Saturday COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Saturday:
  • Top government infectious disease expert Dr. Anthony “Uncle Tony” Fauci said on Friday he disagreed with President Donald Trump’s assessment the United States has “rounded the corner” on the coronavirus pandemic, saying the statistics are disturbing. (Reuters)
  • National Institutes of Health Director Dr. Francis Collins says the coronavirus vaccines in trials will be held to “the highest standards ever applied” and calls America’s polarization on the pandemic “unfortunate.” (MSNBC)
  • An estimated 41% of U.S. adults say they have delayed or avoided medical care due to COVID-19 including urgent or emergency care (12%) and routine care (32%) according to a new federal study (CDC/MMWR).
  • A classic type of epidemiologic study called a case-control design was just published showing that adults who tested positive for COVID-19 were about twice as likely to have reported dining at a restaurant compared to those who tested negative. This and other studies suggest that dining and drinking establishments may be playing a key role in keeping the epidemic going (CDC/MMWR)
  • Antartica: the last place on earth that is still COVID-19 free? For now (Axios)
  • Dakotas lead the U.S. on COVID-19 case growth as both reject mask rules (ABC News)
  1. After a week of improvement, cases and deaths pop back up as U.S. outbreak see-saws toward Fall. Transmission remains high in 6 Midwest states
     My Wednesday briefing advanced a hopeful tale of falling infection and death numbers. Well, the coronavirus epidemic in the U.S. seems like the weather in [insert your state here] where they say: if you don’t like the weather, wait an hour and it will change. The post-peak epidemic curve in the U.S. is looking more and more like a crazy “dragon tail” (See Figure A). After a hopeful Tuesday, new cases climbed alarmingly on Wednesday (30,000), Thursday (36,000) and Friday (44,000), leaving the 7-day total at 234,000 cases, a number that still represents a declining long-term trend, but not the dramatic plunge the data seemed to portend in the week’s first half. The surge appears to be the result of continued elevated transmission intensity in the Midwest where 6 states remain above the 20 daily cases per 100,000 benchmark (Figure B). Once again, North Dakota stands out as the only state above 30, having reported 1,711 cases last week (see a state spotlight in Point 4 below). Other Midwest states above 20 include Iowa (21 per 100,000 per day), Kansas (27), Missouri (21), Oklahoma (20.2), and South Dakota (25). Thankfully, all other states in the other three regions remain below 20. The pattern is similar in deaths (Figure C) after three consecutive days of more than 1,000 a day. I am sad to report the U.S. just passed 180,000 total deaths among lab-confirmed COVID-19 cases, a number that represents the highest death toll of any nation on earth and roughly 20% of all global deaths.
    The bottom line: after a hopeful start to the week, Midwest flare ups have deflated our balloon of hope leaving a confusing picture about where the epidemic is headed.
Figure A
Figure B
Figure C
  1. What’s happening on U.S. college campuses? We have a brave Kansas teacher to thank for the answer
     Today’s Top-pick-of-the-day from The Atlantic asks the question: what did colleges and universities think was going to happen when they tried to restart in-person classes? Ok, it’s a snarky question for sure, but a fair one. We are marching toward mid-September and colleges and universities are scrambling, scrapping plans to reopen, sending sick students home, and reshuttering programs and facilities as cases flare up. Personally, I had hoped to get in on the lucrative action as a special consultant to universities this summer but somehow, no schools were interested in what I had to say about the prospects of keeping COVID-19 at bay this Fall. Alert readers already know what that was.
    After a summer of hope that reopening would be possible, a series of high-visibility outbreaks on campuses at like the University of North Carolina, Notre Dame and the University of Texas, caused a last minute change of heart as schools were forced to pivot as August turned to September. As the picture grew more chaotic, many were frustrated by the lack of a good, consistent data source to track campus outbreaks.
    One was a Kansas high school teacher named Alisha Morris who decided to do something about it. So, she set up a system on her own and put it on the NEA website. In a short time, we had a solid tool, the NEA School and Campus COVID-19 Reporting Site, that quickly became the go-to place for information on campus COVID. Let’s take a moment to emphasize that while the COVID-19 pandemic has revealed plenty of weaknesses and problems, it has also given us deeply satisfying stories of innovation, bravery and resourcefulness. This is one of them. The data hub is now visible in real time dynamic updates on the New York Times site. The map in Figure D shows the latest numbers across the country since the outbreak began. It shows that outbreaks on campus are by no means isolated or rare. From the northern tip of Maine, to the western edge of Washington state, all the way to the tip of the tail of Florida, cases have been confirmed at more than 1,190 schools. Here are some of the things we know:
    1. At least 88,000 cases and 60 deaths are now linked to colleges and universities since the pandemic began.
    2. More than 150 schools have reported at least 100 cases.
    3. Illinois State University, the University of South Carolina, Auburn University, the University of Alabama and the University of North Carolina at Chapel Hill have all reported more than 1,000 cases.
