Centers for Disease Control (CDC) | Thomas A. Glass, Ph.D.

Top news, reports and insights for today:

Daily headline summaries for Wednesday:

Good news: Fresh analysis of multiple studies shows that treatment with corticosteroids to reduce inflammation lowered the death rate in critically ill COVID-19 patients (JAMA)
“Uncle Tony” Fauci predicts ‘safe and effective’ coronavirus vaccine by the end of 2020 (NBC News)
CDC announced it is using its broad powers to impose a nation-wide moratorium on evictions to assist out-of-work renters from becoming homeless. The order will last until the end of December and will protect up to 40 million renters at risk. The catch: the order does not suspend rent or late fees (Vice)
New study from South Korea suggests that symptom screening doesn’t capture COVID-19 in children and that SARS-CoV-2 virus is detectable in children for an unexpectedly long time period. Together, these new clues increase our worry that children, while not getting sick in large numbers, may be key to keeping the epidemic going (JAMA Pediatrics)
Multiple studies confirm that older age is the biggest risk factor for death following COVID-19. While we knew this already, the new studies show the risk gradient is even steeper than previously thought (Nature, See Figure A)

Figure A. Screen grab from Nature News, Aug 28

Decline in new daily U.S. cases stalls, deaths droop, parts of the Midwest exploding
September 1 has arrived. The U.S. COVID-19 epidemic is now 224 days old. In August, we saw another wavelet peak. Two weeks ago, it looked like transmission was declining overall. Over the last week, that decline in daily cases has stalled (See Figure B). Over 284,000 cases were reported last week, about the same weekly totals I reported on August 27. Looking underneath the national totals, the news is mixed at the state level (Figure C). The good news: and it’s quite compelling, we see the rate of new infections (daily cases per 100,000) below 20 for the first time in all Western states, all Northeast states, and in 10 of 13 states in the hard-hit South. Only Alabama, North Carolina and Texas remain over 20. The bad news: the rate of new infections is exploding in 4 Midwestern states. Over the last 2 weeks, the data were warning us that the Midwest was about to be once again in the epidemic’s crosshairs (see last week’s briefings). We now see clear hot spots in Iowa (37 new daily cases per 100,000), Kansas (29), North Dakota (33) and South Dakota (+36). Take a look at the map I pulled from coronavirushutdown on August 31 that provides some insights. The colors represent percent change in new cases in the 7-day average. Most of the previous hot-spot states like Arizona, Florida and Georgia are now a cool yellow (meaning new cases aren’t growing). In the spiking states of the great plains, we see particular counties that are orange or deep red. New cases jumped 49% in Wallace County Kansas, 17% in Butte County Idaho, 40% in Loup Co. Nebraska and 23% in Potter County South Dakota. The story is different in each of these counties, and often the absolute numbers are small, but what we are seeing in recent weeks is high-intensity transmission pockets that signal the epidemic is shifting its focus. Next week we will re-examine the map to see if these isolated brush fires ignited larger blazes in surrounding counties.
Figure E. shows reported daily deaths. The rate of decline in new cases had been fairly brisk until the most recent slowing. Deaths have been declining in a more steady drizzle. After a particularly lethargic weekend of reporting, deaths shut up to over 1,000 again on Tuesday. To add to the Midwestern woes, deaths are climbing in Iowa (9% increase in the growth factor), Missouri (unstable estimates) and Ohio (+35%).
What does it mean: As the nation inches toward the coming election, cases are spiking in several key battle-ground states in America’s heartland. The celebration over falling new cases is on hold for the time being. Deaths are down, but hospitalizations are up, so concerns continue that we are by no means out of the woods.

I think I was exposed, but I don’t feel sick. Wait, should I get tested or not?
What a brouhaha! If you follow the news, you have heard about the firestorm of controversy that erupted last week when the CDC revised its testing guidance to say that people who thought they had been exposed to SARS-CoV-2 but had no symptoms didn’t “necessarily need” to get tested. You heard me say last week that this is about the stupidest thing I have heard anyone say since all this started. If you don’t follow the news, and don’t care, that’s fine, I am not going to give you a blow-by-blow account of the timeline of this outbreak of national fury. Let’s stick to the most important take home messages:
1. First and foremost, every respectable epidemiologist and public health commentator has been unified in condemning the suggestion that people who have been exposed but have no symptoms shouldn’t get tested. That is simply not true. It’s equivalent to a crime scene investigator saying, “it looks like he shot himself from across the room, don’t bother collecting evidence”. In an epidemic that is propagating via asymptomatic carriers, it is vitally important that people seek and get appropriate testing if they believe they have been exposed in order to close down novel chains of transmission.
2. As has been reported by Politico, CNN and others recently, it is now clear that top officials in the White House ordered the CDC to stop promoting testing in exposed, asymptomatic persons for political and not sound scientific reasons.
3. One-by-one, experts are showing contempt for the new guidance and governors, county health officials and public health agencies are announcing they will ignore the guidance.
  
  The bottom line: The new guidelines were announced without public notification and were approved by the White House Coronavirus Taskforce at a meeting during which (get this!) Uncle Tony Fauci was under anesthesia, having vocal cord surgery! You heard that right. The misguided policy was part of the President’s open contempt for doing the right thing and his bold and misguided campaign to gain political favor by suppressing testing to make the pandemic response appear to be better than it is.

Quirky Qorner: Why do so many men refuse to wear masks? It’s not macho, survey says
A quirky news item caught my eye from Fastcompany this week. We have known for a while that men are less likely than women to wear a mask in public. It’s possible this is one of the many reasons men also are more likely to die of COVID-19, but that’s another story. Several surveys show that American men who identify with traditional masculinity engage in lots of negative health behaviors (like for instance, standing on a White House balcony staring at the eclipse). A more recent survey, according to this article, found that men were more likely than women to think masks were “uncool” or a sign of “weakness”. Boston Psychology professor James Mahalik and students find that men who have a penchant for individualism and skepticism toward science, don’t wear masks to the same degree. Turns out, macho dudes don’t need no stinkin CDC advice! For them, masks are not cool man!

Can People Without Symptoms Get Tested for Covid? Who Knows

Science article by By Megan Molteni online at Wired.com, August 28, 2020.

The CDC just quietly revised guidelines on who should get tested. Last month CDC directer Redfield said “anyone who thinks they may be infected—independent of symptoms—should get a test.” The new guidance says those who have been exposed but have no symptoms do not necessarily need a test. This makes zero epidemiologic sense since identifying asymptomatic sources of transmission is a top priority. Where did this new guidance come from? This story reports on the firestorm of criticism that has been unleashed by this seemingly minor change. Tom Frieden, former CDC director under President Obama, called the change “unexplained, inexplicable, probably indefensible.” Did the White House insist on the shift to dampen testing and improve the numbers for political reasons? Read this and decide for yourself.

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.

Thomas A. Glass, Ph.D.

An epidemiologist’s perspective on the COVID-19 pandemic

Tag Centers for Disease Control (CDC)

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Can People Without Symptoms Get Tested for Covid? Who Knows