Wednesday COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Wednesday:
  • Half of U.S. states are reporting increased COVID-19 cases as some leaders are pushing for new control measures (CNN)
  • Top federal immunologist and whistleblower Dr. Rick Bright, fired in April as head of vaccine development program for opposing political pressure on health policy, has just resigned from the NIH saying “…he can no longer sit idly by and work for an administration that ignores scientific expertise, overrules public health guidance and disrespects career scientists, resulting the [sic.] in the sickness and death of hundreds of thousands of Americans,” (Politico)
  • Six U.S. states report record high COVID-19 hospitalizations. Wisconsin Governor Tony Evers said in a statement: “We’re in a crisis right now and need to immediately change our behavior to save lives. …. We are continuing to experience a surge in cases and many of our hospitals are overwhelmed…” (Reuters)
  • Skepticism toward science fell globally during the COVID-19 pandemic, according to a new survey following a 3-year trend of rising mistrust (Axios)
  • President Trump again tweeted that COVID-19 is “far lass lethal” than influenza. The truth: in just 8 months, SARS-CoV-2 has killed more than the past 5 seasons of flu combined and is much more contagious (CNN)
  1. Trend toward rising daily cases continues in the U.S. Deaths are steady at 700 a day. New infections continue to surge in the Midwest
     Average daily U.S. COVID-19 cases remain over 40,000 after the weekend reporting slow down. The Tuesday numbers were, like last Tuesday, encouraging but may be followed by a rebound on Wednesday. As data systems mature and routinized, I suspect we will see the weekend lull extended to Tuesday in the foreseeable future. At the state level (Figure B), the picture is similar to recent briefings: 8 Midwest states currently have new daily cases per 100,000 residents of 20 or more, making this region the ongoing national hot spot. Three states stand out in particular: North Dakota (56 daily cases per 100,000), South Dakota (47) and Wisconsin (40). Of these, North Dakota is the only one that is higher than October 3, suggesting that transmission intensity continues to increase in that state. Two Western states are above 30: Montana (35) and Utah (33), while thankfully, only Arkansas (25) and Tennessee (23) are above 20 in the South. While overall new case reporting is low in the Northeast, the growth factors show the biggest week-over-week gains are happening there, with new cases doubling last week in New Hampshire, Rhode Island and Vermont. On Tuesday, an additional 626 COVID-19 deaths were reported (Figure C) continuing a slight decline in deaths over the last week. Consistent with the lag in how the data proceeds from testing to hospitalizations to deaths, we are now seeing elevated growth factors for weekly deaths in Iowa (+88%), Kansas (+86%), Minnesota (+63%), Nebraska (+7%) and Wisconsin (+102%).
    What it means: The U.S. remains in a precarious position in terms of COVID-19 as daily cases continue to edge higher since the Mid-September trough. The Midwest remains the region of greatest concern while signals continue to foreshadow a coming surge in the Northeast.
Figure A
Figure B
Figure C
  1. Update on hospitalizations: Upper Midwest states under significant hospital stress, Wisconsin and South Dakota are ‘white hot’
     If you read the headline summary from Reuters on hospitalizations you know already that a number of upper Midwest states are right now seeing hospital beds fill to capacity with COVID-19 patients amidst the surge in cases. If you have read this blog for a while, you know that I am keen to pay close attention to hospitalization rates because they provide a concentrated surveillance signal for the epidemiologist. Because the barriers to being identified accurately and reliably as a case differ for testing, death and hospitalization, each offers a different window into the workings of the underlying transmission dynamics. None is free of bias and distortion, but hospitalizations may be especially “clean” from a data quality point of view. Let’s start with a look at current hospitalizations by region over the last month (Figure D). These data come from our good friends at the COVID Tracking Project. These data show rising hospitalizations in all regions in the last week, except the Midwest. That suggests a general trend toward increasing transmission intensity that is not specific to the particularities of one place. These data tell us that on an absolute basis, there are more people hospitalized in the south than in the other three regions combined. The South and West have seen a net decrease in overall hospitalizations since a month ago, while the trend is rising in the Northeast and Midwest. Let’s look more closely at the situation in the Midwest in the states we highlighted in the case report above.
     Figures E and F, also from the COVID Tracking Project, show daily cases and hospitalizations for 5 Midwest states with the largest new daily cases per 100,000 now: Wisconsin, Iowa, Kansas, North Dakota and South Dakota. There are two views of the data here, one is absolute numbers (Figure E) and the other is rates per million (Figure F). This is vitally important for an apples-to-apples comparison between a populated state like Wisconsin (5.8 million) and South Dakota, which has no major cities and far few people (885,000). Both figures show just how intensely the epidemic is crushing Wisconsin right now. Since their previous peak of 944 cases a day on July 27, Wisconsin has tripled to 2,500 a day. North and South Dakota were at fewer than 100 day till mid-summer, now both are averaging over 400 a day. Hospitalization numbers are chilling. Wisconsin now has 853 hospitalized having not previously exceeded 443, with 261 currently in ICU beds. Iowa and Kansas have surging cases but hospitalizations have not exceeded previous peak levels. Like Wisconsin, the Dakotas have seen exponential and explosive growth in hospitalizations in recent weeks. Shifting to Figure F showing rates, the situation looks especially challenging in South Dakota. On a per capita basis, both cases and hospitalizations in that state are off-the-charts at 2.5 times higher than any of the other states. I can’t find any case where COVID-19 hospitalization exceeded 200 per 1 million since the pandemic began. Is this perhaps a ballooning in testing? Figure G says no. Testing has risen about 75% since July but remains lower than the peak in June. Every metric in South Dakota is showing exponential and explosive increases except testing.
     The bottom line: COVID-19 hospitalization data confirms what we see in the data stream for cases and deaths: a handful of upper Midwest states are ‘white hot’ with extreme transmission intensity. Hospitalization data offers a third leg in the information stool.
Figure D. Total COVID-19 hospitalizations by region for 9/2/20 – 10/6/20 from the COVID Tracking Project
Figure E: Daily COVID-19 cases and hospitalizations, absolute numbers for 5 Midwest states from the COVID Tracking Project
Figure F: Daily COVID-19 cases and hospitalizations, rates per million for 5 Midwest states from the COVID Tracking Project
Figure G: Key metrics from South Dakota, October 6
  1. Quirky Qorner: COVID-19 is infecting our dreams
     I read a fascinating article in Scientific American over the weekend about how COVID-19 is impacting our dreams. It came from a Montreal Psychiatrist, Tore Nielsen, who is the director of the Dream and Nightmare Laboratory. Fun place I bet. The article was banging around in my head for a couple of days when I woke up yesterday morning in the middle of, you guessed it, a COVID-19 dream. Has this happened to you? In the article, they describe several ongoing research efforts that point to a surge in dreaming as so many of us adapt to more time at home, more time in the sack, and altered sleep patterns. Qualitative content analysis also suggests the content of our dreams is being impacted as a growing fraction of dreams include themes of loneliness, isolation, loss of control, anxiety, insufficiently completed tasks, contamination and cleanliness.
    The bottom line: Studies show we are taking COVID-19 to bed with us.