    4. Many colleges are sending students home in response to outbreaks. “Uncle Tony” Fauci told ABC news this is the “worst thing you could do.” All disease detectives know he is right.
    5. There is growing evidence that outbreaks on college campuses are tied to larger surges in some states.
    6. Despite rules and procedures to the contrary, college kids are partying, gathering, traveling, mixing and exchanging SARS-CoV-19. Who knew?
Figure D. Screen grab from
  1. What’s the story in North Dakota?
     Just because I am a curious disease detective, I decided to look a bit more deeply at the situation in North Dakota, a state that has been running hot for weeks and that leads the nation with the highest rate of new cases over the last week at 32.1 per day per 100,000 people (see Figure B). Why care about North Dakota? We know that population density, linkage to commuter and commercial urban centers, international travel and large public transit systems are all associated with increased spread of infectious diseases. North Dakota has none of these in abundance. High transmission intensity in a sparsely populated state with no major cities and lots of open space is a mystery for the disease detective. What it does have is meat packing plants, large factories, the occasional mass gathering and perhaps a population that believes itself to be safer than it is. North Dakota now tallies 15,151 positive tests and 167 cumulative deaths, according to the official North Dakota government portal. It’s rate of infections (cumulative positive tests per 100,000) stands at 1,927, which is higher than 31 states including California (1,889), Michigan (1,112), Minnesota (1,467), Kentucky (1,119), North Carolina (1,738) and Massachussetts (1,758). Among Midwest states, only Iowa (2,311) and Illinois (2,034) are higher and both have much larger populations. It is also more than double the rate of other remote states like Wyoming (627), Alaska (819), Hawaii (732), Montana (822), Oregon (684) and Maine (340).
     For a deeper look, let’s turn to one of my top sites at and examine the trends. Figure E shows overall epidemic curve for the state. Between mid-March and the 4th of July, things were fairly stable with about 50 cases a day statewide. Cases doubled over July and then went, well viral in August and September with exponential growth. New cases adjusted for error and testing variations leapt past 400 a day this week. Isn’t it possible that this explosion, now 6 weeks old, is an artifact of a sudden spike in testing? Figure F gives us a clear answer: no. The pink lines tell us the number of positive results (clearly rising after July 4), but the testing volume (gray bars) show inconsistent but stable numbers that if anything likely understate the true transmission intensity. Figure G shows the model-based estimates of the effective reproduction rate or (Rt). North Dakota now is 1.23 and rising, which is top two or three in the nation across many estimates. It’s one of the only states that has been steadily above 1.2 since early August. That number means each infected person is currently expected to transmit the disease to 1.23 other people on average, a number that is more than sufficient for continued high transmission intensity and rapid growth in cases and deaths. So where is all the action happening?
     The final two maps (Figures H and I) show us the raw and adjusted numbers of active cases. I show them both as a reminder for good disease detectives about the dangers of being mislead by the data. Absolute numbers of active cases indicate explosive outbreaks in Burleigh and Kass counties. The story in each of these counties is interesting and complex involving a mix of rising social gatherings, institutional outbreaks, the opening of new testing sites, and plant and businesses restarting. The last graph shows active cases per 10,000 people, which directs our attention to different counties entirely with no doubt a different set of circumstances and stories.
    The bottom line: North Dakota has been and continues to be a hotspot state worth examining. The high transmission intensity is not limited to the past few days or even weeks and is not due to isolated clusters in one community. In theory, the circumstances in this largely rural state should make it hard for coronavirus to propagate. More so than neighboring states, North Dakota persists as a friendly destination for SARS-CoV-2.
Figure E. Epidemic curve for North Dakota as of 9/12/20 From:
Figure F. Testing results and volume for North Dakota as of 9/12/20 From:
Figure G. Effective Reproduction Rate (Rt) for North Dakota as of 9/12/20 From:
Figure H. North Dakota active positive cases as of 9/12/20. Taken from
Figure I. North Dakota active positive cases per 10,000 population as of 9/12/20. Taken from
  1. Quirky Qorner: Afraid to visit grandparents during COVID-19? To fight the epidemic of loneliness, try a robot!
    VOX reports on a new option for combatting the epidemic of social isolation and loneliness during this pandemic: robots (Figure J). Even before COVID-19, robots were being introduced in nursing homes and senior centers to provide companionship to residents. This spring, New York’s Association on Aging sent robotic pets to over 1,100 seniors. Socially adept robots have advantages: they don’t get impatient or frustrated, they don’t forget the need for a medication, and they don’t breath virus-laden air. Bioethicists are of mixed mind on whether this trend is a good idea. Who’s a good robot!
Figure J. From
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