Daily COVID-19 Briefing: Wednesday

Top news, reports and insights for today:

1. Daily headline summaries for Wednesday:

• The U.S. death rate from COVID-19 per 1 million people just passed 340. That’s more than 100 times the rate in China (Time)
• A trend toward a “second U.S. virus wave” emerges in 22 states after reopening (Bloomberg)
• As harvest season nears, outbreaks seen among migratory farm workers in North Carolina, Florida and Washington. The federal government has not made safety rules mandatory, leaving it to farmer’s discretion (Politico)
• Half the states (including California, Florida, North Carolina and New York) are failing to follow CDC guidelines and reporting probable coronavirus cases and deaths, leading to inconsistent and inaccurate surveillance (Washington Post)

2. Back to where they started: Epidemiologic deja vu in 14 states that have matched or exceeded daily cases compared to April/May peaks
   The President continues to say and do things that suggest he believes the epidemic is over and behind us. A journalist sent me an inquiry yesterday asking my opinion on whether a second wave might be in our future now that the first one is over. A new poll suggests that about half the country thinks it’s time to get back to normal life.
   Huh? I remain puzzled and wonder what information people could possibly be looking at. Internationally, we have seen the epidemic move from country to country, rising and falling in the global whack-a-mole pandemic we are in. Months ago it was Italy, France and Spain in the hot seat. Now it’s Brazil, Peru, India, Russia and Chile. The same shifting is occurring in the U.S. as one state grows quiet as another surges. What strikes me when looking at the New York Times tracking data is just how many states seem to be right back where they were during the peak period of April and May. After looking closely, I believe there are 14 states that now meet or exceed the high water mark of daily cases. Take a look at the two image galleries below. The first one shows the 8 states where the recent 7-day moving average for daily new cases is higher (and in some cases much higher) than the peak in April/May. The second gallery is the 6 states where recent average daily cases are about the same as they were at the April/May peak. Some of these states are quite striking. Arizona averaged under 300 cases a day throughout April and May, and is now above 1,000 after an alarming rise starting May 27. Arkansas peaked at under 200 a day April 26 and has now risen to over 300 a day. California, North Carolina and Utah are all essentially on a continuous rise since the start of the outbreak with little notable drop off in new daily cases. Texas and Oregon both appeared to peak twice, with a corresponding dip in new cases in late May, but in both states, cases have surged to all time highs with continued transmission intensity. In the lower gallery, we see that Florida, Kentucky, Nevada, New Mexico and Tennessee, all had noticeable peaks in April/May, and all have seen resurgence of new cases back to about the same peak levels in recent days.
   The bottom line: Overall, new cases remain close to flat in the U.S., as many states are seeing sustained declines. However, the rest of the story is that 14 states are right back to where they were in the peak period of April and May and 8 of those states are setting new records. Texas, Arizona, Florida, Nevada, South Carolina and Mississippi were the most aggressive in reopening 2-3 weeks ago.

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  Arizona

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  Arkansas

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  California

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  North Carolina

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  Oregon

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  South Carolina

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  Texas

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  Utah

States where new cases are higher than April/May peak

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  Florida

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  Kentucky

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  Mississippi

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  Nevada

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  New Mexico

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  Tennessee

States that have matched earlier peaks

3. Not just increased testing: COVID-19 hospitalization rates rising in reopening states, mirroring trend in rising cases
   A story in Bloomberg highlights what the article calls a “second U.S. virus wave” emerging in reopening states. They mention that hospitalizations in Texas jumped 6.3% on Tuesday to 2,056, the highest total since the pandemic emerged. California hospitalizations are at their highest point since May 13 and have risen 9 of the last 10 days. This nudged me to go back to my favorite source of state-level data on hospitalizations from the COVID-19 Hospitalization Tracking Project at the University of Minnesota Carlson School of Management. While their data doesn’t cover all states, the figure and table below captures a few that have surging cases. The graph shows daily COVID-19 hospitalizations per 100,000 adults for 6 states. Since May 17, the largest increase has been in Arizona, where rates rose by 56%. North Carolina saw the second highest rate rise and 57%. Rates are up nearly a third in Kentucky, Texas and Utah. California is back to where it was in late April.
   Why does this matter: Tracking hospitalizations may be a more accurate window into the epidemic than other measures that depend on testing. These data show, I believe, that hospitalizations are rising in line with expectations of post-reopening increases in transmission intensity. The situation in Arizona is especially extreme.

