July. The national surge is being driven by a handful of states with COVID-19 hospitalizations of 500 per million population or higher including California (500 per 1 million), Pennsylvania (492), Alabama (517), and Arizona (581). The mortality numbers have also nosedived, indicating a 15% drop in weekly deaths (Figure D). I am inclined to believe that this drop is also nothing but an artifact of the holiday reporting hiatus. Again, note the temporary dip in the death numbers around Thanksgiving.
      Bottom line: The case and death data are telling us the virus’s grip on the country is slackening. The hospitalization numbers contradict this, as does previous experience. In both cases and deaths, the magnitude of the dip is already bigger for Christmas than it was at Thanksgiving so we can hold out hope that the declines may be a hybrid of sluggish reporting and a real flattening of transmission intensity. I won’t be holding my breath.
Figure B
Figure C: From the COVID Tracking Project
Figure D
  1. When will the “third” wave be over? Actually, in the U.S., the first wave is still going strong: comparing and contrasting cumulative cases in linear and log scales
     When the daily numbers get wobbly, I am inclined to go big picture. The figures below show cumulative U.S. lab-confirmed cases on both the linear (Figures E), and the log scales (Figures F). As disease detectives, we know these are different ways to graph and depict the same information. I wanted to highlight this to show how linear and log representations produce an effect on the eye that is like looking at a negative and a photo (the same image but inverted). Figure E shows U.S. cumulative cases and how long it takes to add each million cases on a linear scale. It took 58 days to get to our first million, but starting November 2, things shifted; a million cases were reported a week, further intensifying to a million every 5 days from 14 to 18 million. That is rapid growth to be sure. The story here is that November and December have been the worst two months of the U.S. epidemic. Figure F shows the same data but on the log scale with a focus on doubling times. This almost looks like a reverse image, with clearly exponential growth in March and April (exponential growth looks like a straight rising vertical line in log scale). Here, an inflection point is seen at 1 million total cases and again at 4 million with a slowing of new cases and elongation of doubling rates. What we look for on the log scale is a flattening of growth, which signals a shift from exponential growth to simple linear growth. There was hope we would see that in August. That didn’t happen. Instead, doubling rates shrank from 88 days to 57 days in the jump from 8 to 16 million. That is graphically easier to see in the previous graph. What the log scale graph shows is that the first “wave” never actually ended (cases never completely flatten on the log scale). That’s why you hear me pushing back at any suggestion of a second or third wave. So far in the U.S., we have one continuous wave with three distinct peaks.
    That’s not the case in other countries. The last figure shows the log-log plot best suited to signal the end of a wave (look for a sharp hook where the plot becomes straight vertical for some period of time). Figure G was made using Aatish Bhatia’s super-cool website. I include here a handful of countries where a clear hook can be seen, evidence that the first wave of COVID-19 actually ended. For convenience, I show Spain in highlight. After explosive exponential growth in Spain in the early months, the inflection point happens in April after extensive national lock down. In each of the other countries shown, the telltale hook can be seen. The first “wave” ended in Singapore in Mid-July, in early April in South Korea and France, and in late May in Italy. In the U.S., we see three peaks, but no hook.
    Bottom Line: Unlike most other peer nations, the U.S. has never taken the steps necessary to arrest the spread of coronavirus. This, folks is still the first wave.
Figure E
Figure F
Figure G: From https://aatishb.com/covidtrends/?location=France&location=Italy&location=Singapore&location=South+Korea&location=Spain&location=US
  1. Quirky Qorner: A Texas Boy Scout troop created a hug booth for nursing home residents
      As a former boy scout, and a fan of hugging, I could not help but smile when I saw this story in CNN about a Texas scout troop that made a special contraption that allows for protected “hugs” in a nursing home (See photo below). When the story of COVID-19 is finally written, I suspect that the emotional toll exacted by the virus in terms of loneliness and disconnection will prove to be substantially greater than we now are aware. This story will stick in my mind under the best bright spots heading.
Photo taken by screen grab from https://www.cnn.com/2020/12/27/us/boy-scouts-hug-booth-nursing-home-clear-lake-trnd/index.html

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