Daily COVID-19 Briefing: 5/9/20

Top news, reports and insights for today:

1. Daily headline summaries for Saturday:

• Ditch the valve masks; they are selfish. The whole point of wearing a mask is to protect others from being infected by you. If your mask has a valve, it doesn’t do that. That valve just spews your respiratory secretions straight out potentially infecting others if you are sick and don’t know it (ABC News)
• COVID-19 deaths in Los Angeles County pass 1,500 with 1,800 currently hospitalized as trails, golf courses and some businesses reopen (Los Angeles Times)
• U.S. FDA has granted emergency use authorization to a more rapid kind of COVID-19 test called an antigen test. It’s basically similar to the rapid flu test done in doctor’s offices. They give quick results but are less accurate than the PCR test we all love to hate. In my opinion, this is a bad move because these tests have a higher false-negative rate than the current test (which already has an unacceptably high false-negative rate). Use of this test will mean more infections and deaths because people who actually have COVID-19 will falsely believe they don’t and are likely to behave less carefully (The Verge)

2. U.S. deaths fell yesterday, but grew by 21% last week, surpassing 70,000
   On Friday, an additional 1,695 Americans lost their lives to COVID-19, a rise of 2% and a third straight day of declines. Arizona had the highest increase in deaths last week, rising 62%, roughly doubling every 10 days. As I reported yesterday, Arizona has tested fewer of its residents than any other state. New record highs were set in Arizona (67) and Washington DC (19) yesterday. In addition to Arizona out west, there are 4 midwestern states reporting more than 40% growth in deaths last week (Iowa, Minnesota, North Dakota and South Dakota), along with 1 southern state (Mississippi) and 3 northeastern states (New Hampshire, Pennsylvania and Rhode Island). Overall, there were 4,369 COVID-19 deaths last week, an increase of 21% in the cumulative total. Several midwestern states that had been slowing have surged in the last 3 days including Illinois and Ohio. Pennsylvania has had a very rough week, adding more than 1,000 deaths in the last 4 days.
   What this means: Deaths have plateaued in the U.S. over the recent few weeks averaging 1,780 a day. That tells us the epidemic remains in a steady state of linear growth. This means the epidemic is not waning, it is not ending soon and the worst is not yet behind us.

3. Global cases pass 4 million, how epidemiologists see the big picture
   Most major data sites suggest that more than 4 million global cases have occurred. The graphic below is a screen capture of the WORLDOMETER dashboard at this moment. This is a useful big picture summary of the pandemic. How do epidemiologists look at this information?
   1. First, what is the ratio of active to closed cases. Here, it’s considerably greater than 1, indicating the global pandemic is still growing significantly. There are almost half a million more estimated active cases than closed cases now.
   2. Next, we look the breakdown of cases by severity. In this case, we can see 3 categories: mild, serious/critical and death. The vast majority of active cases are mild (98%), a proportion that has been rising around the globe as more nations are testing people other than just those who are sick. That sounds like good news to most people, but not to us. The very high proportion of mild cases is bad news because it tells us why this pandemic will be remembered for generations. Paradoxically, it is much easier to stop an epidemic that kills or sickens a far higher fraction of its victims.
   3. We note with sadness that the global death toll is now above 280,000 human beings. That represents 16% of the closed cases. Epidemiologists don’t confuse this with the case-fatality rate because we know that the denominator (total number of infections) is no where near accurately estimated by this case total. Also, because the duration of illness is long for a virus, closed cases are not a good metric even for the crude death ratio, especially when there are more active cases than closed cases. Finally, we can’t forget that deaths are being undercounted probably by half.
   4. The bottom two curves show us global cases and deaths on the log scale. We look at the data this way because we want to tell the difference between exponential and linear growth. When the curves rise on the log scale, that’s exponential growth. Flat sections indicate a transition to linear growth. Everyone is talking about a “second wave” in the fall. Based on this graph, I would say there is partial evidence that on a global scale, we are in the second wave now, having seen a plateau in cases and deaths in early March. More importantly, the trend in both the blue and orange is for continued non-linear growth if not acceleration in the pandemic in the last 2 weeks.
      Bottom Line: There is no evidence here that the global pandemic is weakening.

