Wednesday COVID-19 Briefing

Top news, reports and insights for today:

  1. Daily headline summaries for Wednesday:
  • Russia becomes the first country to approve a coronavirus vaccine, declining to complete a clinical trial to demonstrate that it is safe and effective (New York Times)
  • Anthony Fauci (among others) says he “seriously” doubts Russia’s coronavirus vaccine is safe (Axios)
  • A Stanford University report shows that teens and young adults who use e-cigarettes are five to seven times more likely to test positive for the virus that causes COVID-19 (Wired)
  • A new database created by The Guardian and Kaiser Health News say that over 900 U.S. health workers have died of COVID-19; front-line nurses and people of color are especially hard-hit (Kaiser Health News)
  • University of Florida study (not yet peer-reviewed) isolated live, viable SARS-CoV-2 virus from aerosols collected at a distance of seven to 16 feet from patients hospitalized with Covid-19 adding additional evidence of transmission through the air (New York Times)
  • Confirmed coronavirus cases in U.S. children rose by 90% in about four weeks this summer, bringing the total to over 380,000 (Time, See Figure A)
Figure A: From:
  1. U.S. cases hover at 50,000 a day. Deaths flat at 1,000+
     In the last seven days, the U.S. has added 362,000 new COVID-19 cases, about the same as the week before (See Figure B). If new cases had been falling since late July, that trend appears to have stalled. The 1-week moving average remains above 50,000 daily cases. As I have said before, it is difficult at this point to tell whether these numbers are telling us what is happening with the epidemic or with our testing regime. That’s why we disease detectives need to focus on numbers other than daily case totals (See Point 3 below).
     After the weekend reporting lull, COVID-19 daily deaths jumped to 1,334 on Tuesday, the highest daily death count since July 29 (Figure C). In the last week, deaths rose substantially in Washington (+37%), Arkansas (+23%), Georgia (+20%), Tennessee (+31%), and Pennsylvania (+40%). On a more positive note, weekly deaths declined 9% Florida and in 6 Midwest states.
     Bottom line: Both new cases and deaths continue to hover in place as testing stagnates and uncertainty, fatigue and confusion continue.
Figure B
Figure C
  1. COVID-19 testing is falling in the U.S., test positivity rate (TPR) remains stubbornly high
    To make sense of the falling daily case totals, we must keep our eyes on two really important numbers: a) how many total tests are being done each day and b) what percent of those tests are coming back positive. Figure D is my graph showing the most recent data based on numbers from the COVID-19 Tracking Project. Daily tests peaked at over 900,000 back on July 27. Since then, testing has been falling. It’s not surprising since the commander-in-chief keeps telling people we were testing too much. If the President’s goal was to suppress testing to make the numbers look better, he appears to be succeeding. Over the past two weeks, daily tests have fallen from over 900K to less than 750K. That is a sizable jump. This is partly due to supply shortages, lack of surge capacity in the big testing labs, and long lines in some testing centers. The other number we care about is the test positivity rate or TPR (orange line). If testing were falling, and so was the TPR, we would be in a better position to believe that the real number of cases was dropping as the totals have been suggesting. But we are looking now at a bad combination of factors. Fewer tests are being done. The percentage of tests that are positive is not falling, and if anything is drifting slightly higher. We are still not closer to the 5% target. That tells us that most likely the apparent fall in cases is an artifact of running fewer tests.
    What does it mean: The COVID-19 epidemic continues to surge in the U.S. with no apparent end in sight. Testing problems are stacking up right before schools are suppose to reopen. These challenges are likely to be amplified when cold and flu season hits in a matter of weeks.
Figure D
  1. State variation in TPR remains huge, 11 states are under control, 10 Southern and Western states are “on fire”
     I just told you testing is falling across the U.S. and that the overall test positivity rate is hovering above 8% (which isn’t great). Looking one level deeper, I made the graph in Figure E to look at variation in the TPR across states and regions as of now. First the good news. There are 11 states that are at or below the 5% benchmark. That’s a good indicator that transmission is under control in those states, all other things being equal. Most of those are small-population states not surrounded by high-transmission neighbors like Montana, Vermont and Alaska. Congratulations are deserved however for a few stand outs including Michigan, New Mexico, Oregon and Kentucky that look to be doing a good job. West Virginia is the only Southern state with a favorable TPR. On the other side, 10 states are above 10%, twice the target number, all in the South or West. Arizona continues to have truly baffling numbers. Despite the mind-boggling explosion in cases, they are still testing the smallest fraction of their population resulting in a TPR that is almost 20%.
    The bottom line: Due to the lack of national leadership, resources, standards and planning, we have ended up with states that have TPR rates that differ from low to high by more than a factor of 10. Wow.
Figure E
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