Saturday COVID-19 Briefing

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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• A new study (not yet peer reviewed) reports on experiments that show when SARS-CoV-2 was introduced to heart muscle cells, it resulted in “carnage” on the slides, providing clues to explain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.

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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.