Worldometer dashboard screen grab at 7:30pm EST, May 9: https://www.worldometers.info/coronavirus/

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Daily COVID-19 Briefing: 4/30/20

Top news, reports and insights for today:

1. Daily headlines for Thursday:

• At least 31 states will reopen in the coming days as stay-at-home orders expire across the U.S. (CNN)
• As states move to re-open, none has met federal criteria: 14-day drop in cases (NBC News).
• L.A. County becomes first in California to offer testing to all residents as cases surge in the city (Los Angeles Times).
• Dr. Anthony Fauci (America’s Uncle Tony) says that a viable coronavirus vaccine is possible by January (NBC News).
• Georgia reopening: an experiment with lives at stake, puts working-class in the cross-hairs of the pandemic (The Atlantic)

2. States that never issued stay-at-home orders, and those that did so late, have steeper epidemic curves
   On April 19 I posted a graph that shows how states compared in the rate of case growth since the day of the 100th case comparing three groups of states among those with moderate-sized outbreaks. This compares the pace of the epidemic in states that issued stay-at-home (SAH) orders early, vs. late vs. never. Today I present an update on that graph after 10 more days of data (see below). It’s a busy graph, but contains I think very compelling evidence that SAH orders have been effective. The black line is the average growth across all states and DC. States below that line are below average growth in cases, states above that line have more rapid growth. All states start on the day they reached 100 cases. There are 3 big take home messages here.
   1. All states that adopted SAH restrictions before March 30 (solid lines) are growing cases slower than the national average. Wisconsin was above the black line until day 26 but has since remained below the US average.
   2. All states that adopted SAH orders after March 30 had more rapid growth than the US average except South Carolina and Nevada.
   3. Among states that never adopted SAH orders (dotted lines), 3 have seen dramatic acceleration of their curves. I have marked Nebraska, Arkansas and Iowa. In those states, on different days, their curves turned dramatically upward after a period of slower growth. This pattern is not seen in any state that adopted early. Utah’s inflection is less severe but still evident at day 35.
   The bottom line: These data suggest that stay-at-home restrictions have slowed the epidemic generally, that early adopting states have done better, and that states that never adopted have been vulnerable to dramatic periods of accelerated growth. This provides a template for looking over time at what happens as these restrictions are lifted.

3. U.S. deaths spike again to second highest daily total, new cases remain flat
   On Wednesday, reported COVID-19 deaths spiked again to the second highest daily total of 2,549, a rise of 5%. While the 7-day moving average, had showed a trend toward decline since April 21, the last two days have adjusted the trend back in the direction of rising deaths (top graph). Nine states matched or set new record high deaths, including 5 in the midwest (Iowa (12), Indiana (63), Nebraska (13), Ohio (138), and South Dakota (2)). In the Northeast, records were set in DC (15), Massachussetts (252) and Pennsylvania (479). New cases in the U.S. have passed 1 million rising by 3% on Wednesday by more than 25,000 (bottom graph). The 7-day moving average has been trending flat over the last week, however it remains unclear if this is flat case growth or flat testing capacity.
   What this means? The disconnect between the push from states to reopen and the story the data are telling is more striking every day. Neither deaths nor new cases show sustained declines. The White House continues to say we are on the cusp of getting past this epidemic. I have no idea where they get that assessment.

4. Brazil ranks second yesterday in new cases (behind U.S) raising concerns about South America as temperatures there fall
   On Wednesday, Brazil reported the second highest new case totals (6,462), a 1-day rise of 9%. The graph below from WORLDOMETER shows that new cases and active cases have been rising exponentially over the last two weeks. Brazil joins Peru, Chile and Mexico as nations in the top 25 in new cases. Of further concern, Brazil has tested only 1,600 per million, suggesting that these case totals may be severely under-estimated.
   Bottom line: So far, few have paid much attention to Latin America. This may soon change. As temperatures begin to fall in the southern hemisphere, all eyes will be on South America and Africa to see what happens when COVID-19 collides with an entire season of “normal” respiratory illnesses. Brazil is an especially important country to watch due to high population density, intense tourism and substantial areas of poverty. Brazil is also in the midst of a severe recession.

Accessed from WORLDOMETER April 30, 2020: https://www.latimes.com/california/story/2020-04-29/talk-of-reopening-grows-in-l-a-orange-county-despite-rising-death-toll