Daily COVID-19 Briefing: Monday

Top news, reports and insights for today:

1. Daily headline summaries for Monday:

• WHO warns the pandemic is worsening across the globe as the number of new cases on Sunday reached an all-time high. Large rises seen in central and South America and South Asia (CNBC)
• Florida is preparing to reopen restaurants, bars, gyms, shops, amusement parks and vacation rentals. At the same time, new cases have been surging after the first wave of reopening, reversing a downward trend. That state has seen new cases exceeding 1,000 a day for 5 straight days (Futurism, see Figure B below)
• New study shows stay-at-home orders in Illinois lowered infections compared to Iowa in the 15 counties on the boarder between those states (Jama, see Figure A below)

FIGURE A: From Lyu and Wehby, JAMA, 5-15-20: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766229?utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamanetworkopen&utm_content=mthlyforyou&utm_term=060720

FIGURE B: Taken from Futurism: http://91-divoc.com/pages/covid-visualization/

2. U.S. daily cases are flat at 20,000 per day for 12 days, epidemic intensifying in 25 states
   Today, I will focus on recent changes in COVID-19 cases by state (see the 3 figures below). Overall, the U.S. now reports over 1.9 million cases (2 million plus if counting probable cases), or 28% of all global infections. Brazil now has the second most cases at 694,000, 9.7% of the total across the planet. Among countries with 100,000 cases or more, the U.S. now ranks 3rd in cases per 1 million population behind Chile and Spain. As the top graph shows, daily cases have been flat at just over 20,000 since May 26 (based on 7-day moving average). This reflects, I believe, the start of resurgence of transmission intensity in states that have reopened. Over the past 3 days, 5 states have set new record highs for daily cases (Arizona, New Mexico, Utah, Oregon and North Carolina). Utah and North Carolina set records on back-to-back days. Arizona, for example, had reported more than 1,000 daily cases once before. That state had 1,579 cases on June 5. The middle graph shows daily new cases per 100,000 population by state. The positive news is that 21 states had fewer than 5 new cases per day per 100,000. However, cases are spiking at 10 or more a day in Arizona, Utah, Nebraska, Arkansas, and Washington DC. The southern region had the most states with more than 5 a day (11 of 13). The area comprising Iowa, Illinois, Indiana, Minnesota, North Dakota, South Dakota and Wisconsin, all had significant rises in cases, indicating the upper midwest is still a hotspot. The bottom graph shows growth factors by state for change in cases over the last week. Numbers greater than 1 means cases are growing week-over-week. In the northeast, only Vermont is rising although numbers are small. In the south, transmission intensity is rising in 9 of 13 states, the most in Arkansas, now doubling in cases every 10 days. In the midwest, cases are spiking in North Dakota with 80% rise last week. The western region also has all but 3 states with cases climbing, with Alaska, Arizona, Hawaii, New Mexico, Oregon and Utah reporting 50% or more increases in new cases.
   What it means? States continue to reopen even as widespread intensification of infections is seen, particularly in the south and west. Weekly cases are rising in 25 states. I expect the trend of 20,000 daily cases to continue and to rise slowly over the next two weeks.

3. The great influenza of 1918-19: Learning lessons from the “mother of all pandemics”
   We still don’t know whether there will be additional waves of epidemic transmission of coronavirus in the U.S. and other countries in the Fall and Winter of 2020. However, we should be planning now for the possibility that it might. One place to look for insights is the Spanish influenza epidemic of 1918-19, which claimed the lives of more than half a million Americans and more than 50 million world wide. A cautionary tale from that epidemic points to the possibility of major re-ignition of epidemic transmission seen in that pandemic. As the graph below shows, taken from a 2006 paper by two experts, the initial wave starting in March of 1918 (shown here for the UK but the dynamic globally was similar) was quite mild. After a quiet summer, the pandemic exploded in October and November of that year, making it the “mother of all pandemics”. This was followed by a third wave in February-April of 1919, more lethal than round 1 but less so than round 2. It’s still not entirely clear why this happened. Its possible the virus mutated between wave 1 and 2, but this cannot be confirmed due to lack of genes from the wave 1 virus. What is known is that both influenza and coronavirus can manifest this repeating wave phenomenon. We don’t know if this will happen with SARS-CoV-2 but now is the time we need to prepare for the possibility that the pandemic will roar back to life in the fall.

From Taubenberger and Morens, Emerg. Inf. Dis. 2006.

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Daily COVID-19 Briefing: 5/4/20

Top news, reports and insights for today:

1. Daily COVID-19 headlines for Monday:

• Public health authorities are warning of a nationwide uptick in fatal opioid overdoses during social distancing, reminding us that we face parallel pandemics (The Daily Beast)
• President Trump now says U.S. deaths could be as high as 100,000 (Reuters)
• New Chinese study shows COVID-19 patients are most contagious in first 7 days (South China Morning Post)
• UK finds most COVID-19 patients make antibodies, immunity however is far less clear (Reuters)

2. U.S. deaths and cases trending down overall, masking shifting hot spots: The mid-West is now the epicenter
   We now expect administrative lag in reporting of deaths and cases on Sunday and Monday. The data shows a down-ward trend in both over the weekend. Deaths and new cases both rose by 2% on Sunday to 61,582 and 1.15 million respectively. The chart below shows growth in new cases as a percentage of total over the previous 7 days by state and region. New York, which for the first time has less than 1/3 of the nation’s total burden of cases, saw reported cases rise by only 10%. That’s good news, but because the firestorm in New York was driving overall U.S. cases for weeks, the slow-down in new cases there can give a false sense of confidence. This is shown in the overall flattening of new cases across the country. However, as the graph below shows, the epidemic remains fast-moving in 4 states in the midwest, with Iowa, Kansas, Minnesota and Nebraska all increasing cases by 50% or more last week. In total, 16 states saw cases grow by 30% or more.
   What this means? Despite talk of national plateau, sustained community transmission is occurring in a third of the country. The mid-west continues to be the epicenter of the epidemic in the U.S.. As many states rush to reopen, these data suggest that the only states that should be doing so are Hawaii, Alaska, Montana, and Vermont, with Idaho, Washington, Louisiana, West Virginia and New York close behind.

3. Cell phone data shows how residents are getting back on the road as lockdowns are eased
   I was fascinated to read a story on May 3 from the Daily Mail about the use of cell phone data to track the rebound in driving across the nation. The data come from anonymized cell phone requests for directions from Apple maps. The two graphs below are examples of what these data show for Georgia, which recently moved to reopen and New York, which has not. There are several conclusions I draw from these graphs. The first is just how cool it is to be able to have real-time transportation data like these to better understand what social distancing is actually doing. Second, in both states, automobile travel declined by over 60% at the height of stay at home orders, starting in mid-March in New York, and mid-April in Georgia. Third, mid-week variation in driving was greater in Georgia (more jagged line) suggesting New Yorkers were more compliant with restrictions. Fourth, the move to reopen Georgia was followed quickly by a reversal of the slow-down in driving, rising 60% as of May 1. In New York, where stay-at-home orders remain in place, driving remains at 30% below the baseline established from January 1 of this year.
   Bottom Line: As New York now appears to be past it’s peak of cases, that state’s continued willingness to restrict driving has paid off. Georgia and other states that are moving quickly to reopen are seeing a rapid return to “business as usual” on the roads. Time will tell whether this leads to subsequent spiking of cases and deaths.

• 

  Georgia

• 

  New York

Cell phone requests for directions on Apple maps, screen capture from the Daily Mail: https://www.dailymail.co.uk/news/article-8282189/The-U-S-Cell-phone-data-shows-states-easing-lockdown.html

 

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