Weekend COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Saturday/Sunday:
  • Just 11 months into the pandemic, global confirmed COVID-19 cases pass 50 million with an estimated 1.25 million deaths. The U.S. remains the “world’s worst failure” at containing the virus (VOX)
  • The US has hit the highest daily number of new cases since the pandemic began (CNN)
  • U.S. COVID-19 hospitalizations soar; 18 states report that more than 10% of inpatients have COVID-19 (Bloomberg)
  • A careful study from Singapore of SARS-CoV-2 transmission among close contacts showed that sharing a bedroom, riding together in a car, and direct conversation, were risk factors for transmission (The Lancet, Infectious Diseases)
  • Denmark plans to kill all the minks in the country after reports surfaced that the animal version of SARS-CoV-2 virus had undergone mutations and could jump to humans. Several experts consulted say the risk of a more dangerous virus leaping back to humans is low (Stat News)
  1. U.S. daily cases set new records each of the last 4 days. Infections rising in all but 2 states, breaking records in 24 states
    Daily cases blasted past 100,000 on Wednesday climbing to new record highs on Thursday, Friday and Saturday (See Figure A). More than 700,000 new cases were added last week. The new daily record of 130,206 on Friday is nearly double the summer peak of 75,900 set on July 17. Despite weeks of high transmission intensity, especially in the Midwest and mountain states, cases are on the rise virtually everywhere as only 2 states have weekly growth factors at or below 1.00 (Figure B). Record highs were broken in 24 states just in the last 3 days, while 6 states broke records more than once. Weekly case growth is over 30 percent in 9 Western States (Colorado, Hawaii, Idaho, New Mexico, Nevada, Oregon, Utah, Washington and Wyoming), and all but 2 Midwest states (Iowa, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, North Dakota, Nebraska, Ohio and Oklahoma (where weekly cases doubled)). Thankfully, cases are finally leveling off in South Dakota. On a more positive note, in the South, only Florida and Louisiana saw 30% case growth last week. Worrisomely, the Northeast continues to show signs of escalating intensity in Connecticut (+34%), Maryland (+32%), Maine (+98%), New Hampshire (+37%), New Jersey (+39%), and New York (+33%) and 5 other states over 20%. Figure C is the rate of transmission (daily cases per 100,000 population in the past 7 days). States that are in good shape are below 5, states above 20 (4 times that target) are in moderate transmission, while 40 and above (8-times higher) are high transmission intensity. Nation-wide, only Maryland (which I just mentioned is increasing quickly) and Vermont are now meeting the containment target. High intensity persists in every midwest state except Ohio (now 35). Ten states are above 50 (ten times target) with Kansas (143), North Dakota (174) and South Dakota (115) into “off the charts” territory. To put this in perspective, if California had the rate of transmission seen in North Dakota, it would be adding over 600,000 infections a day.
     With cases skyrocketing, we remain in the calm before the storm of rising death numbers. Figure D shows where we are now, having added more than 1,000 deaths a day for the past five days. The trajectory of daily deaths is starting to increase more rapidly and may be poised to shift to a higher gear in the next 10 days or so. Death growth factors are now inflecting, as weekly numbers have doubled or more in Nevada (+115%), Kansas (+154%), Ohio (+116%) and Maine and have increased by 50% or more in six other states.
     Bottom line: With plenty of susceptible people left, U.S. transmission intensity is setting records with no foreseeable end in sight. SARS-CoV-2 is in the midst of a feeding frenzy. I hope I am wrong, but it will not be long before deaths begin to skyrocket to levels not seen since the dark days of March and April. That will depend on what happens in U.S. hospitals (see next point).
