Saturday COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Saturday:
  • “Uncle Tony” Fauci warns 7 states to take extra precautions over the Labor day holiday to prevent COVID-19 surge (Huffington Post)
  • Up to two-thirds of Americans say they won’t get COVID-19 vaccine when it’s first available, new poll shows (USA Today)
  • After facing criticism for high cases and a go-it-alone strategy, now Sweden has one of the lowest COVID-19 death rates in Europe (CNN)
  • Widespread COVID-19 vaccines not expected till Mid-2021, WHO says (Reuters)
  • A new study (not yet peer reviewed) reports on experiments that show when SARS-CoV-2 was introduced to heart muscle cells, it resulted in “carnage” on the slides, providing clues to explain widespread evidence that COVID-19 does lasting harm to some hearts (STATNews)
  1. U.S. COVID-19 cases spike to 50,000 on Friday, total cases exceeds 6 million. Big spikes seen in the Midwest
    Things were looking good for a slow-down in new cases in the U.S. for about 10 days. I said on Wednesday it appeared the slow-down might be stalling. Like a cold slap in the face, Friday’s numbers leapt to over 50,000 for the first time since August 15 (Figure A). Driving this spike were large rises in several key states increasingly in the epidemic’s cross-hairs (Figure B). Of the nine states with a rate of new case growth of 20 or higher, six are in the Midwest where conditions continue to deteriorate. They include Iowa (+5,851 new weekly cases), Kansas (4,172), Missouri (+9,223), North Dakota (+1,863), Oklahoma (5,780), and South Dakota (2,079). Growth factors in that region showed increasing weekly cases in all states except Michigan and Iowa. The Northeast and West both remain relatively calm although notable surges in cases were reported in Hawaii. Although new cases fell for the week in California, that state still reported over 33,000 new cases in the last 7 days.
    What does it mean: We are still in deep whack-a-mole in the first wave of the U.S. outbreak. We get lulled into a false sense of progress when cases slow in one region, only to see big surges happen in another (in this case the Midwest). Figure C shows the big picture as we eclipse the 6 million case threshold. The most recent 500K cases were added in 12 days (compared to 11 days in the previous half million). The big picture remains largely stable as the U.S. outbreak enters a seventh month.
Figure A
Figure B
Figure C
  1. How is the U.S. doing compared to other nations in the Western hemisphere? Not great.
    As disease detectives, we seek to make apples-to-apples comparison to see how things are changing in different countries. The best way to do that (as I have explained before) is to use Log-log plots showing standardized growth trajectories of cases and deaths setting each country to a time metric indexed by days since a fixed number of cases (as opposed to calendar time). Figure D below does that for cases. The diagonal reference line shows the rate of growth if cases are doubling every week. Countries where cases are growing faster will be above that line, slower nations are below it. The U.S. is the pink line. This figure paints a particularly grim picture. Almost all the nations in our hemisphere saw rapid growth for the first 10,000 cases (on or above the 7-day doubling line). After that, every nation except the U.S. managed to react in a way that slowed the pace of new cases. After about 20,000 cases, every other country managed to get under the 7-day doubling rate. The U.S. didn’t get there until 500,000 cases. This tells us that the first half million cases were especially costly and put us substantially behind the 8-ball. The pace of the US epidemic slowed between 500K and 2 million. Then, things went very badly again: the rate of growth spiked severely between 2 and 4 million. Even compared to Brazil, the U.S. trajectory shows an inability to react early and to maintain epidemic control measures at critical points. While new case growth has been extensive in Argentina, Columbia, Peru and Mexico, none of those nations saw the prolonged unregulated growth seen in the U.S. Canada, which shares exposure to colder weather in the Northern hemisphere, is hidden here among a second cluster of countries that have dramatically better profiles.
    One might argue that the U.S. was testing more than these countries so perhaps cases are the wrong thing to look at. Plus, the U.S. has far more sophisticated health care systems so certainly we won’t see the same pattern for deaths. I’m afraid that picture is equally discouraging (Figure E). Between 100 and 100,000 deaths, even Brazil out-performed the U.S..
    Bottom line: The U.S. has done worse than any other nation (including Brazil) in the Western hemisphere in controlling the speed of the epidemic both in terms of cases and deaths.
Figure D: created by me using COVIDTrends website showing standardized rate of case growth among Western hemisphere nations as of Sept 4.
Figure E: created by me using COVIDTrends website showing standardized rate of growth in reported deaths among Western hemisphere nations as of Sept 4.
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