Top news, reports and insights for today:
- U.S. deaths resume rapid doubling rate
We are back to looking at the epidemiologic curve for deaths after Washington State and California have resumed timely COVID-19 reporting. The graph below shows that after a few days of flattened growth in deaths, the outlook has darkened; growth in deaths has returned to a rapid pace, doubling every 2-3 days. On Wednesday, a record 940 deaths were recorded. Notable rises in deaths were seen in numerous states including Nevada (+51%), Illinois (+42%), Minnesota (+40%), Wisconsin (+48%), Texas (+41%), Massachussetts (+37+), Maryland (+70%), New Jersey (+33%), and Pennsylvania (+54%).
What it means? The pace of COVID-19 deaths tells us that the White House prediction about April being a difficult month is likely to be correct. At this pace, the U.S. may be facing several thousand deaths every day as soon as the end of next week. The crude fatality ratio in the U.S. rose from 1.9% over the weekend to 2.4% as of this moment. This number must be interpreted in the context of a severe undercount of mild and asymptomatic cases, but it suggests the possibility that the health sector is under considerable stress. This pattern looks similar to what we have seen in Italy. If hospitals continue to run out of supplies and ventilators, and staff continue to get infected, the death rate will rise in the U.S..
- The FDA authorizes first coronavirus antibody test: a game changer?
CNN and others report today that the Food and Drug Administration (FDA) has issued an emergency use authorization for a coronavirus test that can determine the presence of antibodies to SARS-CoV-2. This potentially game-changing test would improve our ability to determine who has been exposed to the virus and who is “immune” to further infection. The new test, from Cellex Inc. requires a blood sample taken from a vein in the arm rather than the current test, which is based on detecting the actual virus in a sample of nasal or oral secretions. This test will not replace viral detection, but will bring a new tool to the arsenal. It is critical to understand that much is not yet well understood about the timeline of how the body makes antibodies in response to infection with this virus. It is not yet known how long after infection antibodies can be detected or how long after symptoms subside that the test will be accurate. It’s also unknown how rapidly the company (or others) will be able to scale up production and distribution. Earlier rumors that the FDA was ready to approve a test that could be done in minutes from a finger prick proved false.
What this means? We must be patient and cautious about this development. Eventually, the benefit of this type of test would be to offload pressure on the standard testing system. More important, the ability to identify which medical workers are “immune” would help hospitals by determining who can work safely with sick patients.
- We don’t know how many tests are pending, so we don’t know how many cases we have
Yesterday, I shined a spot light on the problems in testing in California. As of today’s numbers, California has results for 30,000 tests done, but another 57,400 tests are in testing limbo. If the same fraction of tests are positive, then California has 23,800 cases, not the 8,155 they are reporting. California may have 3 times more COVID-19 infections than we are now counting. And that only deals with the tests that have already been performed, let alone the huge numbers that have never been tested. Today, I ask what we know about “pending” tests in other states. The best data I can find is by the COVID Tracking Project. As of today, their state-by-state tally gives us information on the number of pending tests for only 5 states and Puerto Rico. There is no information for the other 46 states and DC. The good news is that the fraction of pending tests is pretty low in Florida (2%), Hawaii (0.2%), Nebraska (0.2%), and New Hampshire (2%). Puerto Rico, in contrast, has over 1,000 pending tests (37%). Data on testing is getting harder, not easier to get nationally. Some states have started and stopping the reporting of negative results. The shift to private labs has taken the CDC out of the loop in tracking testing. The graph below was clipped from the CDC website today. It shows a couple of things: 1) The CDC’s own labs are playing no significant role in US testing and have completely disappeared after March 13; 2) US public health labs appear to have reached their peak testing capacity of about 8,500 tests per day around the middle of March. If there was more surge capacity in testing, we would have seen a continued increase, but we don’t. Of course, the private labs are not shown.
What does this mean? Currently we have no idea how extensive the backlog of tests seen in California is across the nation. If we are to get a handle of the course of this epidemic, private and government labs must begin systematic reporting of pending tests.