Wednesday COVID-19 Briefing

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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)

2. 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

3. 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

4. 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 Northjersey.com 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

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Daily COVID-19 Briefing: Saturday

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Top news, reports and insights for today:

1. Daily headline summaries for Saturday:

• Nineteen states this week set new highs for coronavirus infections recorded in a single day (Axios)
• White House has blocked CDC Director Redfield and other officials from testifying on school reopenings (USA Today)
• FDA approves pooled testing for coronavirus, promising to increase testing efficiency and reduce backlogs (Axios)
• 85 children under age 2 tested positive for coronavirus in 1 Texas county (NBC News)
• Studies in both the U.S. and U.K. show evidence that several candidate vaccines show early signs in Phase II studies showing they produce an immune response. Still, the highest hurdle remains as drug makers move to initiate Phase 3 trials in coming weeks (BBC News)

2. New daily high case records set Thursday and Friday. Deaths rising. Increasing transmission seen in all but 5 states
   New record high daily case totals were established on Thursday and Friday, with more than 145,000 cases reported in two days (Figure A). This brings total U.S. cases to over 3.5 million. A half million cases were added in just 8 days, faster than any previous period (Figure B). At the state level, while the nation has been watching a Arizona and Florida, community transmission this week is increasing across the board. Figure C shows one week growth factors (ratio of cases in last 7 days to the previous week) by state. All but 5 (46 of 51) states are increasing. Unlike last week, cases are rising again in the Northeast, where new cases rose by 20% or more in Washington DC (+21%), Maryland (+51%), New Hampshire (+30%), and Rhode Island (+50%). All states in the South saw cases rise by 10% or more, lead by Alabama (+43%) and Virginia (+46%). Transmission increased in all Midwest states except South Dakota. The largest 1-week rise was in the West, lead by Colorado (+96%), Alaska (+58%), Montana (+66%) and Nevada (+42%). Thankfully, new cases finally went down in Arizona by 2%. The trend toward rising deaths continued as 936 deaths were reported Friday (Figure D). Still, the number of deaths remains far lower than the peak period in April and May despite twice the number of cases.
   What does it mean: Instead of summer suppression, we see summer surge. Deaths, thankfully remain lower than cases would suggest. This tells us that we are capturing a larger percentage of the true cases in our testing. Instead of isolated state hot spots, transmission is intensifying more broadly across all states and regions than at any time in the past.

Figure A

Figure B

Figure C

Figure D

3. The summer story: The rest of the nation catches up with New York and New Jersey
   Over the last few months, I have been repeatedly checking the overall rates of confirmed COVID-19 infections per 100,000 population by state to see how the epidemic’s distribution has shifted. Disease detectives look most closely at rates (rather than raw numbers) when comparing different places. The graphs below show state rates at 4 different time points. Three short months ago (Graph A), New York and New Jersey were “off the charts” at 1,143 and 848 cases per 100K. No other state was above 500, the national average was 202 and it seemed that New York would never be exceeded. By memorial day (Graph 2), New Jersey doubled and New York neared 2,000, while the national average rose to 541. Rates were still 4 times higher in the Northeast compared to the West. One month ago, it was clear other states were catching up (Graph C). New York and New Jersey saw new cases finally subside, just as the surge erupted in the Midwest and South. The Northeast was still 3-fold higher than the West, but there were now 8 other states over 1,000 and two were outside the Northeast (Illinois and Louisiana). With this context in mind, the picture has changed dramatically over the last month (Graph D). Infection rates in the Northeast are now only 2/3 higher than the west. Arizona had just 58 confirmed COVID-19 cases per 100,000 on April 16. Yesterday, they had all but matched New Jersey at 1,903. The average infection rates in the South were 1/10th of those in the Northeast in April and will soon be about the same (1,165 vs. 1,513).
   What does it mean? Three months ago, many were convinced the epidemic was a crisis of the greater New York region. We waited for the summer to deflate the epidemic so we could get back to normal. That has not been the story. Instead, the success of the Northeast in curtailing the epidemic and flattening the curve has been more than matched by the inability and unwillingness of other states to halt transmission. While it was unthinkable 3 months ago, the rest of the nation has rapidly caught up. There is no evidence that the new hot spot states have learned from the successes of New York and New Jersey.

