Wednesday COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Wednesday:
  • Top headline: U.S. hits nearly 2,600 COVID-19 deaths in one day; the second highest daily death toll since April. Also, hospitalizations hit another record high (See Figure A). New Mexico’s largest health care provider says it is virtually out of beds, ICU and otherwise at its nine hospitals. (CNN)
  • The Director of the CDC Dr. Robert Redfield says December and January likely to be “the most difficult time in the public health history of this nation.” (CNBC)
  • The U.K. approves Pfizer’s Covid-19 vaccine, putting pressure on FDA to do the same. Patience is required however as the special committee in charge won’t meet until December 10. Even if one or more vaccines is approved at that meeting, it may take days to weeks before distribution can begin (STAT News).
  • An independent panel just issued recommendations to the CDC about who should get vaccines first once approved. Long-term care residents and front-line health workers should get vaccinated first. CDC is deciding whether to adopt these recommendations (BGR).
  • The CDC says it still “recommends” a 14-day quarantine period for those exposed to someone who has been infected. However, new guidance says the quarantine can end after 10 days if the person has not developed symptoms or after 7 days if they receive a negative test. This is based on a new study published in The Lancet that shows the duration of infectivity (shedding live/viable virus) is shorter than previous coronaviruses (SARS and MERS). The change was made in an effort to make it easier for people to comply with quarantine rules (CNBC).
  • Scientists reviewed mutations in the SARS-CoV-2 virus thus far finding no evidence of changes that resulted in increased transmissibility. This is important because all viruses that has not yet fully adapted to humans as a host need to be checked for mutations that increase lethality or transmissibility (Nature Communications).
Figure A. Snapshot of daily COVID-19 hospitalizations, CNN 12-1-20
  1. U.S. cases pass 13 million amid data instability. Deaths spike to daily levels not seen since first peak in May, rising fastest in the Northeast
     Over the weekend I told you the daily numbers had gone wonky amid the Thanksgiving long weekend slow-down. I expect things to shake loose in the second half of this week when we will see more clearly where we are. Cases have zig-zagged for the last few days with daily cases averaging just over 150,000 for the last week (Figure B). At the state level, transmission intensity remains white hot (>40 daily cases per 100,000 population over the last week) in 32 states including all Midwest states, and all but four in the West. Noteable surges are seen in Tennessee where cases grew 37 percent this week to 72 per 100,000, the most in the South. Rhode Island stands out in the Northeast at 87 per 100,000 although cases fell last week. In the Midwest and West, Alaska (81 daily cases per 100,000), New Mexico (90), Wyoming (84), Indiana (80), Minnesota (96), North Dakota (99), and South Dakota (84) all remain above 80 per 100,000.
     Right now, the better numbers to watch are hospitalizations (See Point 3 below) and deaths. After a few days of wobbly data, death numbers started playing catch up surging to 2,388 on Tuesday, higher than any day since May 6 (note my numbers differ slightly from those reported at CNN due to differences in how my data source counts deaths). We are now averaging over 1,400 deaths a day; that number will rise to over 2,000 a day in the next week or sooner. That prediction is based on the leading trends in Hospitalizations and the fact that deaths are actually rising fastest in the part of the country that has been the most quiet for weeks: the Northeast (Figure E). Deaths rose there by 15% or more last week in Connecticut (+45%), Massachussetts (+18%), Maryland (+37%), New Jersey (+30%), New York (+49%) and Rhode Island (+17%). My home state of Maryland saw weekly deaths jump from 139 to 191, a 37 percent jump. Weekly total deaths were over 500 in Illinois (726), Michigan (636), Florida (522), Texas (799), and Pennsylvania (612).
    Bottom line: While the national totals were down 5% from the previous week, nobody believes deaths have slowed. I expect significant catch-up over the next two weeks. Overall the U.S. has passed 250,000 cumulative deaths. If someone had told you in March that a quarter of a million Americans would be dead from this virus before Christmas, would you have believed it? “Normal” seasonal flu rarely exceeds 60,000 deaths in an entire season; this death toll is 4-times higher in just nine months. And keep this in mind: the additional infections caused by Thanksgiving won’t start dieing until Christmas.
