Sunday COVID-19 Briefing

Top news, reports and insights for today:

  1. Daily headline summaries for Sunday:
  • California smashed daily record for coronavirus deaths for the 5th time in a month (Los Angeles Times)
  • After apparent success, Japan acted like the virus was gone. Now the island nation is facing a formidable resurgence (Bloomberg)
  • People are apparently jerking off with their phones during the pandemic (Gizmodo)
  • More than 200 kids (out of 600) tested positive for COVID-19 after attending a summer camp in Georgia at the end of June according to the CDC (CBS News)
  • Assistant Health Secretary Adm. Brett Giroir says it’s time to move on from hydroxychloroquine efficacy claims telling “Meet the Press” there is ‘no evidence’ it works (HUFFPOST)
  • President Trump slams Dr. Fauci over comments on coronavirus surge calling him “Wrong!” The President falsely claims the surge is because we have “tested more than any other country” (Slate)
  1. U.S. daily cases appear to have peaked but 15 states still very hot; latest half million cases added slower than previously
    New daily cases remained erratic over the past several days (Figure A) with the 7-day moving average hovering around 65,000 a day. Testing supply shortages and delayed results reinforce the worry that this flattening may be more about testing shortfalls (see Top pick of the day). That should sound like deja vu to those who follow my blog. It’s especially concerning in light of the President’s tweet this weekend telling Uncle Tony Fauci that he is wrong about the reasons for the surge in cases (see last headline). I strongly suspect the White House is effectively suppressing testing to give the appearance of a flattening epidemic. We can look at the testing data in the coming week to see if this is true.
    If you believe the declining numbers, then it is encouraging that it took 9 days to add the latest half million cases, as the U.S. passed 4.5 million on Saturday (Figure B). This halts a trend of shortened intervals between each half million mark since early July. Despite this apparently positive development, new daily cases of 20 or more per 100,000 residents per day continue to be added in 15 U.S. states (Figure C). Despite some worrisome numbers from that region, no Northeastern state is currently above 15 new cases per day. However, only Kentucky, North Carolina, Virginia and West Virginia in the South are below that threshold. Florida and Mississippi are still over 40 while Alabama (+31), Arkansas (+25), Georgia (+33), South Carolina (+29) Tennessee (+36) and Texas (+27) are all over 25. Hot states in the Midwest include Missouri (+25) and Oklahoma (+28). Out West, progress seen last week in Arizona has vanished (+33) and California (+20), Idaho (+26) and Nevada (+34) remain hot.
    The bottom line: Encouraging trends in overall daily cases are off-set by continued high transmission intensity in 15 states. It remains unclear if waning cases are due to the epidemic or a slow down in testing.
Figure A
Figure B
Figure C
  1. NEW Analysis: 6 U.S. states are under moderate to severe strain in hospital capacity
    For some time I have been saying that we should be paying more attention to what is going on in hospitals to gauge the epidemic’s intensity. Daily cases and deaths can be skewed in lots of ways as we have discussed. But hospitals are where the epidemiological rubber meets the road! It’s only recently that the data has been available. It’s still not perfect, but we can at least start to look. I do so with a significant degree of caution however since hospitals have been sending their data to the White House instead of the CDC since mid-July. While that get’s sorted out, let’s see where we are. Figure D below is a new graph I made based on data They have done a good job of data assembly and visualization on this topic. Their hospital data is coming mostly from the COVID Tracking Project, which is a most-trusted source in part because they are transparent and open about limitations. I did some background research on what constitutes a hospital system under stress. My classification differs a bit from the site: I am suggesting that a state where the overall capacity of ICU beds or hospital beds is at or above 85% should be considered under moderate-severe “stress” or the Red Zone. Because these are state-level summaries of incomplete data, these numbers will be constrained to never go higher than 95%. Given the decline in hospital utilization for elective procedures and non-COVID illnesses, it is striking that an entire state hospital system would be even near having 75% of ICU beds full. This graph reflects what news reports are saying. At least 6 states are in the Red Zone. Arizona is in the above 80% for both ICU and hospital beds being used. Alabama (91%), Georgia (91%) and Mississippi (96%) each have 90% of their ICU beds full leaving little room for error. States in the Purple zone (75-85% ICU occupancy) include California (76%), Nevada (77%), Kansas (80%), Arkansas (75%), Florida (83%), North Carolina (76%), South Carolina (77%), Tennessee (84%), and Texas (81%). Several other states were surprising. West Virginia has 75% of ICU beds filled and 74% of all beds. Delaware has 86% of all beds occupied and ICU occupancy of 72%. Pennsylvania also shows some stress at 76% ICU capacity. Rhode Island is of particular concern at 91% bed capacity and 83% of ICU beds full.
    The Bottom Line: It seemed like the U.S. had largely dodged a bullet in May when fears rose sky-high that states would run short of ICU beds and ventilators. As Wave 1 waned in May and June, it seemed that hospitals were out of the woods. But in recent weeks, the surge has caught up. Hospitals are reaching capacity in at least 6 states. Some states under stress are expected; others, like West Virginia, Delaware and Rhode Island have not been on the radar.
Figure D
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