Figure A
Figure B
Figure C
Figure D
  1. As U.S. cases explode, hospitalization rates have nearly doubled since September 20. ICU beds are 80% full or higher in 11 states
     I want to zoom in on the situation in hospitals. Nobody questions that health care professionals have raised their game when it comes to keeping COVID-19 patients alive. In an ever evolving pandemic, lessons learned on the front lines have translated to lower case mortality rates across the nation. Those gains came partly as a consequence of successful efforts to beat back infection rates and lower the burden on hospitals that occurred from the peak of 60,000 occupied beds in late July, down to a trough of 28,600 beds on September 20. Figure E shows the big picture of U.S. hospital bed utilization for COVID-19 cases from the COVID Tracking Project since March 1. Since the late September trough, hospitalizations have again surged, nearly doubling to about 55,000, edging back to the peaks seen in April and July. More cases means more patients in the hospital. Figure H shows the situation in 6 states. Not just in North Dakota and Wisconsin, but hospitalizations are exploding in Texas, Illinois and Michigan among others. We know that case fatality rates increased during the two previous peaks when hospitals were equivalently stressed. Many experts have noted the possibility that standards of care will suffer when personnel, equipment and resources run thin relative to the demand for care (see today’s Top Pick of the Day).
    Figure F is from the Department of Health and Human Services hospital surveillance system. It’s a map showing ICU bed availability by state. Critical care resources are under strain across the board, not just in the states we have been talking about. Currently, 28 states have 70% or more of their ICU beds filled. I dug into the data further and set up my own graph to track this in more detail (Figure G). This shows each state’s percent of filled hospital (striped bars) and ICU beds (solid bars) as of Friday. Eleven states now have more than 80% of ICU beds full. Hospital systems are running out of headroom. Given soaring cases, states will increasingly be required to move patients, limit care and modify standards.
    Already we have isolated reports this is happening. The Idaho Statesman reports one of Idaho’s biggest hospital stopped taking new patients temporarily over Halloween as up to a third of all patients now have COVID-19. The Salt Lake Tribune reports that the situation is so dire in Utah that hospitals are expecting to begin rationing care within a week or two. Texas now has more hospitalized COVID-19 patients than any other state. El Paso County has issued a mandatory curfew after hospitalizations surged by 300 percent, forcing local officials to set up a field hospital. A University of Texas study predicts El Paso has a 95% probability of needing more ICU beds than it has starting next week.
    Because there is no national standards and limited leadership around monitoring the situation in U.S. hospitals, it is very hard to know just how bad things are. A critical care physician at Yankton Medical Clinic in North Dakota told ABC news that “…we’re headed in a direction of overwhelming our health care systems and I think that’s closer than what people understand”. Our ability to monitor the whole system from above is quite limited and incomplete. We know hospitals are moving patients, that the U.S. military is dispatching medical teams to some areas and that bed capacity is getting threadbare in many places.
    Bottom Line: U.S. hospital systems are under significant and rising stress across much of the U.S. due to the surge in COVID-19 cases. This will certainly get much worse before it gets better with no end in sight. Thanks to the absence of national leadership, our ability to monitor the whole system is limited and incomplete. We know hospitals are moving patients, rationing care and that the U.S. military is dispatching medical teams to some areas and that bed capacity is getting threadbare as caseloads continue to rise. How much this will translate into higher death rates in the coming weeks or months is not known. I am as worried as I can be.
Figure E
Figure E.
Figure G.
Figure H
  1. Quirky Qorner: Not only can dogs reliably detect COVID-19, they do it faster and better than any available test
     I love a good shaggy dog story. Weeks ago, I mentioned that dogs have now been trained to sniff out coronavirus and have been put to work in the Helsinki airport doing just that. Woof! BGR reports on just how well they are doing. Finnish researchers have learned that dogs can pick up the virus before the state-of-the-art PCR test does. The dogs not only found COVID-19 in those who were sick, but the canine clinicians kept calling positive results in passengers who tested negative. Experts thought the dogs were giving “false positives”. After following up passengers later, it turns out, Miina, Kössi and Valo (their actual names) were actually more accurate than the tests at picking up infections very early in the disease. What is even more amazing is that the dogs do this just by sniffing a wipe that has been rubbed on the person’s skin. That’s right, the dog doesn’t get anywhere near the person (see below).
Screen grab from: https://bgr.com/2020/11/06/coronavirus-test-dogs-better-than-pcr/
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