Weekend COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Saturday/Sunday:
  • President Trump tests positive for COVID-19, checks in to Walter Reed hospital. Doctors say he is on steroids and improving after brief ‘episodes’. Treatments indicate possible serious disease. (NBC News)
  • U.S. has reported nearly 100,000 new COVID-19 cases and 1,600 deaths since the news of the President’s positive test (VOX)
  • Freshman New Jersey congressperson Mikie Sherrill introduces a bill to jumpstart U.S. testing program by rewarding testers for quick turnarounds and increasing capacity (ARS Technica)
  • New study summarizes lessons learned as countries ease COVID-19 restrictions including a) success comes from gradual shift to a new normal, not return to prepandemic conditions, b) decisions should be based on the epidemiology, c) restrictions should not be lifted until capacity to track and trace new infections is in place, and d) the need for ongoing transmission control measures will remain in effect for a long time (Lancet)
  • A patient information page published in JAMA reports that risk of COVID-19 during air travel is low; planes are safer than an office building, classroom, supermarket or commuter train (JAMA, See Figure A)
Figure A: Taken from Pombal, JAMA Oct 1, 2020 (see link above)
  1. U.S. daily cases again leap over 45,000. Most new infections in the Midwest but alarming surge on the horizon in the Northeast. Just how crazy is Wisconsin?
     This week started on a promising note as daily cases dipped below 45,000. That changed on Friday and Saturday when more than 47,000 cases were logged both days (See Figure B). Rates of new infections remain highest in the Midwest (Figure C) where eight states exceed 20 cases per day per 100,000 people. Again today, the states with the highest transmission intensity are North Dakota (52), South Dakota (46) and Wisconsin (42). In the West, Idaho (27), Montana (33), and Utah (30) remain high, contributing to a continuation of the regional hot spot in the upper plain states. In the South, only Arkansas remains “hot” (27) while things appear to be quiet in the Northeast.
     However, alarms sounded for me when I saw the case growth factors (Figure D) showing brush fires igniting in seven Northeast states (indexed here by weekly case growth of 30% or more). In New Hampshire, weekly totals more than doubled from 201 to 476 with a new record high 217 cases reported on Friday. From the beginning to the end of the week, daily cases about doubled in Washington DC, New York and Vermont. Some of these growth factors are understated due to lack of Saturday reporting in Connecticut, Pennsylvania and Rhode Island. Substantial surges in weekly cases in Massachussetts (+48%), New Jersey (+33%) and New York (+50%) are especially disconcerting. It is my opinion that we are about to see a new wavelet of higher transmission intensity in the Northeast region, likely intensified by the start of cold and flu season.
     On Wednesday, I pointed out how important it is to look both at new case rate (Figure C) and growth factors (Figure D). While the former remains very high in North and South Dakota, thankfully both states have very modest increase in new cases. Then there is Wisconsin, where things have gone from bad to worse. Not only are they currently white hot at 42 cases per day per 100K, but new weekly cases rose another 22%. While there was some hint that things may be slowing there, the pace of the epidemic has been dramatic. To paint a picture, have a look at Figure E from Covid Trends showing the problem states on a linear scale. Wisconsin now has over 138,000 confirmed cases, rising at 17,769 per week. One month ago (September 3) they were at 83,000 total cases and 4,900 a week. September was a very bad month for Wisconsonians, with weekly cases more than tripling. According to an article in the Wall Street Journal, state health officials initially blamed returning college students for the surge, but then the plot thickened; more recent numbers show big rises in towns and cities without colleges.
