Wednesday COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Wednesday:
  • U.S. death toll hits 200,000. President Trump tells a rally in Ohio: “It affects virtually nobody” (Vox)
  • Both nationally and in 6 swing states, most voters worry President Trump is trying to rush release of coronavirus vaccine to help his reelection, new polls show (CNBC)
  • The Helsinki Airport in Finland is now using specially trained dogs to sniff out COVID-19 in passengers. A study shows dogs can detect the virus almost instantly without an uncomfortable nasal swab (FastCompany)
  • COVID-19 conspiracy theories are spreading rapidly, like the virus, complicating public health efforts. A new study in Social Science & Medicine finds that conspiracy theories are commonplace and have increased from March to July (Time)
  • New cheaper, faster tests are coming on line, which is good, but nobody knows how to report and count them, leading to growing blind spots in our surveillance. Increasingly, it is impossible to say how many tests are being done (ABC News)
  • Aerosols are back on! CDC reverses course, acknowledges the possibility of airborne transmission via aerosols (Los Angeles Times)
  1. U.S. cases surging again. Only 5 Northeast states below 5 cases per day per 100,000
     New daily COVID-19 cases demonstrate yet another dip as Tuesday numbers soar back above 45,000 (See Figure A). It’s still too early to say whether the numbers will be inconsistent week-to-week or whether return to schools, economic restarting or overlapping respiratory infections are pushing things steadily toward greater transmission intensity.
     As is my habit, my eye turns to the state data to determine whether there are regional patterns. At this point, we would hope to see some states in relatively good control with new daily cases below five per 100,000 per day. Figure B shows the numbers as of today. No states in the Midwest, South or West meet that benchmark (although several are close). The only states under control are in the Northeast and include my state of Maryland, along with Maine, New Hampshire, New York and Vermont. The only Northeast state over 10 is Rhode Island. On the other hand, eight of thirteen Midwest states are four times higher including Iowa (27 per 100,000 per day), Kansas (28), Missouri (23), Oklahoma (28), South Dakota (35), Wisconsin (32) and North Dakota, which continues to lead the nation with the highest transmission intensity at 46. In the West, Idaho (20), Montana (19) and Utah are “hot”, while in the South, we are concerned about Arkansas (27), Tennessee (21) and Texas (24).
    The bottom line: It is important to note that the Tuesday numbers were boosted in part by a bolus 13,600 “older cases” added in Texas. Having said that, the trend is discouraging as the 7-day moving average (red dotted line) indicates. With the exception of a handful of Northeast states, transmission intensity remains worrisomely elevated in the other three regions.
Figure A
Figure B
  1. U.S. testing is getting harder to track. Updated data from the COVID Tracking Project now shows testing numbers holding strong
     If you took note of headline 5, you read about the challenges posed by tracking the intensity of U.S. coronavirus testing. In the beginning of the epidemic it was easier because the number of labs processing tests was smaller, the reporting system was working consistently and there was a smaller number of test types (predominantly PCR-based tests to detect viral RNA). Now, as new faster and cheaper tests have come on line, we are dealing with saliva tests, antibody tests, antigen tests and a host of other types that are increasingly difficult to track and monitor. Last Wednesday, I showed you a graph showing daily tests and the test positivity rate based on numbers from OurWorldInData. Based on that graph, I concluded that U.S. testing had fallen dramatically since September 3. As the testing data has gotten more complex, the story they tell becomes increasingly varied depending on the data source. I had been relying on data from COVID Tracking Project before last Wednesday. This week, I compared the data from the two sources and found a big difference. For several reasons, I am going back to the CTP data (Figure C). These data tell a more reassuring story. It looks like testing is holding steady and perhaps even rising over the last week. The drop in testing seen last week in the other dataset is not apparent. That gives me more confidence that the daily cases are more reliable and not an artifact of falling testing intensity. The test positivity rate is still not where we would like it (at or below 5%) but it is creeping down toward six percent.
    What this means: Tracking testing is getting harder. I’ll follow many observers and stick with the CTP data. It looks like U.S. testing is at least keeping pace. It is worth noting that the White House promised a million tests a day in March, a number that has still not been achieved.
Figure C
  1. Quirky Qorner: What’s funny about coronavirus? Nothing. But, that hasn’t stopped the flow of dark jokes
     As the death toll tops 200,000, the need for some dark humor intensifies. My attention was grabbed by a story by Jim Beckman from making the case for Rona humor. A couple of highlights:
    1. “Today’s Weather: Room Temperature.”
    2. “Anyone else’s car getting three weeks to the gallon?”
    3. “Never in my life would I imagine that my hands would consume more alcohol than my mouth.”
    4. Q: Why do they call it the novel coronavirus? A: It’s a long story…
    5. Q: What types of jokes are allowed during quarantine? A: Inside jokes

Top pick of the day: Friday

America is now a Covid-19 hot spot

Article by German Lopez, posted online at VOX, July 31, 2020.

What are the best numbers to focus on to gauge how things are going in your state? That is an important question. German Lopez, who has provided excellent coverage, zooms in on three key numbers: the number of daily new cases; the infection rate (aka Rt); and the percentage of tests that come back positive (aka test positivity rate or TPR). This article gives a big-picture breakdown of where we are across the U.S. and what is likely to be next.

Today’s bite-sized, handpicked selection of important news, information or science for all who want to know where this epidemic is going and what we should do.

Daily COVID-19 Briefing: Tuesday

Top news, reports and insights for today:

I wish to thank those who reached out to me in the past few days with encouragement and feedback. I needed to hear that my efforts in this blog are making a difference. My plan is to continue with regular briefings at least 3 times a week (tentatively Tuesday, Friday and Sunday). I will add supplemental posts when timely and important events arise. I plan to add a new feature: reader comments and questions. I will add an option on the blog for visitors to post specific questions of interest. I will try to address those questions as best I can and share the back and forth in this space. Thanks again for continuing to read this blog and I look forward to continuing to bring you fair, balanced and scientifically-oriented news, insights and analysis. Please keep the feedback coming!

