Top news, reports and insights for today:
- U.S. deaths hit an all-time high again on Wednesday
Yesterday, an additional 2,438 COVID-19 deaths were reported in the U.S., a new daily high and a 9% increase. This continues a trend of continued escalation of deaths since April 7, albeit with a temporary 2-day decline on Sunday and Monday, which I believe was a lag in reporting due to Easter. Eight states tied or exceeded their previous daily high death totals including 5 in the Northeast (New Hampshire, Maine, Maryland, Massachussetts, and Connecticut), and 3 in the south (West Virginia, Virginia and Texas). Connecticut (+197) and Massachussetts (+151) were especially hard-hit on Wednesday with triple-digit deaths for the first time, suggesting that the epicenter is spreading from metropolitan New York to a broader area of the eastern seaboard. Substantial three-day rises in deaths occurred in Idaho (+51%), Wyoming (first 2 deaths reported), Ohio (+43%), North Carolina (+44%), West Virginia (+47%), Connecticut (+57%), DC (+44%), Massachussetts (+47%), and Maryland (+48%).
What this means? Unfortunately, this suggests not only that we are not at peak but that daily deaths continue to rise. Yet, the news is full of reports of re-opening. While the rate of increase is slower than it had been through much of March, the pattern we see now suggests that community transmission remains robust but that we continue to flatten-the-curve. In my view, broad loosening of social distancing now will lead to steeper increases in deaths in the short term.
- Maryland requires masks in public, cases surpass 10,000
I thought I would check in on the situation in my own state (Maryland), which has been identified as a hot spot in recent days. The figure below shows the daily case curve since the first reported case on March 5. The pattern shows the epidemic took off around the 24th of March, with rapid growth of cases through April 10th, followed by a plateau in new cases of around 600 a day over the last week. It is not clear if this is a true flattening of cases or a peak in the state’s capacity to test. As of Wednesday, Maryland reports 349 deaths from confirmed COVID-19 cases, plus an additional 64 “probable” deaths. That suggests at least a 16% higher death toll compared to official reports and further supports the fact that testing is not keeping pace. Among deaths where age is known, 43% have occurred among those 80 and older, however notably 29 people under age 59 have died (0.3% of deaths). Maryland also reports 278 cases (3%) among children; 66% of cases are below age 60. Women outnumber men slightly among cases (54%) while more deaths were reported in men (52%). Just under half of the state’s cases (45%) were reported in the two counties closest to Washington DC (Montgomery and Prince George’s) and a quarter of the cases are in Baltimore city and county. However, numbers are rising faster outside these areas. African Americans represent a disproportionate percentage of deaths (46%) compared to whites (43%), however the crude fatality ratio (deaths / confirmed cases) is comparable (4.1% in blacks and 5.9% in whites).
Where we are in testing? Based on data from the COVID Tracking Project, Maryland has done about 56,000 tests, with about 28% positive results. Since April 1, the state has been averaging 2,500 tests a day, but that number hasn’t increased, suggesting we are maxed out on capacity to test. Because 30% of tests are positive in recent days, it tells us we are testing quite selectively. Not until testing is more widespread and available to the general public, will it be clear how far the epidemic has penetrated. Overall, the crude fatality ratio is 4.1% in the state, which suggests that it is highly likely that Maryland has between 4 and 8 times as many infections as are currently known.
- COVID-19 is filling in the middle of the U.S.
Last night I was staring at the Johns Hopkins COVID-19 dashboard and thinking about the spatial pattern visible in the map. Then, I went back to older screen grabs of the same map and noticed something interesting (see the two maps below). The top image is from yesterday, the bottom from March 28. Most of us have been focused on big coastal cities. While the bubbles are not entirely comparable here, the big urban centers look quite similar in these two images. What really strikes me about this comparison is how pockets of infection have broken out in the nation’s middle in smaller cities and towns and rural communities. From March 28 to April 15, we went from 101,000 U.S. cases and 600,000 globally to 640,000 U.S. cases and over 2 million global cases. From Texas to North Dakota and Florida to Maine, the dispersion of the epidemic into new territory in all corners of the country is the big story. This has important implications for areas of the country with far fewer resources. It also reinforces the idea that no area can count on remaining untouched by this virus.