Wednesday COVID-19 Briefing

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Top news, reports and insights for today:

1. Curated headline summaries for Wednesday:

• Top story: U.S. daily deaths top 3,000 for the first time on Wednesday with additional data still rolling in. Reports of hospitals running out of ICU beds are on the rise (CNN)
• The first signs of a post-Thanksgiving surge in coronavirus cases are beginning to show up in data released by states across the country in a troubling prelude of what may become the deadliest month of the pandemic so far. In the summer wave, the virus was spreading fastest in Arizona, where at its peak 380 residents per 100,000 were becoming infected every week; now, 35 states have per capita infection rates higher than that (The Hill).
• New poll says American’s COVID-19 fears are stronger than they have been in months as worries intensify about job security, paying bills and the prospects of returning to normal (Axios, See Figure A).
• Los Angeles county passes 8,000 COVID-19 deaths with cases, hospitalizations and new deaths spiraling out of control. Public Health Director Barbara Ferrer calls it an “incalculable loss” for the region (USA Today)
• Chief infectious disease doctor Anthony “Uncle Tony” Fauci says (again) that we should “close the bars and keep the schools open” as evidence mounts that indoor congregation at drinking establishments is pouring gas on the fire (Eat This Not That).

Figure A.

2. It’s now 9/11 every day
    On Tuesday more than 191,000 COVID-19 cases were reported putting the U.S. at 14.5 million total cases and over 1.3 million in the last week (See Figure B). That 7-day rise increased the total by over 10% – an indicator that this country is back to exponential growth in cases after the Thanksgiving dip. It is my view that we are starting to see the consequences of Thanksgiving-related exacerbation of transmission intensity. Where are new cases the highest? Everywhere except Hawaii (Figure C). After weeks of sky-high transmission intensity in the Mid-west and West, we now see all but two states in the South above 40 daily cases per 100,000 with two states above 70 (Arkansas and Tennessee). The worst state at the moment is Rhode Island which soared to over 124 reaching Dakotas territory. The Northeast is rapidly catching up with the Midwest and now has three states over 70 (the other 2 being Connecticut and Delaware). As the Northeast catches fire, the Midwest remains white hot with 9 states still over 70 (Illinois, Indiana, Kansas, Minnesota, North Dakota, Nebraska, Ohio, Oklahoma and South Dakota).
      Bottom line: The September 11th terrorist attacks of 2001 killed an estimated 2,977 Americans in what was widely seen as the worst tragedy of the 21st century in the United States. At this writing, WORLDOMETER reports more than 3,200 deaths for Wednesday, after 2,581 on Tuesday (Figure D) and likely more than 3,000 tomorrow. We are recording 9/11-level mortality every day. Where are deaths rising? Everywhere (except Montana, See Figure E).

Figure B

Figure D

Figure E

3. U.S. Government releases new, more complete data for monitoring COVID-19-related hospital burden. What it says: 21 states are running out of ICU beds and 25 states are under stress
    Last week I was complaining about the lack of good data for monitoring hospital utilization, telling you we were flying blind. NPR just had a story about a new release of government hospitalization data on Monday. This data is not perfect but represents a step forward and shows that I am not the only one complaining about this important weakness in our national surveillance. I spent the day digging into the numbers; I made two graphs (I had to do it myself because the HealthData website is hardly close to user-friendly). I’ll spare you the technical details, but the thing I was most interested to see is the estimated fraction of an entire state’s ICU bed capacity that is currently filled. The most recent data available is for December 4 (Figure F). Any state that has headroom of less than 20% of it’s ICU capacity is under stress. Having parts of one or two states in this situation would be bad news. There are currently 21 states with 80 percent or more of ICU beds occupied, with five over 90 percent (North Dakota, Rhode Island, Oklahoma, Alabama, and Missouri). North Dakota is estimated at 100% full on 12/4. This data is a few days behind. COVIDACTNOW reports that 5 states are now 100% maxed out in terms of ICU capacity (Oklahoma, New Mexico, New Jersey, Tennessee and Nevada). That’s five U.S. states where there are zero ICU beds available in the entire state!
   Another measure of hospital stress is the percent of all in-patient hospital beds taken up by COVID-19 patients. It is similar to the test positivity rate in the testing data but applied to hospitals. When more than 15% of a state’s hospital beds are filled with COVID-19 patients, the hospital system is under stress in terms of staff, resources and equipment. The December 4 data showed that 25 states meet that standard (Figure G) with seven states at 20% COVID-19 patients (Michigan, Maryland, South Dakota, Rhode Island, Arizona, New Mexico and Nevada).
    Bottom Line: I welcome the federal government’s attempt to increase access to vital information. The new release reported by NPR is welcome. There is still a long way to go. The bottom line is that U.S. hospitals are under tremendous strain right now with reports increasing by the day that the situation is quickly turning code red.

Figure F

Figure G.

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Top pick of the day: Wednesday

A vaccine is not enough. How America’s COVID-19 epidemic ends.

Article by German Lopez published online at VOX.com December 8, 2020.