  1. Daily headline summaries for Tuesday:
  • U.S. coronavirus deaths top 150,000 (NBC News)
  • It’s not just the U.S. that is experiencing coronavirus fatigue as several European nations are seeing recent spikes in new cases as control measures become more lax (Washington Post)
  • At least a dozen states are running out of doctors and nurses as COVID-19 cases surge. Shortages are especially acute in intensive care units. Military units stepping in to assist in California (ARS TECHNICA)
  • Opinion from 19 doctors and a nurse: Trump administration issued a new rule this month requiring hospitals to report COVID-19 data directly to the Trump administration instead of the CDC. “This sudden and radical decision to change hospital reporting from the CDC to a private third party within the Department of Health and Human Services will disrupt established lines of communication and has grave potential to hobble our ability to respond to the pandemic….” (USA Today)
  1. U.S. daily cases have leveled out; the latest half million cases added in just 7 days
     From Mid-June till Mid-July, we have seen daily cases rapidly and steadily rise in the U.S. as a result of widespread transmission intensity across multiple states and regions. In the last week, that trend has finally shifted and new COVID-19 cases have plateaued. That is welcome news. As was the case in the first apparent peak in late April, it is not clear if the flattening is driven by the epidemic itself or by a new ceiling in testing capacity. There is evidence that both are at play (see main point 3). The U.S. now has over 4.2 million total lab-confirmed COVID-19 cases, which is over 1/4 of the world’s cases (27%). The cumulative total rose from 3.5 to 4 million in just 7 days, the shortest interval thus far that half a million cases were added (See Figure B).
     At the state level, transmission intensity remains high in many states. Two states now exceed the overall rates of infection per 100,000 in New York (now at 2,120 per 100,000): Arizona (2,251) and Louisiana (2,394). New daily cases over the last week per 100,000 is shown in Figure C. Fourteen states added 25 or more new cases per day last week including Arizona (+37), California (+25), Idaho (+27), Nevada (+33), Oklahoma (+26), Alabama (+33), Arkansas (+26), Florida (+48), Georgia (+34), Louisiana (+46), Mississippi (+44), South Carolina (+30), Tennessee (+35), and Texas (+26). Transmission continues to be well controlled in much of the Northeast where Connecticut, Massachussetts, Maryland, Maine, New Hampshire, New York, New Jersey and Vermont remain below the benchmark value of 5 new cases per day per 100,000.
    The bottom line: The overall trend is flattening of new cases. It is possible we have simply maxed out on testing capacity. The virus continues to spread extensively in 14 states. Conditions in Arizona, Nevada, Alabama, Florida Georgia, Louisiana, Mississippi and Texas remain especially alarming.
Figure A
Figure B
Figure C
  1. What’s going on with testing in the U.S.?
     Across the nation, testing is under the microscope. Viral twitter posts have planted the idea that the U.S. only thinks it’s in bad shape because we are testing too many people. More tests make more cases, so the logic goes. Some national leaders have suggested a slow down in testing. The Trump administration has sent mixed signals. This week, “Uncle Toni” Fauci, the nation’s top infectious disease doctor told government panels two key things: 1) more testing does not lead to more cases by itself, and 2) he has never been told by the White House to slow down testing. But the question remains in a lot of minds: is the recent surge in cases just about more testing?
     To begin tackling this, let’s consider some basic facts. First, it is true that relative to the true underlying rate of a disease, the more testing that is done, the higher will be the number of cases identified. That’s why we have to look beyond total numbers of positive tests. Second, just as with cases, we can be easily mislead by looking at the raw number of tests. We have to look at rates. There are two that matter. The first is tests per million people. There are now 78 countries with 10,000 or more cases. Among those nations, the U.S. currently ranks 1st in total cases and 9th in testing per 1 million. That’s an improvement since the U.S. ranked 17th 2 months ago. The top graph below is from and shows the current place of the U.S. in testing rate compared to some other key nations. It shows we are in the middle of the pack. It also shows that while testing rates have climbed steadily, there is no big jump that would explain the June surge in cases.
     The other key rate is the test positivity rate (TPR). In many ways, the TPR can be a better measure of viral transmission intensity than the number of positive tests. Ideally, we would like the TPR to be at or below 5%, which tells us we are testing broadly in the population and that 95% of people are testing negative. In the early phase of the epidemic, we are only testing selectively: mostly those we already know to be sick. For that reason, the TPR was over 30% in the initial weeks of the pandemic. Let’s look now at the lower graph I made using data from the COVID Tracking Project, showing total tests per day in the U.S. and TPR since May 1. This graph shows two really important things. The blue bars are how many tests we are doing a day. That number has been steadily climbing since May 1. But, and here is the important point, it appears the growth in testing has flattened in the last week and may be declining. That is important when we put the numbers of daily positive tests in perspective. It is possible that the flattening of new cases is partly due to a flattening in the growth of new tests. To help clarify, we look at the orange line, which shows the TPR. That number fell from 17% on May 1 to around 8% in late June. Total tests continued to rise, but TPR did not fall. That’s important. If it had, we would be able to say that our testing is coming into better alignment with the true magnitude of the outbreak. That didn’t happen. The TPR has been consistent since Mid-June. That’s a sign that the surge in cases is mostly about the epidemic, and not “excess testing” whatever that might mean.
     The bottom line: We still aren’t testing enough. The surge in cases is mostly the spread of disease, not the rise in testing. Our capacity to test may have maxed out, suggesting we should be cautious in celebrating the apparent plateau in cases.