Top news, reports and insights for today:
- The US becomes the nation with the most COVID-19 infections
Yesterday, according to data from the Johns Hopkins Center for Systems Science and Engineering (CSSE) the United States passed China for top spot in total COVID-19 cases. At this moment, the US has more than 83,000 cases compared to 81,782 cases in China and 80,589 in Italy. The epidemic is surging in the US as a function both of increases in testing and because the SARS-CoV-2 virus is highly contagious and humans do not have immunity to it. The daily epidemic curve below shows the shape of the outbreak in the U.S. indicating that the epidemic is accelerating due to exponential growth in cases.
What does it mean? While the numbers are surging, the overall attack rate (infections per 100,000 persons) remains low. The epidemic is just getting started here and we expect to continue to see large and increasing daily jumps in cases. It is clear that the United States is following a path illustrated by Italy and that the outbreak will not be over in the next few weeks as some have hoped. In my opinion, what we see in New York state will occur in other states unless intensive counter-measured are put in place immediately.
- Rise in deaths lags behind cases but will catch up
Yesterday, the total number of Americans who have died rose to 1,295 according to Worldometer. That included a record high 100 deaths in New York state. This trend will no doubt continue as rises in deaths will be following in the footprints left by the exponential rise in cases.
What does this mean? As epidemiologists, we pay attention to the numbers of deaths, but also the rate. The death rate is much better for comparing to other populations and for providing clues about the nature of the epidemic. Also, the case-fatality rate is of vital importance in monitoring how well we are doing as a nation in responding to the pandemic. It also allows us to make predictions about how many deaths we can expect. Right now, deaths are occurring in about 1.5% of confirmed cases. This is not a true estimate of the overall CFR because we are still so far behind in testing that the lion’s share of cases remains undetected (or covert). However, just using that rate tells us a lot. The rate of deaths per confirmed case (1.5% in the U.S.) is way lower than what is seen in Italy (10.2%), China (4%) and Spain (7.7%). This is mostly because we are earlier in the process than other countries. Germany is an especially fascinating case, where >49,000 cases have occurred but only 304 deaths, a mortality rate of only 0.6%. According to a story on NPR by Rob Schmitz, the Germans started testing early and often; they have done significantly better so far than most countries in identifying and isolating cases before they can spread the illness to high risk groups.
- The U.S. is ramping up testing, but remains way behind the curve
In terms of COVID-19 testing, the U.S. continues to make strides as early road blocks are starting to be cleared away. However, as the figure below shows, while we are doing lots of tests, the U.S. remains near the bottom in our testing rate (tests done per 100,000 people). Spain has tested 6 times as many of its citizens in comparison; Italy has tested nearly 4 times the number. Iceland continues to outpace other nations testing about 3,100 per 100,000, with only 648 total positive tests. There is still a long way to go on testing in the U.S., especially in some states. According to data from OurWorldInData, several states and territories have still yet to complete the first 1,000 including Arizona, Delaware, Maryland, Missouri, and Puerto Rico.