Top news, reports and insights for today:
- Daily headline summaries for Monday:
- As Americans celebrate Memorial day, new cases continue to rise in 17 states, stay flat in 13 and are going down in 20 (CNN)
- All eyes remain on Georgia where cases have declined slightly since reopening began with a slight uptick since May 12. So far there has been no spike of cases and test positivity rate are falling and daily tests are rising (CNN)
- Largest study yet published in Lancet of impact of antimalarial drugs hydroxychloroquine and chloroquine in COVID-19 found the drugs had no benefit and were associated with higher risk of death in hospital patients (CIDRAP)
- Recent study shows that state-level stay-at-home orders were consistently followed by reductions in daily infection rates in 42 states and DC studied (American Journal of Infection Control)
- U.S. cases remain flat, deaths continue to trend downward, midwestern and southern hotspots remain
Over the last week, U.S. cases (top graph) show a generally flat trajectory adding more than 152,000 infections, a rise in cumulative cases of 10%. The U.S. now has a third of all cases on the planet, more than 1.3 million more cases than Brazil, now at #2. Among nations with more than 100,000 cases, the U.S. now ranks second in cases per 1 million population at 5,098 behind Spain (6,050) and ahead of the UK at 3,825.
As always, we pivot from the overall national numbers to what is happening in states. The middle graph shows 7-day change in cases by state and region. Seven northeast states had less than 10% case increases and none had more than 25% increases. Similarly, 7 of 13 western states saw slow case growth and none rose more than 20%. As was true last week, the epidemic has shifted to the midwest and south. Among the states that saw cases grow more than 25% (a rate of doubling in 4 weeks), 2 were in the midwest (Minnesota and North Dakota) and two were in the South (Arkansas and North Carolina). Kentucky, Michigan and Louisiana were the only states in these two regions with less than 10% growth in cases (although Kentucky hasn’t reported new cases since Saturday).
The bottom figure shows the overall trend in COVID-19 deaths by day. In contrast to the steady continued rise in cumulative cases, the trend in deaths is more clearly toward decline in daily deaths as evidence by the 7-day moving average line. Sunday and Monday again saw new deaths below 1,000, although in the past 3 weeks, similarly low numbers were followed by substantial jumps on Tuesday as the weekend lag ends and state authorities catch up.
What this means: Despite warming weather, the epidemic continues to yield rising cases, especially in the midwest and south, even as deaths drop. Minnesota, North Dakota, Arkansas and North Carolina continue to be the U.S. hotspots. Experts brace for new surges in cases and deaths.
- The new front line of the coronavirus epidemic is in rural America: a deadly ‘checkerboard’
A recent article in the Washington Post by Reis Thebault and Abigail Hauslohner highlights a theme that I have stressed over the last week. Two months ago, many were convinced that COVID-19 was a crisis for big coastal cities in densely populated places like Los Angeles and New York. In the whack-a-mole story of this epidemic, a very different picture emerges as May comes to a close with the U.S. poised to pass 100,000 deaths and 2 million cases in the next few days. We are reminded that viral outbreaks spread like water from area to area, seeking a favorable ecology for transmission even as barriers to transmission succeed in the places initially attacked. The top graphic, taken from the Washington Post article shows the whack-a-mole effect. Until the middle of April, the majority of cases were in the 14 counties that were initially impacted, while the fraction of new cases over the last 6 weeks are in the rest of the country. As of this week, there are now twice as many cases elsewhere than in New York, Washington, Detroit and New Orleans. The bottom graphic from the same article shows that while death rates have dropped substantially in large cities and their suburbs, those rates are largely flat in small cities, towns and rural counties. The shift to small towns and rural communities is fueled by a variety of factors very few thought of in the epidemic’s earlier days. Of the 25 rural counties with the highest per capita case rates, 20 have a meatpacking plant or prison where the virus took hold and spread rapidly, then jumped to the surrounding community when workers took it home. Like all other health scourges, the coronavirus has capitalized on the spatial patterning of poverty, racism and inequality to find cracks in our epidemic control measures. Take for example Texas County, Oklahoma, where predominantly Hispanic workers from a local pork processing plant started filling the local hospital with symptoms. Two weeks ago, state health officials finally tested everybody at the plant and found 350 positive cases among the 1,600 asymptomatic plant workers, roughly 4-times more cases than had been known.
What it means: Lack of adequate health care resources, language and cultural barriers, poverty, lack of testing, low adherence to social distancing measures have all conspired to create the conditions for the coronavirus epidemic to seep into high-severity pockets across rural America. At the same time, there are still 180 counties across 25 states that report no positive cases. This has made middle-America look like a checkerboard of risk.