Wednesday COVID-19 Briefing


Top news, reports and insights for today:

  1. Curated headline summaries for Wednesday:
  • CDC director Dr. Robert Redfield predicted today that most of the American public will not have access to a coronavirus vaccine until at least late spring or summer of next year. This prompted strong rebuke from President Trump who said he was wrong. Virtually all experts agree with Director Redfield and most think that’s even optimistic. Since we do not yet have any vaccine that has proven to be effective, talking about any timelines is putting the cart before the horse. (Washington Post)
  • UK scientists are testing whether COVID-19 vaccines might work better if inhaled vs. injected. A small study using the Imperial and Oxford vaccine is underway. Previous influenza studies have shown that sending the vaccine directly to the airway can improve response. (AP News)
  • Urban hospitals serving poor and working class communities like Mercy Hospital & Medical Center in Chicago are joining the ranks of many smaller rural community hospital as endangered species, as COVID-19 adds to financial strains for underfunded centers of care (NPR)
  • President Trump’s top communication aide in charge of coronavirus response Michael R. Caputo told news outlets this week that the CDC was harboring a “resistance unit” determined to undermine the President and (without evidence) that left-wing hit squads were threatening armed insurrection after the election and out to get him. Somebody needs a time out! (New York Times)
  • Researchers at Duke looked at the link between socioeconomic disadvantage, red/blue politics, and change in COVID-19 cases in U.S. counties throughout June. They found that counties with a big city, more social deprivation and that voted for Trump in 2016, all had significantly faster growth in new cases. This suggests that republican policies at the state and local level may be less effective at stopping the spread of coronavirus. (Clinical Infectious Disease)
  • We already knew that the broad-spectrum anti-viral drug Remdesivir (brand name Veklury) improved outcomes in severe COVID-19 patients. A new study looked at this question in moderately sick patients. The results are complicated, or (in my opinion) borderline. There was a small but significant benefit for a 5-day course of treatment, but no slam-dunk improvement after a 10-day course. It’s very positive however that we are now able to dig into the details of what works and does not. (JAMA)
  • Powerful study of nursing home residents in Connecticut shows a higher percentage of asymptomatic infections than we thought. Why does this matter? Many have assumed that the most vulnerable groups (very old people living in nursing homes) would be less likely than younger people to have inapparent infections. For that reason, nursing home residents with no symptoms were often not tested. A survey of CT nursing homes in May found that more than 600 residents (or 28%) were positive. Importantly, 88% of positive cases were entirely asymptomatic when tested. Inapparent infections are key to understanding and controlling the risks for our most vulnerable citizens. (JAMA)
  1. Once again, it looks like U.S. cases are finally. Here’s why I don’t believe it
     Through most of the last week, it looked like the U.S. case numbers had resumed their steady decline. Numerous commentators have spoken of infection rates that are finally coming down (See Figure A). Not so fast. First of all, you will notice an upward hook in the 7-day moving average. It’s not caused by a dramatic uptick on Monday and Tuesday, but rather, by the big dip on September 7-8. But there is a bigger reason.
    Have a look at Figure B. I found out how to recreate a graph I was making myself for a few months using the 91-divoc site and data from Our World in Data. Three cheers to both those groups! The darker blue line shows COVID-19 tests per day (Figure B). I have highlighted September 3, when the U.S. was averaging 860,000 tests a day or 260 per 100,000 people. That rate was significantly below the U.S. peak, which occurred on July 22, topping out at just over a million tests a day. Look at the last 2 weeks. As of today, the U.S. has plummeted to an average of 503,000 tests or 152 per 100,000. That is a 30% drop in testing capacity in just 2 weeks (35% since the July peak). Gee, I wonder why testing is dropping faster than the leaves on the trees? Test positivity has inched down slightly but remains above 6% and appears to be spiking upward in the last couple of days (thinner blue line). It certainly isn’t going down enough to warrant taking our foot off the testing accelerator.
    The bottom line: The sneaky way to slow an epidemic is to slow how much you test for the disease. If you cut out a third of the testing, you will make it look like there are a third fewer cases even when transmission intensity is holding steady. That’s why I don’t believe the story the daily case totals are telling us now. Next time, I will dig into the states that are cutting testing the most. Any guesses?
Figure A
Figure B: U.S. COVID-19 tests performed per day, days since first 100 cases. From:  http://91-divoc.com/pages/covid-visualization/?chart=countries&highlight=United%20States&show=highlight-only&y=both&scale=linear&data=tests-daily-7&data-source=merged&xaxis=left&extraData=testPositivity&extraDataScale=separately#countries
  1. U.S. daily deaths holding steady for now, rising in some surprising places
     After a fairly quiet weekend, U.S. daily COVID-19 deaths spiked again to over 1,000 on Tuesday as the total number of fatalities from lab-confirmed COVID-19 approaches 200,000 (See Figure C). A look at the state numbers reveals some surprises. Compared to two weeks ago, deaths nearly tripled in Washington state (+182%) with the addition of 62 reported fatalities. In the West, deaths were also on the rise in Idaho (+62%), and Oregon (+57%). In the Midwest, deaths rose in all states except Missouri, and going through the roof in Nebraska (+314%). Sizable weekly increases were also reported in Alabama (+96%), Florida (+61%), Kentucky (+57%), Mississippi (+62%), Tennessee (+101%) and Virginia (+86%).
    The bottom line: Deaths and hospitalizations are up in several states in all regions. Thankfully, deaths are falling in Arizona, Missouri and Texas, which helps to mitigate severity of the overall picture.
Figure C
Figure D
  1. Quirky Qorner: What Are The New Dating Rules? And, is sex with masks a thing?
     Not sure about you, but my love life is going great guns right now. NOT! Admit it, the question on everyone’s mind: when can we start dating again? That’s why an article by Isabella Gomez Sarmiento at NPR.org caught my eye this week. If nothing else, the cartoon under the headline is worth our time. Among the hot topics discussed in this article: Are sex with masks really a thing? You’ll have to read it for the answer.
Figure E: From NPR.org (see complete reference above)

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