State	May 17	June 9	Change	% Change
Arizona	14.9	23.3	+8.4	+56%
California	10.3	11.4	+1.1	+11%
Kentucky	11.4	15.7	+4.3	+38%
North Carolina	6.3	9.9	+3.6	+57%
Texas	7.4	9.4	+2	+27%
Utah	4.8	5.9	+1.1	+23%

From the COVID-19 Hospitalization Tracking Project, University of Minnesota, Carlson School of Management, captured 6/10/20

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Daily COVID-19 Briefing: Tuesday

Top news, reports and insights for today:

1. Daily headline summaries for Monday:

• As Americans celebrate Memorial day, new cases continue to rise in 17 states, stay flat in 13 and are going down in 20 (CNN)
• All eyes remain on Georgia where cases have declined slightly since reopening began with a slight uptick since May 12. So far there has been no spike of cases and test positivity rate are falling and daily tests are rising (CNN)
• Largest study yet published in Lancet of impact of antimalarial drugs hydroxychloroquine and chloroquine in COVID-19 found the drugs had no benefit and were associated with higher risk of death in hospital patients (CIDRAP)
• Recent study shows that state-level stay-at-home orders were consistently followed by reductions in daily infection rates in 42 states and DC studied (American Journal of Infection Control)

2. U.S. cases remain flat, deaths continue to trend downward, midwestern and southern hotspots remain
    Over the last week, U.S. cases (top graph) show a generally flat trajectory adding more than 152,000 infections, a rise in cumulative cases of 10%. The U.S. now has a third of all cases on the planet, more than 1.3 million more cases than Brazil, now at #2. Among nations with more than 100,000 cases, the U.S. now ranks second in cases per 1 million population at 5,098 behind Spain (6,050) and ahead of the UK at 3,825.
    As always, we pivot from the overall national numbers to what is happening in states. The middle graph shows 7-day change in cases by state and region. Seven northeast states had less than 10% case increases and none had more than 25% increases. Similarly, 7 of 13 western states saw slow case growth and none rose more than 20%. As was true last week, the epidemic has shifted to the midwest and south. Among the states that saw cases grow more than 25% (a rate of doubling in 4 weeks), 2 were in the midwest (Minnesota and North Dakota) and two were in the South (Arkansas and North Carolina). Kentucky, Michigan and Louisiana were the only states in these two regions with less than 10% growth in cases (although Kentucky hasn’t reported new cases since Saturday).
    The bottom figure shows the overall trend in COVID-19 deaths by day. In contrast to the steady continued rise in cumulative cases, the trend in deaths is more clearly toward decline in daily deaths as evidence by the 7-day moving average line. Sunday and Monday again saw new deaths below 1,000, although in the past 3 weeks, similarly low numbers were followed by substantial jumps on Tuesday as the weekend lag ends and state authorities catch up.
    What this means: Despite warming weather, the epidemic continues to yield rising cases, especially in the midwest and south, even as deaths drop. Minnesota, North Dakota, Arkansas and North Carolina continue to be the U.S. hotspots. Experts brace for new surges in cases and deaths.
   

3. The new front line of the coronavirus epidemic is in rural America: a deadly ‘checkerboard’
   A recent article in the Washington Post by Reis Thebault and Abigail Hauslohner highlights a theme that I have stressed over the last week. Two months ago, many were convinced that COVID-19 was a crisis for big coastal cities in densely populated places like Los Angeles and New York. In the whack-a-mole story of this epidemic, a very different picture emerges as May comes to a close with the U.S. poised to pass 100,000 deaths and 2 million cases in the next few days. We are reminded that viral outbreaks spread like water from area to area, seeking a favorable ecology for transmission even as barriers to transmission succeed in the places initially attacked. The top graphic, taken from the Washington Post article shows the whack-a-mole effect. Until the middle of April, the majority of cases were in the 14 counties that were initially impacted, while the fraction of new cases over the last 6 weeks are in the rest of the country. As of this week, there are now twice as many cases elsewhere than in New York, Washington, Detroit and New Orleans. The bottom graphic from the same article shows that while death rates have dropped substantially in large cities and their suburbs, those rates are largely flat in small cities, towns and rural counties. The shift to small towns and rural communities is fueled by a variety of factors very few thought of in the epidemic’s earlier days. Of the 25 rural counties with the highest per capita case rates, 20 have a meatpacking plant or prison where the virus took hold and spread rapidly, then jumped to the surrounding community when workers took it home. Like all other health scourges, the coronavirus has capitalized on the spatial patterning of poverty, racism and inequality to find cracks in our epidemic control measures. Take for example Texas County, Oklahoma, where predominantly Hispanic workers from a local pork processing plant started filling the local hospital with symptoms. Two weeks ago, state health officials finally tested everybody at the plant and found 350 positive cases among the 1,600 asymptomatic plant workers, roughly 4-times more cases than had been known.
   What it means: Lack of adequate health care resources, language and cultural barriers, poverty, lack of testing, low adherence to social distancing measures have all conspired to create the conditions for the coronavirus epidemic to seep into high-severity pockets across rural America. At the same time, there are still 180 counties across 25 states that report no positive cases. This has made middle-America look like a checkerboard of risk.
   
   

Top pick of the day

Their States Are in Crisis. They’re Declaring Victory Anyway.

Article in The Atlantic, Politics by Elaine Godfrey, May 8, 2020

Five republican governors have claimed victory over the virus. In four of those states, cases are rising. The growing disconnect between what some officials are claiming and what the data shows.

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.