Top news, reports and insights for today:
- Daily headline summaries for Monday:
- WHO warns the pandemic is worsening across the globe as the number of new cases on Sunday reached an all-time high. Large rises seen in central and South America and South Asia (CNBC)
- Florida is preparing to reopen restaurants, bars, gyms, shops, amusement parks and vacation rentals. At the same time, new cases have been surging after the first wave of reopening, reversing a downward trend. That state has seen new cases exceeding 1,000 a day for 5 straight days (Futurism, see Figure B below)
- New study shows stay-at-home orders in Illinois lowered infections compared to Iowa in the 15 counties on the boarder between those states (Jama, see Figure A below)
- U.S. daily cases are flat at 20,000 per day for 12 days, epidemic intensifying in 25 states
Today, I will focus on recent changes in COVID-19 cases by state (see the 3 figures below). Overall, the U.S. now reports over 1.9 million cases (2 million plus if counting probable cases), or 28% of all global infections. Brazil now has the second most cases at 694,000, 9.7% of the total across the planet. Among countries with 100,000 cases or more, the U.S. now ranks 3rd in cases per 1 million population behind Chile and Spain. As the top graph shows, daily cases have been flat at just over 20,000 since May 26 (based on 7-day moving average). This reflects, I believe, the start of resurgence of transmission intensity in states that have reopened. Over the past 3 days, 5 states have set new record highs for daily cases (Arizona, New Mexico, Utah, Oregon and North Carolina). Utah and North Carolina set records on back-to-back days. Arizona, for example, had reported more than 1,000 daily cases once before. That state had 1,579 cases on June 5. The middle graph shows daily new cases per 100,000 population by state. The positive news is that 21 states had fewer than 5 new cases per day per 100,000. However, cases are spiking at 10 or more a day in Arizona, Utah, Nebraska, Arkansas, and Washington DC. The southern region had the most states with more than 5 a day (11 of 13). The area comprising Iowa, Illinois, Indiana, Minnesota, North Dakota, South Dakota and Wisconsin, all had significant rises in cases, indicating the upper midwest is still a hotspot. The bottom graph shows growth factors by state for change in cases over the last week. Numbers greater than 1 means cases are growing week-over-week. In the northeast, only Vermont is rising although numbers are small. In the south, transmission intensity is rising in 9 of 13 states, the most in Arkansas, now doubling in cases every 10 days. In the midwest, cases are spiking in North Dakota with 80% rise last week. The western region also has all but 3 states with cases climbing, with Alaska, Arizona, Hawaii, New Mexico, Oregon and Utah reporting 50% or more increases in new cases.
What it means? States continue to reopen even as widespread intensification of infections is seen, particularly in the south and west. Weekly cases are rising in 25 states. I expect the trend of 20,000 daily cases to continue and to rise slowly over the next two weeks.
- The great influenza of 1918-19: Learning lessons from the “mother of all pandemics”
We still don’t know whether there will be additional waves of epidemic transmission of coronavirus in the U.S. and other countries in the Fall and Winter of 2020. However, we should be planning now for the possibility that it might. One place to look for insights is the Spanish influenza epidemic of 1918-19, which claimed the lives of more than half a million Americans and more than 50 million world wide. A cautionary tale from that epidemic points to the possibility of major re-ignition of epidemic transmission seen in that pandemic. As the graph below shows, taken from a 2006 paper by two experts, the initial wave starting in March of 1918 (shown here for the UK but the dynamic globally was similar) was quite mild. After a quiet summer, the pandemic exploded in October and November of that year, making it the “mother of all pandemics”. This was followed by a third wave in February-April of 1919, more lethal than round 1 but less so than round 2. It’s still not entirely clear why this happened. Its possible the virus mutated between wave 1 and 2, but this cannot be confirmed due to lack of genes from the wave 1 virus. What is known is that both influenza and coronavirus can manifest this repeating wave phenomenon. We don’t know if this will happen with SARS-CoV-2 but now is the time we need to prepare for the possibility that the pandemic will roar back to life in the fall.