Trump does better in COVID-19 ravaged states than expected. Exit polls show voters worried about the economic effects of lockdowns if the encumbant lost. Many voters fell victim to the false belief that policy makers must choose between public health and the economy (see Main Point 3). Meanwhile, the economic damage of the pandemic have been much less in the countries that have controlled the epidemic best (VOX)
A study from Mount Sinai found that SARS-CoV-2 virus was circulating in New York city in February, weeks before the first case was noticed. The study also shows that as many as 22 percent of New York City residents may have been infected, still far from the herd immunity threshold (BGR)
Dr. Deborah L. Birx, who has carefully straddled the line between science and politics as she helps lead the Trump administration’s coronavirus response, delivered a stark private warning on Monday, telling White House officials that the pandemic is entering a new and “deadly phase” that demands a more aggressive approach (New York Times)
A study of cell phone data shows that people who live in low income neighborhoods are not able to social distance to the extent those who live in affluent communities. Socioeconomic barriers to social distancing is part of why COVID-19 disproportionately impacts residents of low income communities (Nature Human Behavior)
Federal officials add pregnant women to high risk groups after CDC study finds that COVID-19 increases risk of preterm delivery and the need for intensive care (New York Times)
U.S. cases keep climbing, crashing through 9 million. Latest million took just 2 weeks. It took three months for the first million U.S. official COVID-19 cases to be identified and tallied. From 8 to 9 million took just 2 weeks, the fastest million thus far, and a further indication that the coronavirus outbreak continues to accelerate (Figure A). As the U.S. edges toward 100,000 cases a day, more than half a million cases are being added each week (Figure B). A part of the current rise is due to increased testing. However, Figure C shows the trends in daily cases (red) and daily tests (blue) averaged over 7 days since September 1. The inflection point in cases happened on October 2, starting a rise from 42,000 daily cases to the current levels above 85,000. In that time, tests rose from 1.03 million a day to 1.24 million, a jump of only 16%. Since October 2, daily cases doubled while testing increased less than a quarter. Testing actually rose faster in September, while cases were fairly flat. Figure D is our old friend, the state daily case growth-factor situation. Where are cases rising fastest? The Midwest and Northeast, where only Oklahoma and Vermont are seeing weekly cases fall. In the Midwest, weekly cases grew by 50% or more in Iowa (+70%), Kansas (+85%), Michigan (+59%), and Minnesota (+61%). Showing no light at the end of the tunnel, weekly cases are still rising in North Dakota (+46%), South Dakota (+22%) and Wisconsin (+14%). Despite this, President Trump won or leads the election results in all these states except Wisconsin, Minnesota, and Michigan. In the Northeast, 9 states saw weekly cases grow 20 percent or more, led by Maine (+116%). Those who follow me will recall that I showed you a map over the weekend indicating that case explosions are tracking with the arrival of super cold air (e.g., Maine, Montana, Idaho, the Dakotas and Colorado). Bottom line: Cases are surging substantially in the U.S. which is only marginally a result of rising testing. At the current rate, adding a million cases every 2 weeks, the U.S. may reach 13 million cases before 2020 ends. There is no end in sight to the surge of cases in the Midwest and Northeast in particular. The Trump administration may win another term because of the epidemic, not despite it (see Headline 1).
Government actions to control the epidemic AND maintain economic health can work: the German case I vish to talk about Djermany (silly accent). As I process my own reactions to the election, I am struck once again by how wrong the polls and pundits were. Most experts believed that the recent surge of cases in battleground states would hurt the President at the polls. That was largely not the case. There was no Biden landslide spearheaded by worried swing voters in the hard hit states. Trump won the Dakotas, Iowa, Montana, Idaho, Utah, Kansas, Nebraska, and Missouri, all states that have been on fire with COVID-19 in recent weeks. Exit polls indicate many voters were worried that a Biden win would mean further economic harm from tougher lockdowns. In other words, it looks like the coronavirus actually helped the President. That idea, that policy makers must choose between the competing goals of controlling the outbreak and supporting the economy, appears to underly this phenomenon. It is, sadly, a widespread view that