Top pick of the day: Tuesday

How California went from a coronavirus success story to a worrying new hot spot

Article by German Lopez, posted online at Vox, July 6, 2020.

A few months ago, it looked like California had it right where New York had dropped the ball. Now, total cases have risen by 90% in the past 2 weeks, the test positivity rate is increasing, and hospitalizations jumped by more than 50% in 2 week as hospitals in Los Angeles and elsewhere could reach capacity soon. What happened in the Golden state and what can the rest of the nation learn?

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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.

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Daily COVID-19 Briefing: Thursday

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Top news, reports and insights for today:

1. Daily deadline summaries for Thursday:

• U.S. daily coronavirus case count crosses 50,000 setting a single day record as some states reverse course on reopening and hospitals were hit by a surge of patients (Wall Street Journal)
• Experts suggest a plastic face shield, if properly fitted and warn, has advantages over cloth masks for use by the public and should be used more widely (JAMA)
• The American Academy of Pediatrics issues guidance in favor of reopening schools in the fall. Guidance stresses that children do not appear to be driving the epidemic, are less likely to be infected than other respiratory illnesses and that in-person education is better than online teaching (American Academy of Pediatrics)
• Italian researchers studied nearly all residents of one town before and after lock-down. Main results were that 40% of those infected never developed symptoms. None of the children in the study became infected. Those with and without symptoms did not differ on viral load. Half of those infected had cleared the virus 2 weeks later. The lockdown was very effective at halting transmission (Ars Technica)

2. U.S. enters new dangerous phase, smashing previous daily high record new cases, decline in deaths stops
    I have said for months that a return of widespread community transmission with R_t>1 was inevitable by July 1 given that states reopened recklessly. However, the ferocity of the resurgence in cases has caught me and many experts off guard. I apologize for showing you 4 different graphs for today’s briefing, but the story they tell is chilling. The first graph is our usual epidemic curve of new reported lab-confirmed COVID-19 cases by day. A record high 52,554 new cases were reported yesterday, the first day with more than 45,000 cases and 16,000 more than the peak set in late April. For the first time since the epidemic, the U.S. reported more than 300,000 new cases in one week. In just 7 days, the U.S. reported more infections than were accumulated from the start of the epidemic until April 4. The U.S. now has more than 2.6 million reported cases, 26% of all cases on the planet and twice as many as Brazil, still ranked second.
    Deaths flatten: The second graph shows daily deaths. This remains a mystery. The 7-day moving average has been falling since Memorial day. In the last few days, that decline looks to have stopped. Yesterday, Arizona, a state on the front edge of the case surge, reported a spike in deaths with 88, a rise of 100% from the previous day. Arizona, Iowa, Oklahoma, South Dakota, Kentucky, Texas, Virginia, and Rhode Island, all have seen deaths rise by 20% or more in the last week. I believe we will see deaths rising sharply in the states where cases first started surging.
    Cases increased last week in all but 3 U.S. states: The next graph shows the weekly growth factors by state. Nationally, the U.S. had it’s first week with 300,000 new cases. Astonishingly, the growth factors for last week compared to the week before are >1 in all U.S. states except Rhode Island, New Jersey and the nation’s capital. Weekly cases rose by 50% or more in Alaska, Idaho, Montana, Kansas, Florida, Georgia, Louisiana, Mississippi, and Tennessee.
    13 States reported more than 15 new daily cases per 100,000 population last week. The last graph shows the rate of new daily cases last week. Arizona continues to be the most extreme, now reporting more than 47 new cases per 100,000 every day. That is the highest rate we have seen anywhere at any point. In the South, 9 of 13 states are above this mark, which is 3-times higher than the 5 cases per day per 100,000 benchmark for low transmission. Florida, Georgia, Louisiana, Mississippi, South Carolina and Texas are all over 20. Only 1 Northeastern state is over 5.
    The bottom line: The U.S. epidemic is out of control with no end in sight.

3. U.S. capturing about 2/3 of the true number of COVID-19 deaths
   We already know that deaths from COVID-19 are undercounted for a variety of reasons. We also know that an accurate tally of the death toll is very important. As I have emphasized here before, our best tool for understanding the true mortality picture is to examine deaths from all causes using the best available data and comparing the numbers from 2020 to previous yearly averages. This allows us to capture excess deaths above what is expected in a “normal” month taking seasonal variation into account. It’s not perfect, but it is closer to the truth than our current count. Previous studies using similar methods have found that the ascertainment rate (% of true COVID-19 deaths that are counted) is about 50%. Over time, we hope that will improve. Yesterday, a new study was published by my former colleague and friend demographer Steven Woolf and in JAMA that adds important new information. They used a state-of-the art model to estimate total excess deaths that are probably COVID-19 related. This includes cases where COVID-19 is mentioned on the death certificate, but also more indirect causes. They specifically examine rises in deaths above temporal trends in past years that may reflect those who died because they didn’t seek care for existing problems, had exacerbations of chronic diseases, or may have succumbed to secondary distress (e.g., drug overdoses). Their main finding is that in the 8-week period from March 1 through April 25, about 65% of the excess deaths likely related to COVID-19 were actually counted as such. That means, the remaining 35% of deaths were not counted. The 5 states with the most COVID-19 deaths experienced large proportional increases in deaths from non-respiratory underlying causes including diabetes (96% increase), heart disease (89%), Alzheimer disease (64%) and cerebrovascular disease (35%). New York City, which reported the highest number of COVID-19 deaths, saw a 398% rise in the number of heart disease deaths. The graph below, taken from the paper, shows that in the 5 hardest hit states, a significant jump in deaths can be seen in March and April of this year for heart disease, diabetes. Smaller but still substantial increases happened for stroke and Alzheimer disease as well. Diabetes deaths rose from 40% to more than doubling depending on the state.
   The bottom line: The true number of COVID-19 deaths is probably about 1/3 higher than our current numbers suggest. If true, the U.S. now has an estimated 177,000 deaths rather than the official count of 131,000. Significant numbers of people are dying of non-respiratory manifestations of SARS-CoV-2 and are not being counted. States vary widely in the accuracy of their counts.

From Woolf et al, JAMA Published online July 1, 2020. doi:10.1001/jama.2020.11787

Daily COVID-19 Briefing: Monday

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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?