Top news, reports and insights for today:
- Daily deadline summaries for Thursday:
- President Trump’s administration is ending support for 13 coronavirus testing sites including 7 in Texas just as that state reports an all-time daily high in cases (The Hill)
- California sets record daily high of more than 6,600 cases sparking fears the epidemic is out of control in that state (Los Angeles Times)
- Alarming resurgence of COVID-19 cases seen in Europe across 11 countries as countries reopen, mirroring trend in the U.S. (BBC News)
- The national weekly average daily incidence of new cases is now nearly as high as it was at the initial peak on April 10 (STAT News, see graph below)
- U.S. cases explode, new record daily high reported. Things are really crazy in Arizona
On Wednesday, a record high 37,915 new COVID-19 U.S. cases were reported eclipsing the previous daily high set April 24. This further clarifies two important facts: 1) reopening has led to wide-spread transmission intensification; 2) the “first wave” is still in progress (see today’s Top Pick). The surge in cases nationally is the result of significant increases in new cases in 17 states throughout the south, midwest and west. The lower chart shows where the new case growth is most intensive. As has been true over the past 10 days, Arizona is “off the charts” now reporting more than 37 new daily cases per 100,000 population, a number in excess of what has been seen in any state since April 1. Arizona’s total increased by almost 20,000 last week, a 47% surge, indicating cases are doubling every 2 weeks. The incidence rate has risen almost 900% in the last 2 months. COVID-19 hospitalizations and patients in the ICU have both doubled there since April 24. Big rises in new cases (>8 daily cases per 100,000) are also being reported in California, Idaho, Nevada, Utah, Iowa, Oklahoma and 10 of 13 states in the South, where only Kentucky and West Virginia are below the 5 cases benchmark. Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas are all higher than 10 new cases per 100,000. The surge in cases in the warmest states clarifies that the epidemic is not curtailed by heat and humidity.
- The big mystery of the moment: Why are deaths not rising
Disease detectives are driven by the prospect of solving puzzles and unraveling mysteries. A big mystery is coming into clearer focus. Have a look at this graph showing daily deaths. Cases have clearly been on the rise since June 10. The trend in deaths however is quite different. The 7-day average continues to trend downward. While new daily cases are now back to where they were at peak, deaths are at 600 a day, a third of what they were at peak over 2,000 on April 24. This is a big mystery. Why have deaths not surged as cases have? There are many possible explanations, but the 4 most likely are listed below. In coming blog posts, I will try to unravel this mystery.
- Cases have risen as a function of more testing, that has not translated to deaths. I will comment on this in Point 4 below.
- The time lag between infection, symptoms, a positive test and death is longer than we thought. Deaths will rise soon.
- COVID-19 deaths are being hidden for political reasons.
- COVID-19 is becoming more infectious (especially among younger people), less lethal or both.
- Increased testing does not explain the spike in cases
President Trump believes testing is a bad thing because it finds too many cases. Don’t get me started. Some governors have blamed surging case numbers on increases in testing. Let’s look at some data. The first thing I went to is the overall shape of the epidemic curve in testing. Like the daily case and death totals we saw above, we can learn important things by looking at the overall shape of global testing intensity. Using data from the invaluable COVID Tracking Project, the graph below shows what the pattern in global testing looks like since March 15. The blue area describes the steady rise in daily testing over the course of the U.S. outbreak. It shows, in my opinion, four phases. First, there was rapid acceleration of daily testing from mid-March till the end of April. Next, we saw linear growth that stalled out by April 20. This was followed by steady linear increase until the end of May (Memorial day). Since June 1, the increase has been slower that the previous period. Daily testing, now at about half a million a day, has doubled since the beginning of May. However, the period of greatest interest, when U.S. daily cases changed direction and began a steady rise, starts around June 9. During that period, testing rose modestly from about 425,000 a day to just over 500,000. Similarly, the test positivity rate, has been declining steadily, dropping by half since April 22. Strikingly, that decline has stalled at around 7% over the last week.
What this means: If the surge in cases has been caused by a rise of testing, we would expect to see something different than we do. Testing rose more rapidly before Memorial day, when cases were falling. There is no visible bounce in testing that would explain the June surge. If anything, the absence of any big shift in the TPR tells us that the overall testing regime has been business as usual for most of May and June. I believe this chart provides solid evidence that the surge in cases is being driven by the virus, and not by increased testing.