     The bottom line: U.S. epidemic remains robust. The upper Midwest remains a hot spot of hot spots. I see the potential for a significant explosive rise in transmission intensity in the Northeast.
Figure B
Figure C
Figure E: From: https://aatishb.com/covidtrends/?scale=linear&region=US&doublingtime=10&location=Iowa&location=Montana&location=North+Dakota&location=Oklahoma&location=South+Dakota&location=Wisconsin
  1. Global COVID-19 deaths exceeded 1 million on September 28. Simulations show that without strong action, that number could triple by the start of next year. U.S. deaths remain steady at 700 a day.
     According to most data sources, the number of global COVID-19 deaths shot past 1 million last week. At a moment when individuals, organizations and governments struggle against pandemic fatigue and the ceaseless groundhog day feeling, it’s easy to lose track of just what is at stake. Here is a graphic that I find chilling in its naked simplicity (Figure F). It shows a rough timeline of deaths. What is so stark about this figure is how unbending the escalating global trend has been. There is no end in sight to the onslaught of death and suffering. The figure comes from an article in Nature News that asks “How many more will die?” The answer depends in a big way on what countries do in terms of retaining or ending transmission control measures.
     The article draws attention to the latest projections from The Institute for Health Metrics and Evaluation (IHME) at the University of Washington (Figure G) showing 3 scenarios. They project that by January 1, 2021, deaths will increase to 2.3 million under current conditions. However, if nations were to mandate universal masking policies, deaths would rise to only 1.7 million. On the other hand, if current masking and social distancing policies were eased, that number would balloon to 3.2 million deaths. One can always quibble with such projections; the point is that holding other things constant, this model says that up to 1.5 million people will either die or remain alive by New Years day 2021 depending on the choices nations make.
     Meanwhile, the U.S. reported 4,699 more deaths last week (Figure H) as average daily mortality remains above 700.
Figure F: From Nature News, see link above.
Figure G: Taken from https://covid19.healthdata.org/global?view=total-deaths&tab=trend
Figure H
  1. Quirky Qorner: The pandemic’s silver lining? We put away our gold cards
     I like to find good news about the impact of the coronavirus pandemic wherever I can find it. That lead me to a University of Chicago Beckman/Friedman Institute working paper on the effect of the pandemic on consumer behavior, spending and savings. It’s based on analysis done by economists at JP Morgan Chase using credit card data matched to national household surveys. Compared to last year, American households cut non-essential credit card spending by half in the first month of the pandemic. By the end of May, that spending had rebounded but remained about a third lower than the previous year. What’s more, essential spending fell about 20% and remained about 15% lower than previous years. This trend, along with increases in savings shows that Americans know how to tighten their belts when the going gets tough. To be certain, a good chunk of this lower spending is the result of lost wages, but that’s not the whole story. The authors see most of the decline as direct pandemic impacts, pointing to rising household supplies of liquidity indicative of the effectiveness of pandemic wage replacement policies.
    What it means: I guess we are learning that what seemed “essential” before may be easier to live without than we might have guessed.
Figure I: Taken from BFI Working paper 202082

