Saturday COVID-19 Briefing

---

Top news, reports and insights for today:

1. Curated headline summaries for Saturday:

• “Uncle Tony” Fauci warns 7 states to take extra precautions over the Labor day holiday to prevent COVID-19 surge (Huffington Post)
• Up to two-thirds of Americans say they won’t get COVID-19 vaccine when it’s first available, new poll shows (USA Today)
• After facing criticism for high cases and a go-it-alone strategy, now Sweden has one of the lowest COVID-19 death rates in Europe (CNN)
• Widespread COVID-19 vaccines not expected till Mid-2021, WHO says (Reuters)
• A new study (not yet peer reviewed) reports on experiments that show when SARS-CoV-2 was introduced to heart muscle cells, it resulted in “carnage” on the slides, providing clues to explain widespread evidence that COVID-19 does lasting harm to some hearts (STATNews)

2. U.S. COVID-19 cases spike to 50,000 on Friday, total cases exceeds 6 million. Big spikes seen in the Midwest
   Things were looking good for a slow-down in new cases in the U.S. for about 10 days. I said on Wednesday it appeared the slow-down might be stalling. Like a cold slap in the face, Friday’s numbers leapt to over 50,000 for the first time since August 15 (Figure A). Driving this spike were large rises in several key states increasingly in the epidemic’s cross-hairs (Figure B). Of the nine states with a rate of new case growth of 20 or higher, six are in the Midwest where conditions continue to deteriorate. They include Iowa (+5,851 new weekly cases), Kansas (4,172), Missouri (+9,223), North Dakota (+1,863), Oklahoma (5,780), and South Dakota (2,079). Growth factors in that region showed increasing weekly cases in all states except Michigan and Iowa. The Northeast and West both remain relatively calm although notable surges in cases were reported in Hawaii. Although new cases fell for the week in California, that state still reported over 33,000 new cases in the last 7 days.
   What does it mean: We are still in deep whack-a-mole in the first wave of the U.S. outbreak. We get lulled into a false sense of progress when cases slow in one region, only to see big surges happen in another (in this case the Midwest). Figure C shows the big picture as we eclipse the 6 million case threshold. The most recent 500K cases were added in 12 days (compared to 11 days in the previous half million). The big picture remains largely stable as the U.S. outbreak enters a seventh month.

Figure A

Figure B

Figure C

3. How is the U.S. doing compared to other nations in the Western hemisphere? Not great.
   As disease detectives, we seek to make apples-to-apples comparison to see how things are changing in different countries. The best way to do that (as I have explained before) is to use Log-log plots showing standardized growth trajectories of cases and deaths setting each country to a time metric indexed by days since a fixed number of cases (as opposed to calendar time). Figure D below does that for cases. The diagonal reference line shows the rate of growth if cases are doubling every week. Countries where cases are growing faster will be above that line, slower nations are below it. The U.S. is the pink line. This figure paints a particularly grim picture. Almost all the nations in our hemisphere saw rapid growth for the first 10,000 cases (on or above the 7-day doubling line). After that, every nation except the U.S. managed to react in a way that slowed the pace of new cases. After about 20,000 cases, every other country managed to get under the 7-day doubling rate. The U.S. didn’t get there until 500,000 cases. This tells us that the first half million cases were especially costly and put us substantially behind the 8-ball. The pace of the US epidemic slowed between 500K and 2 million. Then, things went very badly again: the rate of growth spiked severely between 2 and 4 million. Even compared to Brazil, the U.S. trajectory shows an inability to react early and to maintain epidemic control measures at critical points. While new case growth has been extensive in Argentina, Columbia, Peru and Mexico, none of those nations saw the prolonged unregulated growth seen in the U.S. Canada, which shares exposure to colder weather in the Northern hemisphere, is hidden here among a second cluster of countries that have dramatically better profiles.
   One might argue that the U.S. was testing more than these countries so perhaps cases are the wrong thing to look at. Plus, the U.S. has far more sophisticated health care systems so certainly we won’t see the same pattern for deaths. I’m afraid that picture is equally discouraging (Figure E). Between 100 and 100,000 deaths, even Brazil out-performed the U.S..
   Bottom line: The U.S. has done worse than any other nation (including Brazil) in the Western hemisphere in controlling the speed of the epidemic both in terms of cases and deaths.

Figure D: created by me using COVIDTrends website showing standardized rate of case growth among Western hemisphere nations as of Sept 4.

Figure E: created by me using COVIDTrends website showing standardized rate of growth in reported deaths among Western hemisphere nations as of Sept 4.

