Top news, reports and insights for today:
- Daily headline summaries for Tuesday:
- Former FDA commissioner Dr. Scott Gottlieb says we are starting to see cases ramping up in states that have reopened like Texas, Alabama and South Dakota (CNBC)
- Sweden has eschewed wide-spread “lockdown”. Now, that nation must adjust their strategy in response to skyrocketing deaths in nursing homes (Bloomberg)
- Johns Hopkins University in collaboration with New York State now offering online training for contact tracers (Coursera)
- New York City saw 24,172 more deaths than “normal” from March 11 to May 2 based on past trends. About 19,000 were tied to COVID-19, but an additional 5,293 excess deaths remain unexplained and might be coronavirus-related (Bloomberg)
- Southern states are reopening, but patrons are not yet ready to go out for dinner. Data from OpenTable shows that reservations are still down 83-92% in states that have reopened restaurants (Slate, see graph below)
- The whack-a-mole effect: why you shouldn’t trust the U.S. plateau
Everyday people are talking as if there is one big epidemic occurring in the U.S. (and every other country for that matter). This is reinforced by our preoccupation with the national numbers we look at each day. I’m as guilty of this as anyone. But, the truth is that like politics, all transmission dynamics are local. I struggle in this blog to convey deep truths about the nature of epidemics, many of which are contrary to our common sense. Here is another one: there is no one American epidemic. That’s just not how infectious outbreaks work. What we have is better thought of as a series of interconnected local outbreaks that rise and fall in traveling wavelets of infectious chain reactions. The coronavirus acts like a sneaky serial killer. It moves into a new area, spreads for a time at an exponential rate, kills a bunch of people, and then packs up and hitches a ride with a trucker to the next town where it starts it’s killing spree all over. Call it the Wuhan strangler! This creates a massively scaled whack-a-mole game, where the virus waxes and wanes in communities, rising in intensity here at the same time it is running out of easy targets there. When we see the national numbers plateau, we falsely believe we are bringing the disease to heal. But because there is not one giant wave, we fail to see that this is an illusion.
I very much liked an opinion piece by Nathaniel Lash in the New York Times on May 6 that puts this issue into perspective. For weeks, the swell of cases from New York was driving the overall picture. As that hot spot started to burn out, it looked like the national epidemic was slowing. It wasn’t. instead, the serial killer was just shifting locations as the G-men were bearing down on it in the Big Apple. The 4 graphs below, taken from the Lash opinion piece show this clearly. Slide A shows the overall flattening of the national curve in the first week of April. Looks like good news right? Only if you are in New York. Slide B shows the same curve after removing the influence of New York City. It shows a different story; new cases elsewhere continue to rise. Figure C shows the national trend removing New York City, Detroit and New Orleans. There is no plateau. Slide D shows the whack-a-mole effect at the state level in Texas and Oklahoma. Texas looked like it plateaued (at least before early May), but actually, the initial hot spot in Houston was winding down, making it appear that the state was waning when the infectious vanguard had just shifted to other places. The same pattern is seen in Oklahoma. Both states have started reopening, resulting in new case surges both in the initial hot spots and the rest of the state.
What this means: It’s a mistake to think that the U.S. epidemic is one thing. Transmission dynamics happen on smaller scale geographies. This epidemic, like all others, moves through populations in traveling wavelets that rise and fall and shift locations. Keep the whack-a-mole effect in mind whenever looking at trends in big geographies. We are a long way from herd immunity so don’t make the mistake of thinking we have this sneaky serial killer cornered.
- U.S. deaths fall to levels not seen since March 31, thirteen states saw deaths climb by a third last week
On Monday, there were 836 reported deaths, a 1.1% rise, and the lowest total deaths seen since March 31. While this is good news, we are now familiar the drop in reporting seen consistently on Sunday and Monday; we will have to wait to see Tuesday’s numbers. If you read point 2 above, you now know that we must look beneath the overall trend and ask where the epidemic is now surging. The bottom graph, once again, shows change in deaths over the last week across states. New deaths are down in New York (+11%), Michigan (+11%), and Louisiana (+13%). But 13 states reported cumulative growth of 30% or more last week. That’s whack-a-mole. There were several states in each region where deaths were rising. In the West, Arizona, still on the bottom of the list in testing, leads the region with a rise of 54% in total deaths. New Mexico and Utah also saw concerning rises. Six mid-west states reported rising deaths, lead by South Dakota (+60%). Meat processing plants have played a key role in outbreaks in most of these states including South Dakota, Iowa, North Dakota, Missouri, Minnesota and Nebraska. In the South, Alabama and Mississippi saw accelerating growth in deaths. In the northeast, New Hampshire and Pennsylvania remain in the pandemic’s cross-hairs.
Bottom line: Overall new deaths were down yesterday, a welcome sign, but caution dictates we wait for Tuesday rebound and stay focused on the shifting terrain of traveling wavelets.