Top pick of the day: Monday

How Long After Exposure To Covid-19 Coronavirus Should You Get Tested?

Article by Bruce Y. Lee, senior contributor and professor, published online at Forbes September 26, 2020.

A friend of mine called me in a panic the other day and said he thought he had been exposed to COVID-19 and wasn’t sure what to do. Amidst the groundhog day monotony of life in the time of coronavirus, it’s easy to forget that people are still getting sick and exposing others. Here is a handy go-to guide written by a former colleague who walks you through the process. The bottom line: if you think you have been exposed to SARS-CoV-2, quarantine yourself and seek a diagnostic test.

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.

Image captured from https://www.forbes.com/sites/brucelee/2020/09/26/how-long-after-exposure-to-covid-19-coronavirus-should-you-get-tested/#2fb6e8265c89

Wednesday COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Wednesday:
  • U.S. death toll hits 200,000. President Trump tells a rally in Ohio: “It affects virtually nobody” (Vox)
  • Both nationally and in 6 swing states, most voters worry President Trump is trying to rush release of coronavirus vaccine to help his reelection, new polls show (CNBC)
  • The Helsinki Airport in Finland is now using specially trained dogs to sniff out COVID-19 in passengers. A study shows dogs can detect the virus almost instantly without an uncomfortable nasal swab (FastCompany)
  • COVID-19 conspiracy theories are spreading rapidly, like the virus, complicating public health efforts. A new study in Social Science & Medicine finds that conspiracy theories are commonplace and have increased from March to July (Time)
  • New cheaper, faster tests are coming on line, which is good, but nobody knows how to report and count them, leading to growing blind spots in our surveillance. Increasingly, it is impossible to say how many tests are being done (ABC News)
  • Aerosols are back on! CDC reverses course, acknowledges the possibility of airborne transmission via aerosols (Los Angeles Times)
  1. U.S. cases surging again. Only 5 Northeast states below 5 cases per day per 100,000
     New daily COVID-19 cases demonstrate yet another dip as Tuesday numbers soar back above 45,000 (See Figure A). It’s still too early to say whether the numbers will be inconsistent week-to-week or whether return to schools, economic restarting or overlapping respiratory infections are pushing things steadily toward greater transmission intensity.
     As is my habit, my eye turns to the state data to determine whether there are regional patterns. At this point, we would hope to see some states in relatively good control with new daily cases below five per 100,000 per day. Figure B shows the numbers as of today. No states in the Midwest, South or West meet that benchmark (although several are close). The only states under control are in the Northeast and include my state of Maryland, along with Maine, New Hampshire, New York and Vermont. The only Northeast state over 10 is Rhode Island. On the other hand, eight of thirteen Midwest states are four times higher including Iowa (27 per 100,000 per day), Kansas (28), Missouri (23), Oklahoma (28), South Dakota (35), Wisconsin (32) and North Dakota, which continues to lead the nation with the highest transmission intensity at 46. In the West, Idaho (20), Montana (19) and Utah are “hot”, while in the South, we are concerned about Arkansas (27), Tennessee (21) and Texas (24).
    The bottom line: It is important to note that the Tuesday numbers were boosted in part by a bolus 13,600 “older cases” added in Texas. Having said that, the trend is discouraging as the 7-day moving average (red dotted line) indicates. With the exception of a handful of Northeast states, transmission intensity remains worrisomely elevated in the other three regions.
Figure A
Figure B
  1. U.S. testing is getting harder to track. Updated data from the COVID Tracking Project now shows testing numbers holding strong
     If you took note of headline 5, you read about the challenges posed by tracking the intensity of U.S. coronavirus testing. In the beginning of the epidemic it was easier because the number of labs processing tests was smaller, the reporting system was working consistently and there was a smaller number of test types (predominantly PCR-based tests to detect viral RNA). Now, as new faster and cheaper tests have come on line, we are dealing with saliva tests, antibody tests, antigen tests and a host of other types that are increasingly difficult to track and monitor. Last Wednesday, I showed you a graph showing daily tests and the test positivity rate based on numbers from OurWorldInData. Based on that graph, I concluded that U.S. testing had fallen dramatically since September 3. As the testing data has gotten more complex, the story they tell becomes increasingly varied depending on the data source. I had been relying on data from COVID Tracking Project before last Wednesday. This week, I compared the data from the two sources and found a big difference. For several reasons, I am going back to the CTP data (Figure C). These data tell a more reassuring story. It looks like testing is holding steady and perhaps even rising over the last week. The drop in testing seen last week in the other dataset is not apparent. That gives me more confidence that the daily cases are more reliable and not an artifact of falling testing intensity. The test positivity rate is still not where we would like it (at or below 5%) but it is creeping down toward six percent.
    What this means: Tracking testing is getting harder. I’ll follow many observers and stick with the CTP data. It looks like U.S. testing is at least keeping pace. It is worth noting that the White House promised a million tests a day in March, a number that has still not been achieved.
Figure C
  1. Quirky Qorner: What’s funny about coronavirus? Nothing. But, that hasn’t stopped the flow of dark jokes
     As the death toll tops 200,000, the need for some dark humor intensifies. My attention was grabbed by a story by Jim Beckman from Northjersey.com making the case for Rona humor. A couple of highlights:
    1. “Today’s Weather: Room Temperature.”
    2. “Anyone else’s car getting three weeks to the gallon?”
    3. “Never in my life would I imagine that my hands would consume more alcohol than my mouth.”
    4. Q: Why do they call it the novel coronavirus? A: It’s a long story…
    5. Q: What types of jokes are allowed during quarantine? A: Inside jokes