Wednesday COVID-19 Briefing

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Top news, reports and insights for today:

1. Curated headline summaries for Wednesday:

• Researchers combined information from 32 studies of COVID-19 risk in children, finding that children and adolescents had 44% lower odds of secondary infection with SARS-CoV-2 compared with adults (JAMA Pediatrics)
• Moderna CEO says its coronavirus vaccine won’t be ready until spring of next year (CBS News)
• The White House coronavirus task force again this week strongly recommending mask usage in some states like Iowa and Georgia that still do not have statewide mask mandates (CNN Politics)
• Hospitals feel the squeeze as cases spike in upper Midwest states Wisconsin, North Dakota (ABC News)
• Facebook removes 38 versions of Trump campaign ads claiming (without evidence) that admitting refugees increases COVID-19 risk (NBC News)
• Largest study yet of COVID-19 transmission in India published in Science highlights the role of super-spreaders, a small subset responsible for a high percentage of infections. Study also finds that children transmit the disease as easily as adults (Los Angeles Times)
• Remember how COVID-19 exploded on a cruise ship? The Trump administration has again over-ruled the CDC recommendation to extend the “no-sail” order on cruise ships to next year (ARS Technica)

2. U.S. passes 7 million lab-confirmed COVID-19 cases. Last million cases added in 26 days
    Let’s start with the big picture today. Over the weekend, based on the Wikipedia data, the U.S. passed 7 million cases (See Figure A). On average, the U.S. has added a half million cases every 12 days. We went from 6.5 to 7 million in exactly 12 days. On average, each million cases has been accruing every 26 days. The jump from 6 to 7 million was just that (26 days). That’s a million cases a month. The more important idea here is that the COVID-19 outbreak is now steady-as-she-goes in terms of the pace of growth. On a big picture basis, the epidemic is locked in to an oddly consistent, even robust degree. Seasonality has been less than expected, surges and falls have been less steep than might have been predicted, and overall, the epidemic curve looks more like an endemic than a pandemic.
   What does this mean: Buckle up for the long hall because SARS-CoV-2 is not going away.

Figure A

3. U.S. daily cases holding largely steady. Transmission intensity highest in the Midwest, growing fastest in the West
     Figure B shows daily cases; the 7-day average remains just over 40,000 a day. We are now adding cases about twice as fast as the nadir of the epidemic in the first week of June. Today, I wanted to point out how different ways of looking at the same data are needed to address different questions. What questions? First, where are infections being generated most intensively right now? Second, where is the rate of new infections growing the fastest? Sometimes the answers will be the same. But, if a particular state has high sustained transmission intensity for a long time, the rate of growth of new cases will be very low. Conversely, a state with very low transmission intensity might be growing the fastest through regression to the mean in a natural cycle of change.
    Take a look at Figure C showing new daily cases per 100,000 residents by state over the last week. Let’s remind ourselves that the benchmarks we care about are a) less than 5 indicating “low” transmission intensity, and b) greater than 20, or 4-fold higher, indicating “high” transmission intensity. As has been consistently true for weeks, the Northeast is in the best shape with 5 states in the low category and only Delaware is over ten. The South is, thankfully, also relatively quiet with only Arkansas reporting high spread. The region that is clearly most hot is the Midwest with eight of thirteen states in the red zone. Three stand out in particular: North Dakota (54) is 10x higher than the “low” benchmark, while South Dakota (45) and Wisconsin (39) are surging at a white hot pace. Michigan (9.6) and Ohio (7.8) are the only “warm” states below 10. Iowa (29), Kansas (32), Missouri (22), Nebraska (24) and Oklahoma (26) are all hot. In the West, while Arizona remains coolish, Idaho (25), Montana (27) and Utah (32) are all hot.
    So what about the second question? Have a look at Figure D showing 7-day growth factors in cases. The picture is different. Intensity is low in the Northeast, but growth in new cases is strong with five states seeing a week-over-week increase of 10% or more: Delaware, Massachussetts, New Jersey, New York and Pennsylvania. New cases are falling in nine of thirteen states in the South. The region where the most growth is occurring is the West. Cases are rising fastest in New Mexico (+58%), Wyoming (+53%), Nevada (+46%), Washington (+41%), Alaska (+39%), and Montana (+39%) in that order. Whereas transmission intensity is highest in the Midwest, case growth is over 20% in only Michigan (+21%), South Dakota (+28%), and Wisconsin (+23%). Let’s take special notice of the states that pop out of both figures. Montana, South Dakota and Wisconsin, all regionally propinquitous, all have both high intensity and rapid growth.
    Bottom line: Something big and scary is going on in the upper midwest plains states!

Figure B

Figure C

Figure D

4. Quirky Qorner: Republic of Kazakhstan social influencer Borat tweets praise for U.S. coronavirus handling: “Because of Trump, 350 million Americans still alive”
    If rumors are correct, the long awaited followup to Borat is on its way to Amazon Prime Video sometime soon. According to this piece in Vanity Fair, twitter was shaken by a video appearing just before the first debate, handle @KazakhstanGovt, congratulating “Premier Trump” for his handling of the crisis. Very Nizzzze!

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Wednesday COVID-19 Briefing

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Top news, reports and insights for today:

1. 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

2. 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.

Figure B

Figure C

Figure D. From coronavirushutdown.com

Figure D

3. 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.

4. 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!

Top pick of the day: Tuesday

Seven months later, what we know about Covid-19 — and the pressing questions that remain

Health Article by Andrew Joseph. Helen Branswell, and Elizabeth Cooney, online at StatNews, August 17, 2020.

StatNews has been a valuable and trustworthy source of information and analysis throughout this epidemic. Here, three of their top health reporters team up to offer a big-picture overview of what we know and what we still need to know. Topics covered include: COVID-19 in kids, safe vs. dangerous settings, symptom persistence and “long haulers”, the race for a vaccine, asymptomatic spread, viral mutation, the reinfection question, how long does immunity last and how many infections have occurred.

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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.