Wednesday COVID-19 Briefing


Top news, reports and insights for today:

  1. Curated headline summaries for Wednesday:
  • Pfizer announces early results showing its leading vaccine is more than 90% effective at preventing COVID-19. Details are sparse and not yet published, but the company says their new vaccine is working better than expected with “no serious safety concerns”. While promising, we have a long way to go before this translates to an available solution (New York Times)
  • Big urban medical centers are rushing to buy ultra-cold freezers that will be needed to store the leading vaccine. Rural hospitals can’t afford them (STATNews)
  • COVID-19 in nursing homes grew by 40% between mid-September and late October, erasing several months of progress. Experts say it is impossible to keep the disease out when uncontrolled transmission is occurring in the community. President-elect Biden has promised special emphasis on managing the pandemic in nursing homes. Rising infections will translate into a surge in deaths (Politico)
  • Experts emphasize that wearing masks is important for ‘source control’ (preventing the wearer from transmitting the virus to others). New CDC guidance has been issued after studies increasingly show that masks also protect the person who wears them (CDC Scientific Brief)
  • After months of refusing to require masks, Utah’s governor declares a state of emergency, joins 34 other states in issuing a statewide mask mandate (Washington Post)
  • First people refused masks. Now, reports are growing that more people are refusing to be tested for COVID-19. This has led to big variation in rates of testing (JAMA Network)
  • According to the COVID Tracking Project, today, more than 61,000 hospitalized COVID-19 patients were recorded, breaking the record highs from the two previous peaks (COVID Tracking Project, See Figure A)
Figure A. Current hospitalizations across the U.S. by day
  1. U.S. poised to pass 10 million cases. New weekly cases on the rise in every state and DC. Twenty-nine states now with higher infection rates than New York
     The explosive growth in U.S. daily cases continues despite the weekend reporting slow down as over 821,000 cases reported last week (See Figure B). The website COVID Exit strategy now classifies all but 2 U.S. states as “uncontrolled spread”. For the first time since I have been blogging, weekly cases are now rising in all 50 U.S. states and the District of Columbia (Figure C). While every case growth factor is greater than 1.0 (last week’s cases were higher than the week before), the picture is more dramatic in the Northeast, West and Midwest. Fifteen states saw weekly cases rise by 50 percent or more including Nevada (+52%), Washington (+67%), Wyoming (+71%), Iowa (+79%), Illinois (+73%), Minnesota (+66%), Nebraska (+57%), Ohio (+52%), Oklahoma (+71%), Tennessee (+60%), Massachussetts (+59%), Maine (+90%), New Hampshire (+60%), New Jersey (+53%) and Vermont (+81%). Astonishingly, we see no regression-to-the-mean as North (+14%) and South Dakota (+4%) both continue to rise despite being white hot for weeks.
     Remember when New York had the highest infection rate in the nation and the Northeast was THE hot spot region with rates that would never be matched? All good disease detectives watch Figure D closely during an outbreak (state level variation in COVID-19 infection rates – aka incidence). What does it show? First, New York (2,756 cases per 100,000 population) is actually now below the national average (3,026). Second, there are now 29 states with incidence rates greater than New York. Finally, both North and South Dakota now have rates that are more than double New York at 7,393 and 6,161 respectively. The North Dakota attack rate is now the highest in the world and it’s hospitals are now 100 percent full. Governor Burgum’s response? He says it’s ok for nurses who have been infected to stay at work as long as they don’t have symptoms. WTF!
    Bottom line: The explosive growth in U.S. COVID-19 cases shows no signs of slowing as the 10 million case benchmark will pass today. Cases are growing everywhere. New York has outperformed 29 states. The explosive growth continues to escalate where cold air is descending.
Figure B
Figure C
Figure D
  1. The surge in daily deaths we had feared has arrived
     U.S. daily deaths spiked to 1,366 on Tuesday, surpassing 1,300 for the first time since August 19 (Figure E). Last week, 6,800 deaths were reported, a weekly total also not seen since August. As we have watched cases explode and hospitals fill up, the start of a rising death trajectory was inevitable. For the last couple of months, the Wednesday death numbers have been the highest of the week, so I worry today’s numbers will be a further shock. Where are deaths booming? The Northeast and Midwest stand out (Figure F). Weekly deaths jumped by 40 percent or more in Connecticut, New York and Pennsylvania in the Northeast, Kansas, Michigan, Minnesota, North Dakota and Nebraska in the Midwest. Weekly deaths actually doubled in Wyoming and West Virginia. If you read my blog over the weekend, you may note that Kansas, Michigan, Tennessee and Pennsylvania were all identified as states with hospital systems under stress with 80% or more of ICU beds occupied.
    Bottom Line: Federal and state leaders continue to wait for the vaccine to ride to the rescue. Thus far, flat death numbers have made it more politically feasible to do nothing. What social and political consequences will there be when daily deaths double or more in the coming weeks?
Figure E
Figure F
  1. Quirky Qorner:What sport is exploding due to coronavirus? Golf!
     I have a love-hate relationship with golf. I used to play a lot but it drove me crazy. Recently, I find myself gravitating back to my old clubs with a peculiar renewed fascination. Funny thing, since dusting off my clubs, I find all the courses and driving ranges around me are packed. What gives? Along comes a story from Axios by Jeff Tracy that drives the ball in the right direction. My local situation is not unusual. The number of rounds of golf played in September grew 25.2% compared to last year, the fifth straight month of increases. Golf equipment sales are up 42 percent year-over-year as well. In June the professional golf tour was one of the first professional sports to resume. According to the author, “Golf was a physical and mental safe haven for millions of Americans with cabin fever this year”. Epidemiologically, this makes sense given what we know about how much less likely transmission is when everyone stays outside in the open. Four!
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