such a choice is necessary, that controlling the virus means hurting the economy. Of course, that was a key part of the President’s messaging. However, the data tells us a very different story. That’s why I want to talk about Germany. You may have heard that the U.S. is not the only place where coronavirus is surging. Europe is dealing with another big wavelet as well. Have a look at Figure E below, taken from the European Center for Disease Control and Prevention (ECDC). It shows new case growth per 100,000 population for the two prior weeks as of October 28. This map startled me. It’s very handy to be able to see patterns at the sub-national level, similar to what I do every day with U.S. states. As a thought experiment, let us say that it is true that what national and state governments do to control COVID-19 is pointless and unimportant. If that were so, we would not expect new case rates to vary along national borders. Instead, as was more or less true very early in the pandemic, the spread of disease would not honor national boundaries. Look at Germany and its neighbors. Not only is there clearly a spatial patterning of new cases that follows national boundaries, but Germany is completely surrounded by areas at the highest level of transmission on the scale including France, the Netherlands, and Belgium to the west, Austria, the Czech Republic and Poland to the east. Similarly, Portugal outperforms Spain, Scotland looks better than the rest of the U.K., and Sweden is doing worse than its Scandinavian neighbors Finland and Norway. Greece is doing better than Bulgaria in the last 2 weeks. The best performing European nation right now is Estonia, where only 73 COVID-19 deaths have occurred and their incidence rate (402 per 100,000) is one fifth what it is in the U.S. (2,946 per 100,000). Germany has set an example for the rest of Europe and the world using a combination of stringent control measures (closing schools, banning gatherings over 50, mandatory masks) as well as highly targeted testing and contact tracing. The result is that they have outperformed their neighbors, the U.S. and much of the world consistently and dramatically. All told, the Germans have 712 cases and 13.1 deaths per 100,000 compared to the U.S. rates of 2,946 and 72.2 cases and deaths. The U.S. COVID-19 death rate is five and a half times higher than the German rate. National policies matter and make a big difference. Now, let’s consider the question of trade-offs between the economy and public health. That’s where all this started. For that, we need one more figure, this one from OurWorldInData. Figure F plots COVID-19 deaths per million (vertical axis) against economic decline in the second quarter as percent drop in GDP compared to the previous year. If it’s true that countries have to choose between public health and the economy, then this graph should show that the countries with the highest death rates should have less economic damage, and that countries with low death rates should have paid the price in terms of bigger GDP losses. This graph tells the opposite story. The countries that kept the disease most in check (Taiwan, South Korea, Lithuania, Nigeria, Norway and Finland have had the least negative economic declines, all well-below the United States. On the other hand, the nations with high death rates (>400 per million) including Belgium, the UK, Italy, France, Mexico, Spain (hidden behind UK), Sweden (next to USA) and the U.S., all (except the U.S. and Sweden) experienced GDP losses of 12% or more. Among big, diverse, industrialized democracies, Germany kept its deaths down among the lowest, and at the same time, has an economy that has suffered less than Canada, France, Italy, Spain, Belgium and the United Kingdom. Wunderbahr! Bottom Line: What countries do matters. The evidence strongly shows no trade-off. Countries that have controlled the pandemic the best have seen less economic damage, not more. Allowing the coronavirus to run rampant without control measures causes more economic damage.
Quirky Qorner: North Dakota now has 151 cases a day per 100,000, the highest in the nation by far. Yesterday, the 8th district of the North Dakota House of Representatives elected Republican David Andahl who earned triple the votes of his democratic opponents. The problem: Representative Andahl died of COVID-19 in October I have been wondering what it’s like to be in North Dakota right now. By every measure, the outbreak is out of control in that state. Newsweek tells us today that the voters of North Dakota, despite how bad things are COVID-wise, gave President Trump twice as many votes as Biden. CNBC reports today that North Dakotans have also elected a man who died of COVID last month. My heart goes out to the family of Mr. Andahl, but it seems that North Dakota continues to go down the coronavirus rabbit hole.