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  Graph B: May 31

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  Graph A: April 16

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  Graph C: June 16

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  Graph D: July 17

Daily COVID-19 Briefing: Monday

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Top news, reports and insights for today:

1. Daily headline summaries for Monday:

• Florida breaks state, and U.S. all-time record for highest daily cases with 15,300. The state-wide total including non-residents is 269,811 (Orlando Sentinel, see graph below)
• At least 26 members of Mississippi’s legislature have tested positive for the COVID-19 after weeks of working at the Capital, often absent face masks and social distancing (NPR)
• MIT has developed a robot that uses UV light to kill coronavirus in stores and warehouses (Yahoo/Finance)
• White House seeks to discredit Dr. Fauci as cases surge (The Guardian)

2. U.S. COVID-19 daily cases doubling previous peak daily cases. 13 States adding 20 or more new daily cases per 100,000
   The U.S. crossed the 3 million case threshold this weekend, adding more than 60,000 new cases in three of the last 4 days. We continue to set new daily records at an alarming pace. The most recent daily record of 66,660 came on July 10. That number is almost double the number of daily high cases set during the first peak on April 24. The middle graph below shows the number of days it took to reach each 500,000 new cumulative cases. We went from 2.5 to 3 million cases in a record 10 days, a week faster than the previous fastest interval and half the time it took to add 500,000 cases any previous period. The bottom graph shows what is happening in states. It shows new daily cases per 100,000 population. In the West, Midwest and South, the only 2 state with its epidemic under control (<5 new daily cases per 100K) were Wyoming and Hawaii. Thirteen states added more than 20 (4-times the benchmark) daily cases per 100,000; four in the West (Arizona, California, Idaho and Nevada) and 9 in the South (Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Tennessee, South Carolina and Texas). The Northeast, which was the sole focus of national attention for most of this spring, remained quiet with low growth in cases in all states except Delaware. Arizona (+50), Florida (+43), and Louisiana (+42) remain “off the charts”.
   The Bottom Line: Uncontrolled community transmission is widespread throughout the South despite very hot and humid conditions. The South and West are losing ground as the epidemic surges across many states. More than a dozen states slow or reverse reopening as we enter a period of uncertainty and stagnation. There is no national leadership visible on the horizon.

3. We were waiting to see if deaths would start rising. They just did
   The post-reopening surge in cases took longer to arrive than we thought. But it came. As cases surged beyond the previous peak, we waited to see what would happen with hospitalizations. It took a bit longer than we thought, but the surge in sick patients came. Then we waited to see the numbers rise for deaths. For a moment, it seemed that something had changed, that the gap between cases and deaths was peculiarly large. This week, as the graphs below show, that has now shifted. Eric Topol called it on Twitter on July 13. In the last week, the 7-day moving average for daily reported COVID-19 deaths inflected upward (top graph). According to CNN, counties in Texas are running out of morgue space and asking FEMA for refrigerated trucks to hold the dead. The lower graph shows the story at the state level. Compared to 2 weeks ago, deaths last week rose in all Western states, all Midwest states except Minnesota and all Southern states except Virginia. While numbers were two small for stable estimates in several states (patterned bars), the trend in the south especially is clear where weekly deaths rose from a low of 19% in Alabama to more than doubling (208%) in Texas. Weekly deaths rose by 50% or more in Arizona, Nevada, Washington, Iowa, Florida, Georgia, Mississippi and Tennessee.
   What it means: The much-anticipated rise in daily deaths has begun and its not limited to a few high-profile states. Deaths are rising fast in 8 states. This trend should continue and accelerate. If hospital capacity is dramatically exceeded, deaths may spiral.