Daily COVID-19 Briefing: Wednesday

Top news, reports and insights for today:

1. Daily headline summaries for Wednesday:

• The U.S. death rate from COVID-19 per 1 million people just passed 340. That’s more than 100 times the rate in China (Time)
• A trend toward a “second U.S. virus wave” emerges in 22 states after reopening (Bloomberg)
• As harvest season nears, outbreaks seen among migratory farm workers in North Carolina, Florida and Washington. The federal government has not made safety rules mandatory, leaving it to farmer’s discretion (Politico)
• Half the states (including California, Florida, North Carolina and New York) are failing to follow CDC guidelines and reporting probable coronavirus cases and deaths, leading to inconsistent and inaccurate surveillance (Washington Post)

2. Back to where they started: Epidemiologic deja vu in 14 states that have matched or exceeded daily cases compared to April/May peaks
   The President continues to say and do things that suggest he believes the epidemic is over and behind us. A journalist sent me an inquiry yesterday asking my opinion on whether a second wave might be in our future now that the first one is over. A new poll suggests that about half the country thinks it’s time to get back to normal life.
   Huh? I remain puzzled and wonder what information people could possibly be looking at. Internationally, we have seen the epidemic move from country to country, rising and falling in the global whack-a-mole pandemic we are in. Months ago it was Italy, France and Spain in the hot seat. Now it’s Brazil, Peru, India, Russia and Chile. The same shifting is occurring in the U.S. as one state grows quiet as another surges. What strikes me when looking at the New York Times tracking data is just how many states seem to be right back where they were during the peak period of April and May. After looking closely, I believe there are 14 states that now meet or exceed the high water mark of daily cases. Take a look at the two image galleries below. The first one shows the 8 states where the recent 7-day moving average for daily new cases is higher (and in some cases much higher) than the peak in April/May. The second gallery is the 6 states where recent average daily cases are about the same as they were at the April/May peak. Some of these states are quite striking. Arizona averaged under 300 cases a day throughout April and May, and is now above 1,000 after an alarming rise starting May 27. Arkansas peaked at under 200 a day April 26 and has now risen to over 300 a day. California, North Carolina and Utah are all essentially on a continuous rise since the start of the outbreak with little notable drop off in new daily cases. Texas and Oregon both appeared to peak twice, with a corresponding dip in new cases in late May, but in both states, cases have surged to all time highs with continued transmission intensity. In the lower gallery, we see that Florida, Kentucky, Nevada, New Mexico and Tennessee, all had noticeable peaks in April/May, and all have seen resurgence of new cases back to about the same peak levels in recent days.
   The bottom line: Overall, new cases remain close to flat in the U.S., as many states are seeing sustained declines. However, the rest of the story is that 14 states are right back to where they were in the peak period of April and May and 8 of those states are setting new records. Texas, Arizona, Florida, Nevada, South Carolina and Mississippi were the most aggressive in reopening 2-3 weeks ago.

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  Arizona

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  Arkansas

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  California

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  North Carolina

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  Oregon

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  South Carolina

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  Texas

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  Utah

States where new cases are higher than April/May peak

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  Florida

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  Kentucky

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  Mississippi

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  Nevada

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  New Mexico

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  Tennessee

States that have matched earlier peaks

3. Not just increased testing: COVID-19 hospitalization rates rising in reopening states, mirroring trend in rising cases
   A story in Bloomberg highlights what the article calls a “second U.S. virus wave” emerging in reopening states. They mention that hospitalizations in Texas jumped 6.3% on Tuesday to 2,056, the highest total since the pandemic emerged. California hospitalizations are at their highest point since May 13 and have risen 9 of the last 10 days. This nudged me to go back to my favorite source of state-level data on hospitalizations from the COVID-19 Hospitalization Tracking Project at the University of Minnesota Carlson School of Management. While their data doesn’t cover all states, the figure and table below captures a few that have surging cases. The graph shows daily COVID-19 hospitalizations per 100,000 adults for 6 states. Since May 17, the largest increase has been in Arizona, where rates rose by 56%. North Carolina saw the second highest rate rise and 57%. Rates are up nearly a third in Kentucky, Texas and Utah. California is back to where it was in late April.
   Why does this matter: Tracking hospitalizations may be a more accurate window into the epidemic than other measures that depend on testing. These data show, I believe, that hospitalizations are rising in line with expectations of post-reopening increases in transmission intensity. The situation in Arizona is especially extreme.