New study finds since mid-May, U.S. has the highest COVID-19 death rate of any country with a large outbreak. Since June 7, U.S. COVID-19 deaths per 100,000 were more than twice the next highest countries (Israel and Sweden) and 6 times higher than Canada (JAMA, see Figure A below)
Sweden’s experiment to avoid shutting down is a “disaster” and should not be a model for the world (Time)
For the first time, the U.S. has now hired more than 50,000 contact tracers according to Johns Hopkins data. However, the push to grow a COVID-19 workforce is still less than half way to what experts say we need (NPR)
Harvard study finds that patients who survive severe COVID-19 infection retain high antibody levels for up to 4 months. This is as close as we can now come to President Trump’s unsubstantiated claim that he now has lifetime “immunity” to the virus (Daily Mail)
A 25-year-old man is now the first in North America to have a documented second infection with SARS-CoV-2. His second infection identified in June was more severe than the first found in April. The true extent of COVID-19 reinfection is not currently known (CBS News)
U.S. daily cases continue to track upward, surges seen across all regions. Three Midwest states remain white hot and getting hotter As we move into a new week, the daily U.S. case data shows a continuing trend toward rising transmission intensity with the 7-day moving average lurching over 45,000 daily cases (Figure B). In the last week 340,470 cases were reported, the first time we have seen more than 300,000 weekly cases since mid-August. At my weekend briefing, cases were rising in all but 8 states. The numbers now look worse (Figure C); all but 5 states are now on the incline. There are numerous states in all regions where cases rose 20% or more week-over-week with the largest number in the Midwest: Iowa (+23%), Illinois (+41%), Indiana (+42%), Kansas (+26%), Michigan (+27%), Minnesota (+21%), North Dakota (+31%), Ohio (+26%), and South Dakota (+33%). The situation in the Dakotas remains especially alarming as things have gone from bad to worse. After weeks of very high transmission, both states saw new cases rise by more than a third. North Dakota added another 3,881 new cases raising its overall incidence rate to 3,706 per 100,000, second only to Louisiana. The largest weekly jumps in new cases actually happened in the West where Colorado (+41%), Montana (+63%), and New Mexico (+55%) are potential new hot spots. Switching to the rate of new infections, similar states stand out (Figure D). A week ago, North Dakota had 56 new daily cases per 100,000, now they are at 73. South Dakota, then at 47 is now 62. Montana jumped from 35 to 57 in a week. These are big increases in states that have been hot for some time. All but two Midwest states are now over 20 new daily cases per 100,000 and none are below the 5 benchmark. In the South, only Arkansas, Mississippi and Tennessee remain “hot”. The situation is holding steady in the Northeast although new cases are creeping higher in Rhode Island, now at 22 per day. The bottom line: The overall picture is toward rising cases across the board and in all regions. The Dakotas remain the hottest of the hot spots, followed by Wisconsin, and Montana. Thankfully, deaths have not yet started to rise appreciably but it is only a matter of time.
Is the current surge in U.S. cases due to flu? Not yet! I want to talk about influenza. There has been a lot of discussion lately about what we should expect given the impending rise of flu cases and what that will mean for the COVID-19 pandemic both in the U.S. and throughout the Northern hemisphere. Some people are suggesting that the kickoff of the flu season may be behind the recent surge in cases. I decided to go back and look historically at the time course of influenza in the U.S. in the fall over the last three years. Thankfully, the CDC has a great tool for this called interactive FLUView. It shows trends in influenza-like illness (ILI) across the U.S. by tracking patient visits to doctors with flu-like symptoms each week. Figure E below is my best effort to show you what the U.S. maps look like every two weeks from the middle of October till early January over the last three years. My goal was to answer a very simple question. When does the flu season really start to intensify? If it is late October, it might be true we are already seeing the impact of flu on COVID-19 numbers. Have a look at Figure E. There are at least 3 main lessons I take from this picture. First, it is exceptionally unlikely that the surge we are seeing now is the result of early flu activity. Over the last three years, the intensity coming in January through March won’t actually get started until somewhere between late November (last year) and late December (2018-19). The second thing that caught my eye was that flu-like illness intensifies first geographically in the Southeast and works its way north. I don’t know why but it is an interesting epidemiologic puzzle. I will be looking carefully at Louisiana, Texas, Alabama and Georgia as the states most likely to show early flu intensity. Third, last year was a high-intensity flu season months before COVID-19 was on the radar screen. The bottom line: It is hoped that with good vaccine uptake, mask wearing and social distancing, this year’s flu season will be less severe. If it is, COVID-19 will be more manageable. If, however, we drop the ball on flu prevention, the co-occurence of influenza and COVID-19 could create a double whammy of tremendous death and suffering.
Quirky Qorner: Cyberchondria! Social media and internet browsing are driving COVID-19 fear and anxiety I started reading this week about cyberchondria, defined on Wikipedia as the unfounded escalation of concerns about common symptomology based on review of search results and literature online. It’s a very pretty word for a not-so-pretty facet of the COVID-19 pandemic. We all like to believe that having access to more information at our fingertips is a good thing. More and more we are realizing that this is often not true. Researchers find that google search trends can actually predict where outbreaks are heating up. Now, a team from the Netherlands has published a study in the Journal of Anxiety Disorders. The study, based on a survey of 439 adults conducted in March, found that the coronavirus outbreak is causing fear and worry to increase. That’s hardly surprising. The interesting part is that even after controlling for other factors, time spent regularly looking up coronavirus information online, through social media and through regular media increased fear. You would think it is the opposite. Regular intake of social and traditional media heightened people’s fears rather than empowering them. Of course, that can’t apply to my blog. Right? Well in their analysis, looking up information on “professional” websites was not associated with increased fear! Whew!
