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

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Daily COVID-19 Briefing: 5/15/20

Top news, reports and insights for today:

1. Daily headline summaries for Friday:

• FDA is warning doctors and hospitals about potential inaccuracies with a widely-used rapid point-of-care virus test by Abbott run on the ID NOW system. This test, which has been used in the White House, may miss up to half of all infections. The problem is related to the way the swabs are stored (Los Angeles Times)
• Grocery prices are soaring amidst the pandemic, rising faster in April than any time since 1974 due to supply chain disruptions (CNN Business)
• In the last two weeks, hospital beds occupied by COVID-19 patients rose in New Hampshire, Alaska, Iowa, Minnesota, Kentucky and North and South Dakota (Axios, see graphic below)

From story by Bob Herman, Axios, May 14: https://www.axios.com/state-by-state-coronavirus-hospitalizations-04da87ed-476e-4dad-84ec-bd5db7a7bce7.html

2. New U.S. cases and deaths rise a 4th straight day, continuing the epidemic’s volatile behavior
   On Thursday, 26,768 cases and 1,858 deaths were reported in the U.S., an increase of 2.9% and 2.4% respectively. More than 10,000 American’s died of COVID-19 last week. The U.S. death toll over the first 10 weeks of the epidemic has surpassed 80,000, or roughly twice as many American’s who die in two full years from the flu. The U.S. now has 29% of all global deaths, almost triple the fraction of the second highest country (now the United Kingdom at 11%). The U.S. ranks 8th among nations in COVID-19 deaths per 1 million population at 270, while Spain, the UK and France remain at or above 500. Deaths increased by 30% or more last week in Arizona (+41%), New Mexico (+41%), Iowa (+38%), Minnesota (30%), South Dakota (+38%), Alabama (34%) and New Hampshire (+32%). Five states reported no COVID-19 deaths last week (Alaska, Hawaii, Montana, Wyoming and Vermont). New record high death counts were set Thursday in Texas (58) and Delaware (13).
   The bottom line: The week-long trend is toward slower increase in deaths and cases, but this masks areas where widespread community transmission is still occurring. Deaths and cases have been volatile in recent weeks.

3. Original analysis: How has the test positivity rate changed in the last month across states?
   Yesterday, I showed you how states differ in test positivity rate. This number is important because it tells us how wide a net we are casting in testing. Ideally, we want the percentage of tests that are positive to drop down to 5 percent or lower, a signal that we are testing the entire population broadly, not just people who are sick. The bottom line yesterday was that only 9 states have a TPR that is in the right ballpark, and some states have a very long way to go. Today, I thought I would extend this analysis by looking at how states have done in the last month. That’s important to get a fairer measure of how states like New York and New Jersey are doing since they were doing very selective testing in March and April as testing capacity was ramping up and the viral shit was hitting the fan. The graph below is original analysis using data form the COVID Testing Project that compares where each state was a month ago, on April 13 (solid bars) to what the test positivity rate has been in the month since then (patterned bars). We expect to see the TPR going down as testing capacity rises and more people qualify to be tested. In many states, that is exactly what we see. Most of the hardest-hit states have basically cut their TPR by half, including California, Michigan, Georgia, Louisiana, New Jersey, and New York. A second group of states are going in the right direction; TPR is falling but not as much: Nevada, Illinois, Missouri, Arkansas, South Carolina, Tennessee, Texas, Connecticut, Massachussetts, and Rhode Island. What is surprising to me is the number of states where the TPR is going up, not down. That includes Arizona, Iowa, Kansas, Minnesota, Nebraska, South Dakota, Virginia, Delaware, and my own state of Maryland. What gives? Some of these increases are truly remarkable. Minnesota and Nebraska tripled their TPR. Iowa, South Dakota and Delaware doubled theirs. These are all states where new cases are surging. They are also states that have either reopened or never shut down.
   Why this matters: If the percent of positive tests is still going up three months into an outbreak, either the testing capacity is still severely immature or the outbreak has gone exponential. States with TPR’s above 10% don’t have the testing capacity to reopen their economies safely and are not yet ready to implement contact tracing to quell sporadic transmission chains. In the last month, that applies to 21 states and all but 3 in the midwest, America’s new epicenter.