Wednesday COVID-19 Briefing

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Top news, reports and insights for today:

1. Curated headline summaries for Wednesday:

• Top story: Hospitals grow increasingly overwhelmed. In the last week, 18 states have set single-day records in patients hospitalized for COVID-19, as cases soar all over the country (Washington Post).
• FDA authorizes first COVID-19 home test developed by Australian company Ellume. It will be sold over-the-counter and produces results that can be read at home. This is an important milestone that may help fill in gaps in our testing regime. The FDA claims the new test has very good accuracy (CNN).
• Nurses in 3 Southern California hospitals strike over staff shortages as intensive care unit availability falls dramatically amid a surge in COVID cases. Consider this the canary in the mine teaching the nation an important lesson about how dire things are in U.S. hospitals (Newsweek).
• FDA says Pfizer vaccine vials hold extra doses which may boost supply of newly authorized preventive treatment (Politico).
• By combining many other studies, researchers have come up with the best estimate yet of the level of increase risk men face from COVID-19. We aren’t yet sure why but compared to women, men who get COVID-19 are almost 3-times more likely to need ICU treatment and have a 39% higher risk of death. That’s all the more striking because men and women are getting the disease at about the same rate (Nature Communications)

2. Possible sign of slowing in new cases. Deaths keep rising. The West is in trouble.
    Yesterday was the first Tuesday in weeks that new cases didn’t jump appreciably higher than the Sunday-Monday totals (See Figure A). It’s hard to find anything positive about a daily new case total of 178,000 but as the red moving 7-day average shows, there is potentially a flattening trend that may foreshadow a slowdown in transmission intensity. This figure alone isn’t compelling, but the state new case growth factors tell a similar story (Figure B). Compared to the previous week, new cases were lower in every Midwestern state for the first time in months. Thankfully, new cases fell by half in North Dakota and a quarter in South Dakota. Decliners outnumbered risers in the West, however California stands out with a case growth of 38 percent. That state recorded 228,000 cases just last week with more than 30,000 cases a day. Worrisomely, this doesn’t include a record high 54,000 cases reported today. Cases are rising in more states than are falling in the South and Northeast. The standout numbers come from Tennessee (+68%), Maine (+42%) and New Hampshire (+22%).
    The death numbers are less hopeful (Figure C). After a typically lugubrious weekend, 2,812 American COVID-19 deaths were reported, capping a week of over 16,500 deaths, a 10 percent rise over the previous week. The trend remains upward; it will be weeks before any decline in new cases translates to lower mortality. The weekly growth factors (Figure D) signal a regional surge in deaths in Arizona (+57%), California (+36%), Colorado (+170%) and Idaho (+23%), New Mexico (+30%) and Nevada (+23%). With ICU beds growing increasingly scarce in several of these states, the West is the region of greatest concern at the moment. Other states with notable growth rate in deaths include Virginia (+46%), New York (+42%), and Pennsylvania (+38%).
     Bottom line: There is some early evidence that new case growth may be slowing this week. We will wait to see if this is real. Even if it is, hospitalizations continue to climb, which means that it will be weeks before the surge in deaths might slow. What American’s do over Christmas and New Years will determine whether the coronavirus has a happy holiday or whether we start to get a better handle on this disease.

Figure A

Figure B

Figure C.

Figure D.

3. Is SARS-CoV-2 worse than influenza? COVID-19 has now killed more Americans than 4 of 5 previous flu pandemics combined
    Since modern epidemiology has been counting, the United States has faced five major influenza pandemics. The one most people have heard of was the erroneously named “Spanish flu” (it actually started in Kansas) that ran from 1918-1919. Over two years, that strain of H1N1 flu killed between 550,000 and 650,000 Americans, which makes it the second worst national disaster behind the Civil War in terms of total loss of life. I have showed you a version of the figure below several times, showing that COVID-19 has killed more Americans than died in various combinations of events. This virus has killed more than the Gulf war, September 11 terrorist attacks, the Korean War, Vietnam War and World War I combined (Figure E). Only the Spanish flu has that beat. COVID-19 deaths also now exceed the number of combat deaths from the Civil war (214,938) although total civilian deaths remain greater. Fewer people may know about the four other influenza pandemics that have struck the world and the U.S. including the “Russian flu” (1889-90), “Asian flu” (1957-58), “Hong Kong flu” (1968-69) and “Swine flu” (2009-10). Combined, those four pandemics are blamed for over 242,000 American deaths over a combined eight years, a total matched by COVID-19 on November 22.
     Bottom Line: As the U.S. approaches 300,000 officially recognized lab-confirmed COVID-19 deaths (the true number is 30-40 percent greater), coronavirus has already claimed almost 50,000 more lives than those four pandemics. All that death has taken place in just ten months. Despite the good news about the arrival of the vaccine, COVID-19 will likely match or exceed the deaths from Spanish flu and become the worst infectious disease crisis in U.S. history. Except for 1918, there has never been a flu like this coronavirus.