I worry that America is hoping and waiting for the new vaccines to be the cavalry that rides over the ridge to save the nation’s bacon. I suppose I have been harping on this, and I know most people don’t want to hear it, but we must recognize what this article makes plain: a vaccine will not arrive in time and in enough numbers to quell the current surge. While Israel and the European Union have managed to stop the Fall surge through lockdowns and various control measures (see the Figure taken from the article), the U.S. seems to be stuck in neutral while cases and deaths keep rising unencumbered. I wish there were more choices available to us but it really comes down to this: the next 6-8 weeks can either be bad, or super-bad. This article in VOX I think lays it out nicely. COVID-19 is now killing as many Americans as died in the 9/11 attacks every day. Whether that gets a little worse or a lot worse in the coming weeks depends on what we do as a nation now.

Screen grab taken from https://www.vox.com/future-perfect/2020/12/8/22152652/covid-19-vaccine-coronavirus-pandemic-christmas

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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.

Weekend COVID-19 Briefing

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Top news, reports and insights for today:

1. Curated headline summaries for Saturday/Sunday:

• Top story: COVID-19 is killing more than 2,000 people a day in the U.S. as infections and hospitalizations hit records (CNBC).
• With coronavirus cases surging and ICU capacity rapidly nearing dangerously low levels, nearly 85% of California residents will soon be under sweeping new stay-at-home orders until Christmas (NPR).
• More than half of New York City firefighters told their union they will refuse the Pfizer COVID-19 vaccine when it becomes available to first responders. While willingness to get vaccinated has been edging higher in recent polls, this and other targeting surveys shows there remains a lot of work to do for public health experts to convince Americans to adopt a new vaccine (New York Post).
• Darknet drug dealers are now selling ‘Pfizer COVID Vaccines’ on line. The black market in COVID-19 treatments has arrived (VICE).
• More than 30 million jobs have been lost during the coronavirus disease 2019 (COVID-19) pandemic. Unemployment insurance (UI) was temporarily expanded by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. A new study shows that those who received benefits were at lower risk for unmet health-related social needs, delaying health care, and depressive and anxiety symptoms. This is important because expanded UI is set to expire soon without action by a paralyzed Congress (JAMA Internal Medicine).
• One of the best ways to tell if people are avoiding getting health care is the rate that children show up at hospitals with their appendix exploded. Compared to 2019, overall hospital admissions for appendicitis dropped by 55% but the rate of burst appendices rose 20%. Patients are delaying life-and-death treatments due to COVID-19 (JAMA Open Network).
• With more than 100,000 Americans now hospitalized, hospitals across the nation are nearing the breaking point. We have now entered the phase of turning patients in ambulances away (shunting), rationing care, and lowering treatment standards. This will further inflate the death toll (AXIOS).
• The Fall surge in cases started 2-3 weeks earlier in Europe. The difference now is that Europe successfully bent its curve in response by going back into lockdown while the U.S. has not (Axios, See Figure A).

Figure A. From https://www.axios.com/us-europe-coronavirus-lockdowns-d2bb7b6c-a1c4-4a30-a4a3-8f564775dd74.html

2. U.S. not yet peaking as weekly cases surge post-Thanksgiving. Daily deaths jump over 2,000 for the first time since previous high on April 21. Hot spot shifts to the Northeast as cases, hospitalizations and deaths rise their fastest
    The Saturday U.S. daily COVID-19 cases soared to a record high of over 203,000 wiping out hopes that we may have peaked (See Figure B). The dip seen in the weekly numbers (red dotted line) over the last week is, as I had warned, an artifact of the Thanksgiving slow-down. At the state level, the main message is that the growth factors show conclusively that the epicenter has again shifted, this time to the South and Northeast as every state in those two regions except Virginia saw new cases rise by 10 percent or more this week compared to the week previous (Figure C). Increases were most extreme in Alabama (+61%), Mississippi (+79%), South Carolina (+43%), Massachussetts (+62%), Maine (+44%), New Hampshire (+52%), New York (+41%) and Vermont (+77%). Thankfully, new cases fell in all Midwest states except Indiana (+16%) with states both rising and falling out West.
    In addition to big increases in daily cases, the rise in hospitalizations has been especially rapid in recent weeks. Figure D shows the trends in the numbers hospitalized each day since September 1 in the four regions. While 62 percent of the current hospitalizations are in the Midwest and South, numbers have risen fastest in the Northeast, surging more than 8-fold higher. This is important because we remember how the worst suffering and death occurred in April when hospitals in New York, New Jersey and Connecticut became over-whelmed. Right now COVID-19 is killing more than 2,000 a day, and that is before the deaths caused by Thanksgiving are counted and before things return to crisis levels in the Northeast.
    On Saturday, another 2,263 deaths were reported in the 50 states and DC (Figure E), culminating a week that saw 14,235 COVID-19 deaths in total. This marks the first time since the previous record high on April 21 that the 7-day moving average has exceeded 2,000 daily deaths (dark blue dotted line). The weekly state growth factors for deaths are, frankly a complete nightmare (Figure F). Weekly deaths are going up virtually everywhere (except Montana, South Dakota and Louisiana, all of which were already very high). No region of the country is spared this week with weekly deaths rising by 100 percent or more in Washington (+164%), Kansas (+116%), Nebraska (+144%), Alabama (+146%), South Carolina (+119%), Maine (+112%), New Hampshire (+140%), and Pennsylvania (+108%). Deaths rose by 50 percent or more in another 11 states.
     Bottom line: Despite soaring cases, hospitalizations and deaths, few states are taking the actions needed to bring the virus under control (See California for an exception). While the Fall surge has been arrested in Europe, America is stuck in the inertia of government incompetence and the false hope that the vaccine will come to the rescue. Meanwhile, cases, hospitalizations and deaths are all shifting toward the next epicenter: the Northeast. All of this is occurring before the nation’s Thanksgiving bill comes to the table and must be paid.