State	May 17	June 9	Change	% Change
Arizona	14.9	23.3	+8.4	+56%
California	10.3	11.4	+1.1	+11%
Kentucky	11.4	15.7	+4.3	+38%
North Carolina	6.3	9.9	+3.6	+57%
Texas	7.4	9.4	+2	+27%
Utah	4.8	5.9	+1.1	+23%

From the COVID-19 Hospitalization Tracking Project, University of Minnesota, Carlson School of Management, captured 6/10/20

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Daily COVID-19 Briefing: 5/1/20

Top news, reports and insights for today:

1. Daily headlines for Friday:

• Experts say U.S. death toll may be undercounted by tens of thousands (ABC News)
• California to close Orange county beaches after thousands flocked there last weekend (The Guardian)
• South Korean CDC finds no evidence that once-infected patients can be re-infected (Sky News)
• Coronavirus outbreak likely to go on for two years, scientists predict (CNBC)
• Maryland sees jump in new cases, hospitalizations down slightly (Baltimore Sun)

2. The U.S. has recorded 200,626 new cases and 4,016 deaths. That was last week.
   On Thursday, the U.S. reported 29,818 new COVID-19 cases, a 3% increase. That is more cases in one day than the total accumulated throughout the epidemic in the U.S. as of March 21. Cases grew rapidly last week in 5 midwestern states including Iowa (+82%), Kansas (+71%), Minnesota (+75%), North Dakota (50%), and Nebraska (+102%). The lower graph is from #COVIDMonitor and shows the log-log plot of last week’s cases against cumulative cases. This is the graph that best indicates states that have peaked (visible as a clear down-turning ‘hook’ in the curve). A case can be made in 11 states that peak has happened in new cases (subject to differences in testing across states). Another 10 states, including New York, Michigan, Oregon, Missouri, South Carolina, Oklahoma, Georgia, Florida, and Texas appear to be trending that direction. However, 22 states are still in a high-growth phase, many are still in exponential growth. This includes several central states where the epidemic has barely slowed (including Minnesota, Iowa, Illinois, Nebraska, Kentucky, Virginia, Kansas, North Carolina, Mississippi, and New Mexico).
   Bottom line: Most of the nation has not yet peaked. Opening now is premature from an epidemiologic viewpoint. Many states that would otherwise reach peak if lockdown was maintained are likely to see new case growth return to exponential pace in 2-3 weeks.

Screen capture taken 5/1/20 from: #COVIDMonitor United States: https://www.theguardian.com/us-news/2020/apr/30/california-beaches-closed-coronavirus-risks-experts

2. What a difference a month makes
   Let’s take a moment to talk about the journey the U.S. has been on in April. Here are some pretty interesting maps I got from one of my favorite graphing sites: coronashutdown. The first map shows confirmed COVID-19 cases per 100,000 population by county on April 1. The second map shows where we were on the last day of April. The nation had reported 212,000 cases on the first day of the month, and 1.1 million on the last. Even with inadequate testing, April saw 851,149 cases and 52,354 deaths.
   Staring at these maps, the thing that strikes me is that much of the intensity we see at the end of the month is an extension of what we saw in the beginning. The patches of infection that appeared April 1 radiated outward and became more severe. There were clues in the data on April 1 about where we would be at the end. Very few areas now with high prevalence arose without warning. What we see at the close of the month was, in many cases, predictable. Consider McKinley County New Mexico (labeled on Map 1) now with 1,335 cases/100K. That county had just 34/100K April 1 but was next to counties to the west and northeast that were hot spots then. Dougherty county in southwest Georgia was a hot spot on April 1 at 592/100K. The epidemic radiated east and west by the end of the month, connecting with other hot spots to form a deadly corridor of high-intensity transmission from the Carolina coast to central Texas.
   Bottom line: It was a rough month. Anyone who thinks the coronavirus outbreak is only a problem for big cities on the coast has not seen these maps. May will be all about transmission in rural areas and small towns.

