- Sharp increases in U.S. cases, testing lags dramatically behind other countries
New case reports in the U.S. for March 18 demonstrate dramatic rises. Cases doubled overnight. The most important thing to understand is that this rise is expected and does not yet provide a good picture of the extent of the epidemic. Cases are rising exponentially because testing is rising exponentially. It is not possible to predict a peak in the US right now. Using China or Italy as a guide is inappropriate because by the equivalent point in the epidemic, both countries had tested a much higher proportion of patients.
To put this issue into perspective, I made the graph below. It shows how well countries are doing at testing their populations. These analyses are crude because the data is not great. I found a useful data source from OurWorldInData.org linking the best numbers we have for total tests done as a population rate (tests / 100,000 population). These results are striking. Countries like Kuwait, the United Arab Emirates, South Korea, and Italy have now tested 200 per 100,000 or more.
What does this mean? To make sense of the U.S. numbers, take note of the fact that while there have been 41,000+ tests, this country ranks dead lastin terms of testing per capita. Italy has now tested 20 times the fraction of its people than U.S. has. Until this country catches up, we will continue to see rapidly doubling case totals, and we will not yet be able to tell the true burden of this epidemic.
- California in “lockdown”
Gov. Gavin Newsom ordered all California residents to stay home, placing restrictions on 40 million residents. This marks the first mandatory restrictions placed on all residents of a state to fight against the novel coronavirus. This unprecedented step is the most far-reaching directive issued thus far. The mandatory order allows Californians to continue to visit gas stations, pharmacies, grocery stores, food banks, banks and laundromats. This new directive was motivated in part by a stark briefing the Governor received, which forecasts 25.5 million residents will become infected in the next 8 weeks (more than half of the state).
What does it mean? Yesterday California added 126 new cases (+28%) while more cases were added by Washington (175), New Jersey (162) and New York (1008). It is likely that similar state-wide restrictions will be forthcoming in other states.
- Young people may be at more risk than we thought
A report just released by the CDC details lessons learned from the first 2,500 cases in the U.S. One surprising finding was that the COVID-19 epidemic seems to be hitting young people harder in the U.S. than has been seen in China. While it is true in the U.S. and in China that older adults are at greater risk of severe symptoms and death, the fraction of cases among younger adults was surprisingly high. In the U.S., 29% of cases were aged 20-44 and 5% were in persons aged 0-19 years. Among cases that were hospitalized, 20% were 20-44 years old. Of the 121 patients admitted to ICU, 12% were aged 20-44.
What does this mean? The belief that younger people are safe from becoming sick remains widespread. This has contributed to startling images of college students partying with abandon on spring break. While these data are preliminary, they do show that young people are experiencing significant illness requiring hospitalization and advanced care.
– UPDATED 3/20/20 at 3:13 am