Figure B

Figure C.

Figure D.

Figure E.

Figure F.

3. Top 10 things you need to know right now about the first 3 COVID-19 vaccines
    This is a big week in the epic battle between the United States and SARS-CoV-2. This Thursday, the super-important FDA advisory committee will meet to decide whether to recommend approval of the first of three coronvavirus vaccines that are headed our way. The one they will consider on Thursday, developed by Pfizer and their German partners BioNTech, received approval in the UK last week. The second vaccine will be reviewed a week later by the same committee. Both vaccines have finished phase III efficacy trials to a sufficient degree that they have submitted official applications for approval under an emergency use authorization (or EAU) from the FDA. At this point, all we really know are the headlines from corporate press releases and news accounts, we don’t yet have the details or the data. But, since everybody is talking about vaccines, and because I have been boning up on the science behind it, I thought I would weigh in with a top 10 list:
   1. The first two vaccines have been developed and tested in record time, accomplishing in less than a year what normally takes 5-10 years to do. This was done in part by harnessing a new technology developed outside the vaccine world that represents a huge departure from the typical way we make vaccines. Like all new technologies, this comes with both great promise and great challenges.
   2. The traditional method of making a vaccine is to inject an inactivated, damaged or attenuated version of the actual virus into the body so that the immune system can recognize and destroy the real thing when it shows up. Two things make that kind of vaccine especially hard to develop. 1) Researchers have to make sure that the vaccine virus is really safe and 2) producing the vaccine requires actually growing this phony virus in labs which can’t be ramped up easily. The new mRNA vaccines take shortcuts on both counts (introducing only bits of protein-making instructions rather than a whole virus, and the vaccines are comprised of 100% synthetic molecules that can be manufactured on a mass scale much easier without having to “grow” anything).
   3. Neither of the top candidate vaccines have yet been tested in children. However, special mini-trials are now underway in 12-17 year olds for both of the top 2 candidates.
   4. The clinical trial results appear to show very high vaccine efficacy, ranging from 95% for Moderna and 90% for Pfizer. That roughly means that in the trial, the chances of someone getting COVID-19 who got the vaccine was 10% or less. That is much higher than is typical for a new vaccine. There are important caveats: a) that effectiveness was measured at the maximum right after the second dose and says nothing about what effectiveness will be months later; b) 90-95% effectiveness applies to the people who were in the trial and may not translate to the general public due to “volunteer bias”. All this will be sorted out in time.
   5. Both companies are claiming their vaccines are safe. However, safety is never absolute when it comes to vaccines. Instead, safety is judged relative to the risk of the disease it is suppose to prevent. Both vaccines are known to cause mild reactions in roughly 10-20% of people. That is totally normal and expected. A vaccine’s job is to cause an immune reaction – which inevitably produces symptoms such as tiredness, soreness at injection site, and headache in some people.
   6. Serious and life threatening side effects are being monitored and will be going forward. However, fewer than 100,000 people have been given these vaccines. While those are big numbers, it won’t be until we tens of millions get them that we will be able to fully quantify the risks. That is how all vaccines work.
   7. If the Pfizer vaccine is approved, the company has about 40 million doses ready for the U.S. market (enough for 20 million people because each person requires 2 doses). The plan is to vaccinate residents and staff of long-term care facilities (about 3 million) and essential health care workers (21 million) first. That’s more than we will have initially. Subsequent batches of vaccines will be distributed to states and given to various higher risk groups. If things go according to plan, adults at low risk will likely not have access to the vaccines until at least the Spring and Summer of 2021.
   8. These vaccines were not tested in pregnant women; at least not intentionally. As is always the case, it will be discovered that some women were pregnant while in the trials and a special system is set up (called VSafe) that will monitor and study what happens in these women and their babies.
   9. The clinical trials that were done evaluate only one question: does a vaccine prevent COVID-19. It is not known if the vaccine lowers the risk of death related to SARS-CoV-2 infection. It is unlikely but not impossible that the vaccine prevents less severe disease but has only a marginal effect on COVID-19 death risk.
   10. Bottom Line: None of the three initial vaccines will arrive in time in enough numbers to get us out of the mess we are now in with the state of the epidemic in the U.S..

Figure G