Figure E

4. Quirky Qorner: The hottest trend you didn’t see coming during COVID-19: tooth straightening
     A recent story in VICE caught my eye this week. It’s the latest pandemic trend I didn’t see coming. Apparently, companies like invislign and Smile Direct Club are on to something. At first I thought it made sense since social distancing requires us to stay home and away from the social limelight. Perfect time to do a home project that takes months and is best not carefully observed. But then it hit me. Why not straighten the old choppers as long as I have to wear a mask anyway. Oh, to be a bandit or an orthodontist!

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Weekend COVID-19 Briefing

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Top news, reports and insights for today:

1. Curated headline summaries for Saturday/Sunday:

• Top story: FDA authorizes the Pfizer-BioNTech COVID-19 vaccine for emergency use in the U.S. one day after advisory panel recommendation. A second candidate vaccine will be evaluated this week (NPR).
• “Uncle Tony” Fauci says he will get the COVID-19 vaccine in public (Axios).
• U.S. reaches record daily toll of 3,309 coronavirus deaths on Friday according to Johns Hopkins. This exceeds by 6% the previous record set Wednesday (Market Watch).
• The U.S. expects to have 100 million immunized against COVID-19 by the end of March according to the chief advisor to Operation Warp Speed. That may be an overly optimistic estimate coming from the architect of the federal vaccine development effort (Reuters).
• New genetic study published in Science finds that an international pharmaceutical industry conference held in Boston February 26-27 became a super-spreading event resulting in 205,000-300,000 cases (CBS News).
• New Time/Harris survey shows that 1-in-4 Americans are planning to travel for Christmas despite COVID-19 being out of control and experts calling on people to stay home. More than twice as many men (27%) as women (15%) say they will travel for New Years (Time).
• More than 100 million Americans live in places served by hospitals that have no empty ICU beds left (New York Times, See Figure A).

Figure A: From the New York Times

2. U.S. cases pass 15 million. Last week was the deadliest yet as latest 25,000 fatalities added in shortest interval (12 days)
     On Thursday (December 10) the U.S. passed 15 million lab-confirmed COVID-19 cases, making it the only nation with more than 10 million. Last week, the daily numbers were grim: nearly 1.4 million new cases were reported, an average of just under 200,000 a day and the trend lines continuing to rise (Figure B).
    The numbers were even worse in terms of deaths as Thanksgiving-related illnesses continue to drive daily fatalities to new heights. Last week was brutal with 15,885 COVID-19 deaths, a 12 percent rise over the previous week after four consecutive days of greater than 2,500 deaths (Figure C). Weekly deaths rose in 11 of 12 Northeast states with the biggest gains in Delaware (+76%), and Rhode Island (+43%). Substantial jumps were also seen in the South (Arkansas (+42%) and Virginia (+79%)) and West (Alaska (+50%), California (+50%), and Wyoming (+52%). The Midwest was mixed with 5 states declining in weekly deaths and two states spiking hard: Iowa (+78%) and North Dakota (+58%).
   Is the pace of COVID-19 deaths as bad as it was in the worst weeks of April and May? On a number of fronts, the answer is a clear yes. One way is to check the rate at which deaths are occurring nationally. Figure D is my version, counting how many days it takes to add each 25,000 deaths. We went from 25,000 to 50,000 deaths in 13 days starting April 14; until now that was the fastest interval. The jump from 250,000 to 275,000 took just 12 days. We will get to 300,000 faster than that. More hospitals in more parts of the nation are now filled to capacity compared and more state leaders were taking drastic action to stem the tide than is the case now.
    Bottom line: Daily cases continue to spiral with no end in sight. The vaccine will not stop this surge in transmission intensity and the resulting carnage. This last week was one of the worst weeks in U.S. history with more deaths recorded in one day than on D-Day or 9/11.