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  April 1

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  April 30

Screen captures taken April 30 from:https://www.coronashutdown.com/per-capita

Daily COVID-19 Briefing: 4/27/20

Top news, reports and insights for today:

1. Top headlines for Monday:

• New Washington Post/Yale University collaborative study shows that U.S. COVID-19 death total may be double current estimates (Washington Post).
• Colleges and universities wrestle with prospects of re-opening next fall (The Atlantic).
• California sees serious car crashes fall by half due to social distancing (Wired).
• University of Maryland studies anonymized cell phone data, finds evidence of “quarantine fatigue” as adherence to social distancing falls by 3% (NBC News).
• New York City starts using “self-swab tests” reducing risk to health workers. New testing protocol introduces saliva testing as well (Vice).
• National Bureau of Economic Research working paper argues that New York city subway system may be key to understanding why that city’s outbreak was so explosive (NBER Working paper by Jeffrey Harris)
• Japanese Island of Hokkaido lifted social distance restrictions too soon and was hit hard with second wave of infections, offering reality check to U.S. states (Time magazine)

2. New U.S. deaths drop Sunday to levels not seen in two weeks
   In a hopeful sign, new U.S. COVID-19 deaths rose just 2% on Sunday with 1,168 reported deaths. This is the lowest daily mortality numbers seen since April 5. These numbers as compiled by Wikipedia from state health departments do not include growing numbers of ‘probable’ COVID-19 deaths. Estimates from sites that do include such numbers, such as WORLDOMETER, posts 56,139 deaths now. Also, because we have seen a consistent lag in weekend death reporting, we need to remain cautious about the magnitude of this decline. The U.S. continues to report the highest global death toll, with double the deaths in Italy, which ranks second. Nevertheless, the 7-day trend shows a decline in new deaths, which indicates we may be at or near peak. Minnesota was the only state to set a new record high death count at 28. New Mexico, Minnesota, Nebraska and Alabama all saw total COVID-19 deaths double in the last week.
   What this means? The drop in new deaths is welcome news. I remain concerned about a possible rebound on Tuesday as death reporting from the weekend catches up. The larger trend is toward a decline in new deaths, which may indicate we are at or near peak deaths in the U.S.. The mid-west remains an area where mortality continues to rise.

3. Numerous states move to re-open despite insufficient evidence of peak in new cases
   Last week I explained how important it is to wait until new case growth has peaked before states re-open. I also argued that the best way to see the peak is in a special type of graph that compares last week’s new cases to total cases, both on the log scale. The graph below comes from Aatish Bhatia’s site and is based on the latest data in the 13 states that are now moving toward re-opening. The inflection point we are looking for signals the end of exponential growth and the slowing of linear growth. It shows up on this graph as a sharp pivot from an upward angle to a straight line pointing down. Here we see three patterns. The first is states that do evidence post-peak curves. That includes states with small outbreaks (Alaska and Montana) and just one state that has had a moderate outbreak (Ohio). These data support relaxation of social distancing in these states. New York started to look like it had peaked, but that state’s curve turned this last week, so it’s a special case. A second group of states shows a flat curve, indicating that community transmission is still occurring, but on a linear scale. That includes New Jersey, Oklahoma, South Carolina, Florida and Georgia (the state that has moved most aggressively to re-open). A third group of states is still experiencing rapid growth in new cases (including California, Colorado, Tennessee, and Minnesota).
   That this means? Beaches were crowded in parts of California over the weekend, even as new cases rise precipitously in that state. States with flat curves are at risk of re-igniting exponential transmission by withdrawing social distancing measures, an effect that would not be seen for 1-2 weeks. These data suggest that fewer states should be re-opening.

Link to this image taken by screen capture on 4/26/20: https://aatishb.com/covidtrends/?region=US&location=Alaska&location=California&location=Colorado&location=Florida&location=Georgia&location=Minnesota&location=Montana&location=New+Jersey&location=New+York&location=Ohio&location=Oklahoma&location=South+Carolina&location=Tennessee