Advertisement

Daily COVID-19 Briefing: Monday

---

Top news, reports and insights for today:

1. Daily deadline summaries for Monday:

• Exponential increase in COVID-19 cases continue in Florida as local leaders attempt to crack down on people and businesses. Evidence mounts that recent surges have been mostly among young people (CBSNews)
• Hospitals are gaining new knowledge about how to combat COVID-19 in patients by sharing information and trying new strategies. One promising approach involves using old treatments to address blood clots (Scientific American)
• Oxford university researchers have begun testing their vaccine in Brazil and other hard-hit countries to evaluate potential efficacy (BMJ)
• New poll says 64% of adults believe the CDC mostly gets the facts about the outbreak right; 30% say the same about Trump and his administration. A rising fraction of both Democrats and Republicans now say the epidemic is exaggerated (Pew Research Center)

2. U.S. now in exponential growth of daily cases, fastest rate of increase since the epidemic began. Does anyone care?
   The U.S. has exceeded the highest previously recorded daily total cases in each of the last 5 days. We are used to seeing significant drops in reported cases on Sunday and Monday for each week since March due to reporting lags (darker blue bars). Astonishingly, the Sunday and Monday reports are still higher than any day that occurred during the first “peak” in late April. Not only are cases rising past that first peak, it is now more evident that it’s rising exponentially. For a clearer view, see the bottom figure showing the total accumulating case totals for the U.S. since March 1. The tell-tale sign of exponential growth is the curvature in the rise in cumulative cases, evident here in the last two weeks. For further context, consider the time it takes to arrive at each 500,000 case plateau. It took 40 days for the first half million cases to be reported. Then, the first peak arose as it took just 19 days to hit 1 million cases. After lockdowns, the pace slowed; it took 21 days to get to 1.5 million and 24 days to reach 2 million. However, the next 500,000 cases have come in just 17 days, the shortest interval yet.
   The bottom line: The U.S. is back to where it was before lockdown, with sustained and widespread community transmission resulting in exponential growth of the epidemic. Cases are now rising in 37 states.
   Are we growing numb to the reality?

Daily COVID-19 Briefing: Thursday

Top news, reports and insights for today:

1. Daily headline summaries for Thursday:

• Optimism about a coronavirus vaccine may be premature. Moderna safety study was only 8 patients and they won’t show anyone the data. Experts warn that despite the hopeful timetable, there is a long way to go before a vaccine is proven to be effective and can be mass produced and distributed (New York Times)
• At least 4 states (Virginia, Texas, Georgia, and Vermont) have combined numbers from viral and antibody tests, providing a misleading picture of testing capacity and hampering our ability to track the epidemic (CNN)
• Brazilian health minister resigns after just weeks on the job after clashing with President Bolsonaro over coronavirus response. Today, Brazil reported its highest daily incidence to date of 19,951 new cases. Brazil now has the third most cases in the world as the epidemic begins to surge in South America. (Aljazeera)
• Researchers at Carnegie Mellon University say that nearly half of the accounts tweeting about coronavirus are ‘bots’ rather than real people. Researchers have identified over 100 false narratives tied to these fake accounts. This is further evidence of the potential role of Chinese and Russian intelligence services in spreading mistrust and misinformation (NPR)

2. U.S. cases are flat, deaths remain volatile
    On Wednesday, the U.S. reported 22,368 new cases (up 1.4%) and 1,528 deaths (+1.8%). The recent trend in overall cases has been flat, while daily deaths have been quite volatile. The 7-day pattern has been fairly steady for cases (growth factor = 0.99) and a modest slowing of deaths (growth factor = 0.89). More regional patterns, as always, tell a better story. Growth in cases has slowed in the northeast, with cumulative cases rising less than 10% in New Jersey, New York and Vermont last week. Maryland saw the largest increase in cases in the region growing 22%. New cases grew by 25% or more in two midwest states (Minnesota and North Dakota) and in North Carolina. In the west, only Arizona saw cases rise by more than 20%.

3. Rhode Island again leading the nation in testing. Overall, testing declines for the first time
    Today’s headlines describe the practice in at least 5 states of combining reports of viral and antibody testing. Experts agree that this is a big problem because the two types of tests do very different things and should be kept separate. Treating antibody tests the same risks exaggerating the testing capacity of the state and doesn’t allow us to tell the fraction of people who have active infection. The latter is the information we need to assess reopening benchmarks and to track the resurgence of cases.
    The figure below shows how each state is doing on testing. The bars show completed tests per 10,000 residents as of yesterday. Rhode Island continues to lead the nation by a wide margin, now having tested more than 11% of Rhode Islanders. The four states with the lowest testing rates are all in the West. Pennsylvania and Maine are the only northeast states that are below the national average of 339 per 10,000. States with patterned bars are likely to be doing less of the most important testing than this graph depicts. The magnitude of the problem is not known. Of particular concern are the three states near the bottom already (Pennsylvania, Texas and Virginia) all of whom are experiencing significant rises in cases in recent weeks.
    Why this matters? States that have moved toward reopening are under the microscope to determine whether infections surge. There is every epidemiological reason to expect they will. The political pressure to blunt the apparent impact of reopening is tremendous. Now is the worst possible time for states to play games with their numbers. Of greater concern is that despite the unanimous opinion of experts that more testing is needed, last week marks the first since the start of the epidemic that the number of COVID-19 tests actually declined (see the lower figure from the CDC website).

Taken from CDC website on May 20: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/05152020/images/clinical-labs.gif