Figure B

Figure C

Figure D

Figure E

3. Maryland update: how to tell if a state is doing better or worse
    A couple of days ago, a good friend asked me a good question: the test positivity rate in our state (Maryland) is up to 8 percent, but it was way higher (23 percent) in March. Are we faring better or worse and why do we need to go back into lock down? It’s a good question for my state but also for how to know if things are better or worse in yours. It also shows that people have gotten more sophisticated as disease detectives. Did anyone even know what test positivity rate was a year ago and why that number is so important? The first response I had was that it is not possible to adequately characterize the state of the pandemic in any place by looking at any single number at any single moment. Even if you could say that test positivity is the best number (it’a a candidate for sure), the how-well-is-it-going question requires looking at several key indicators in concert and in a larger temporal context. It’s a bit like baseball. In judging one pitcher over another, we can’t just look at wins, or pitch velocity or any single stat by itself. We need to look at a package of stats to make valid comparisons and we need to see that player in the context of a particular team and season. Let’s go through the top 5 numbers and how they are trending to see if we can hit a home run answer.
    We can start with the most basic number – trends in daily cases (Figure F) compiled from the same data source I use for everything else. The Maryland Fall surge started October 23 (715 daily cases) and has soared to now over 3,500 a day (a nearly 5-fold increase). Like every other state, we see two earlier peaks in May and July, and we see a big but temporary dip in cases due to the Thanksgiving reporting hiatus. As smart disease detectives, we know that we can’t compare this peak to the early ones because we were in a completely different testing regime then. We’ll get to that, but we can look at the relative slopes across peaks: the rate of rise is clearly faster now than in spring or summer. One point for things being worse. Next, let’s go to the Maryland Department of Health official numbers for testing volume and test positivity (Figure G). On Friday, the state logged the highest volume of testing (over 66,000); that is 10-times higher than the daily testing totals in April, but it’s also just one day. At its peak, the test positivity rate topped out at 26 percent on April 17. Only 3,800 tests were logged that day. Back then the lion’s share of testing resources were being spent in hospitals verifying the infection status of patients who were already very sick. Almost no testing in the community was yet being done. For lots of reasons, those numbers are apples-oranges compared to now. Maryland increased its testing volume dramatically about mid-July and stayed pretty steady until Mid-November. Comparing test positivity while holding total testing constant is much closer to apples-to-apples. During that time, test positivity trended downward steadily from 5 percent to 3 percent until October 22. We were really doing better. Then (as Figure F shows) the Fall surge started in Maryland. Over the next 6 weeks TPR doubled from 3 percent to a peak of 6.7 percent on December 5. Did testing increases explain that? No. TPR doubled, but testing rose only 20 percent. What about hospitalizations (Figure H)? Compared to the Spring, more acute care beds are full but fewer ICU beds are occupied. That’s because improved treatments are keeping more patients out of the ICU. The overall hospital burden though is higher. Another point for worse. How about deaths (Figure I)? Average daily deaths now are about 6.5 per million, middle of the pack in terms of U.S. states. That’s a 5-fold rise from 1.3 on November 5. It is however 30 percent lower than the 9.7 deaths per million on April 30. It’s apples to oranges again though because case fatality rates have dropped sharply since then as doctors have improved therapies and kept more severely ill patients alive. Remember all the stories about how we were running out of ventilators? Had those advances not occurred, the daily deaths would be roughly double what they are now.
    Bottom Line: Are we doing better than the Spring in Maryland? Some yes (lower daily deaths and ICU beds full), some no (cases and test positivity rising faster than the spring, overall hospital beds more occupied, fewer municipalities in lock down). If we add in the bigger context of what is going on in neighboring states, the bottom line is that we are worse off than the Spring, things continue to worsen and the next 4-6 weeks will be the worst yet in Maryland. Comparing the 26 percent TPR in March to where we are now is like comparing a pitcher’s ERA in high school to his numbers in the big leagues. Having said that, if my state’s Republican Governor acted like his colleagues in Iowa and North Dakota, the situation would be MUCH worse. The case for the strongest possible intervention is, for the next month or two, open and shut. It won’t be forever though, the vaccine will bring us the fresh start we crave in late spring and early summer.

Figure F

Figure G: https://coronavirus.maryland.gov, December 12

Figure H

Figure I.

4. Quirky Qorner: Pandemic weary New Yorkers shell out $100 each for alcohol-soaked hot-tub party in boats on the Hudson river
    The Daily Mail carried a story today that made me just say really? This story may say more about the Daily Mail than it does about the Big Apple. The British news organ has published a dozen stories on the coronavirus-hot-tub nexus from an earlier report about a hot tub party bus in Nashville, to the latest Hollywood craze, hot tubs in tents. Someone’s mind is in the gutter.

https://www.dailymail.co.uk/news/article-9046217/COVID-weary-New-Yorkers-shell-100-hot-tub-parties-boats-Hudson-River.html

Top pick of the day: Sunday

Everything You Wanted to Know About the COVID-19 Vaccine, in One Place

Article by Shannon Palus published online at Slate.com December 11, 2020.

The Pfizer-BioNtech vaccine was just granted the first emergency use authorization (EUA) in the U.S., allowing the company to start shipping the first couple of million doses. A second vaccine candidate developed by Moderna will be reviewed by the special FDA advisory panel on December 17th. We have questions. Here is a nice summary that checks off most of the right boxes from Slate. Stay tuned as further details emerge and send me any specific questions you might have.

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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.