Researchers combined information from 32 studies of COVID-19 risk in children, finding that children and adolescents had 44% lower odds of secondary infection with SARS-CoV-2 compared with adults (JAMA Pediatrics)
Moderna CEO says its coronavirus vaccine won’t be ready until spring of next year (CBS News)
The White House coronavirus task force again this week strongly recommending mask usage in some states like Iowa and Georgia that still do not have statewide mask mandates (CNN Politics)
Hospitals feel the squeeze as cases spike in upper Midwest states Wisconsin, North Dakota (ABC News)
Facebook removes 38 versions of Trump campaign ads claiming (without evidence) that admitting refugees increases COVID-19 risk (NBC News)
Largest study yet of COVID-19 transmission in India published in Sciencehighlights the role of super-spreaders, a small subset responsible for a high percentage of infections. Study also finds that children transmit the disease as easily as adults (Los Angeles Times)
Remember how COVID-19 exploded on a cruise ship? The Trump administration has again over-ruled the CDC recommendation to extend the “no-sail” order on cruise ships to next year (ARS Technica)
U.S. passes 7 million lab-confirmed COVID-19 cases. Last million cases added in 26 days Let’s start with the big picture today. Over the weekend, based on the Wikipedia data, the U.S. passed 7 million cases (See Figure A). On average, the U.S. has added a half million cases every 12 days. We went from 6.5 to 7 million in exactly 12 days. On average, each million cases has been accruing every 26 days. The jump from 6 to 7 million was just that (26 days). That’s a million cases a month. The more important idea here is that the COVID-19 outbreak is now steady-as-she-goes in terms of the pace of growth. On a big picture basis, the epidemic is locked in to an oddly consistent, even robust degree. Seasonality has been less than expected, surges and falls have been less steep than might have been predicted, and overall, the epidemic curve looks more like an endemic than a pandemic. What does this mean: Buckle up for the long hall because SARS-CoV-2 is not going away.
U.S. daily cases holding largely steady. Transmission intensity highest in the Midwest, growing fastest in the West Figure B shows daily cases; the 7-day average remains just over 40,000 a day. We are now adding cases about twice as fast as the nadir of the epidemic in the first week of June. Today, I wanted to point out how different ways of looking at the same data are needed to address different questions. What questions? First, where are infections being generated most intensively right now? Second, where is the rate of new infections growing the fastest? Sometimes the answers will be the same. But, if a particular state has high sustained transmission intensity for a long time, the rate of growth of new cases will be very low. Conversely, a state with very low transmission intensity might be growing the fastest through regression to the mean in a natural cycle of change. Take a look at Figure C showing new daily cases per 100,000 residents by state over the last week. Let’s remind ourselves that the benchmarks we care about are a) less than 5 indicating “low” transmission intensity, and b) greater than 20, or 4-fold higher, indicating “high” transmission intensity. As has been consistently true for weeks, the Northeast is in the best shape with 5 states in the low category and only Delaware is over ten. The South is, thankfully, also relatively quiet with only Arkansas reporting high spread. The region that is clearly most hot is the Midwest with eight of thirteen states in the red zone. Three stand out in particular: North Dakota (54) is 10x higher than the “low” benchmark, while South Dakota (45) and Wisconsin (39) are surging at a white hot pace. Michigan (9.6) and Ohio (7.8) are the only “warm” states below 10. Iowa (29), Kansas (32), Missouri (22), Nebraska (24) and Oklahoma (26) are all hot. In the West, while Arizona remains coolish, Idaho (25), Montana (27) and Utah (32) are all hot. So what about the second question? Have a look at Figure D showing 7-day growth factors in cases. The picture is different. Intensity is low in the Northeast, but growth in new cases is strong with five states seeing a week-over-week increase of 10% or more: Delaware, Massachussetts, New Jersey, New York and Pennsylvania. New cases are falling in nine of thirteen states in the South. The region where the most growth is occurring is the West. Cases are rising fastest in New Mexico (+58%), Wyoming (+53%), Nevada (+46%), Washington (+41%), Alaska (+39%), and Montana (+39%) in that order. Whereas transmission intensity is highest in the Midwest, case growth is over 20% in only Michigan (+21%), South Dakota (+28%), and Wisconsin (+23%). Let’s take special notice of the states that pop out of both figures. Montana, South Dakota and Wisconsin, all regionally propinquitous, all have both high intensity and rapid growth. Bottom line: Something big and scary is going on in the upper midwest plains states!
Quirky Qorner: Republic of Kazakhstan social influencer Borat tweets praise for U.S. coronavirus handling: “Because of Trump, 350 million Americans still alive” If rumors are correct, the long awaited followup to Borat is on its way to Amazon Prime Video sometime soon. According to this piece in Vanity Fair, twitter was shaken by a video appearing just before the first debate, handle @KazakhstanGovt, congratulating “Premier Trump” for his handling of the crisis. Very Nizzzze!