Figure B
Figure C.
Figure D.
Figure E.
  1. Hospitalizations are reaching the danger zone. Worse, we are flying blind about how bad things are.
      Right now the best gauge of where the pandemic is can be found in the hospitalization numbers. The news is not good; a new record was again set today. The U.S. has over 100,000 patients hospitalized with COVID-19 for the first time (See Figure F). That number is more than 65 percent higher than the peak hospitalizations we saw during the first and second peaks in May and July. In both earlier peaks, the hospitals were getting slammed in fairly limited geographies: New York, New Jersey and Connecticut in peak 1 and Arizona and Louisiana in peak 2. The next map (Figure G) from shows why. The health care sector is being hammered across most of the U.S. interior (28 states now have new cases over 500 per million a day). And it’s not just the big urban hospitals in cities that are under stress; now rural and suburban hospitals over entire regions are in the red zone.
     So just how bad is it right now? How many hospitals are nearing capacity or running low on supplies, beds and personnel. The short answer, and I hate to say this, is that we really don’t know. Sure there are problems and inconsistencies in how we count cases and deaths, but when it comes to our ability to monitor hospitals, things are embarrassingly bad. This is a big issue because the Federal government needs and uses the current system to decide where to allocate resources system-wide from (among other sources) the strategic national stockpile. There is no way of overstating how important it is that we can accurately track the burden on hospitals to fight this disease. The CDC, some state governments and federal authorities currently rely on a Department of Health and Human Services system called “HHS Protect”. Figure G is the map from today that estimates current ICU bed utilization rates across states. Turns out, almost nobody likes this system. The data are incomplete, reporting lacks teeth, it’s not up to date and many states don’t trust its numbers. This week I found an investigative report about this in Science magazine. The authors compared HHS Protect estimates of hospitalizations with state data and found big problems. Recent HHS Protect data has varied “erratically” from state numbers in 22 states. HHS data was off by 20 percent or more compared to the states own data in 30 states. An internal report from the CDC found HHS Protect both under and over-estimates, often drastically, depending on the state. They document a host of rookie mistakes like using the wrong population denominators to determine rates, mis-using population weights etc. HHS data are not well documented and are only released on a very limited basis. Tom Friedan, former CDC director under Obama, has argued for years for a different, better system, but the current administration hasn’t budged. The COVID Tracking Project data is probably better than the official HHS Protect data, but that’s a big problem because the latter is what is used to move resources around and monitor where intervention is needed.
      Bottom Line: U.S. health care providers, especially hospitals, are now being absolutely hammered as the number of COVID-19 patients soars rapidly to new heights across the country. The best data we have says twenty nine states now have 70 percent or more of their ICU beds currently occupied. Well actually, it might be only 20 states or, shoot it could be all of them. We really don’t have any idea because nobody thought we needed a national hospital dashboard that actually worked. That is a national disgrace.
Figure F. Current daily hospitalizations, The COVID Tracking Project, captured Dec 2, 2020
Figure G.
Figure H. Current ICU bed occupancy by state as a percentage as of Dec. 1 according to the HHS Project system.
  1. Quirky Qorner: To skirt lockdown, one British tequila bar tried to become a church. Who says people aren’t resourceful during a pandemic.
     I thank my pal Micah Hanks for alerting me to a story in the New York Post about the resourceful owner of the “400 Rabbits Tequila and Mezcal Cocktail Bar” in Nottingham England who, having grown frustrated with COVID-19 lockdown, came up with a brilliant plan to skirt local regulations. The owner, James Aspell, 34, has applied to local officials for recognition as an official place of meeting for religious worship. Indeed. Perishoners can register either as “bunny believers” or “revered of the righteous rabbits”. I don’t know about you but I have previously been rendered prostrate in “prayer” and silent contemplation after a night of taking taquila communion.
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