Wednesday COVID-19 Briefing


Top news, reports and insights for today:

  1. Curated headline summaries for Wednesday:
  • Half of U.S. states are reporting increased COVID-19 cases as some leaders are pushing for new control measures (CNN)
  • Top federal immunologist and whistleblower Dr. Rick Bright, fired in April as head of vaccine development program for opposing political pressure on health policy, has just resigned from the NIH saying “…he can no longer sit idly by and work for an administration that ignores scientific expertise, overrules public health guidance and disrespects career scientists, resulting the [sic.] in the sickness and death of hundreds of thousands of Americans,” (Politico)
  • Six U.S. states report record high COVID-19 hospitalizations. Wisconsin Governor Tony Evers said in a statement: “We’re in a crisis right now and need to immediately change our behavior to save lives. …. We are continuing to experience a surge in cases and many of our hospitals are overwhelmed…” (Reuters)
  • Skepticism toward science fell globally during the COVID-19 pandemic, according to a new survey following a 3-year trend of rising mistrust (Axios)
  • President Trump again tweeted that COVID-19 is “far lass lethal” than influenza. The truth: in just 8 months, SARS-CoV-2 has killed more than the past 5 seasons of flu combined and is much more contagious (CNN)
  1. Trend toward rising daily cases continues in the U.S. Deaths are steady at 700 a day. New infections continue to surge in the Midwest
     Average daily U.S. COVID-19 cases remain over 40,000 after the weekend reporting slow down. The Tuesday numbers were, like last Tuesday, encouraging but may be followed by a rebound on Wednesday. As data systems mature and routinized, I suspect we will see the weekend lull extended to Tuesday in the foreseeable future. At the state level (Figure B), the picture is similar to recent briefings: 8 Midwest states currently have new daily cases per 100,000 residents of 20 or more, making this region the ongoing national hot spot. Three states stand out in particular: North Dakota (56 daily cases per 100,000), South Dakota (47) and Wisconsin (40). Of these, North Dakota is the only one that is higher than October 3, suggesting that transmission intensity continues to increase in that state. Two Western states are above 30: Montana (35) and Utah (33), while thankfully, only Arkansas (25) and Tennessee (23) are above 20 in the South. While overall new case reporting is low in the Northeast, the growth factors show the biggest week-over-week gains are happening there, with new cases doubling last week in New Hampshire, Rhode Island and Vermont. On Tuesday, an additional 626 COVID-19 deaths were reported (Figure C) continuing a slight decline in deaths over the last week. Consistent with the lag in how the data proceeds from testing to hospitalizations to deaths, we are now seeing elevated growth factors for weekly deaths in Iowa (+88%), Kansas (+86%), Minnesota (+63%), Nebraska (+7%) and Wisconsin (+102%).
    What it means: The U.S. remains in a precarious position in terms of COVID-19 as daily cases continue to edge higher since the Mid-September trough. The Midwest remains the region of greatest concern while signals continue to foreshadow a coming surge in the Northeast.
Figure A
Figure B
Figure C
  1. Update on hospitalizations: Upper Midwest states under significant hospital stress, Wisconsin and South Dakota are ‘white hot’
     If you read the headline summary from Reuters on hospitalizations you know already that a number of upper Midwest states are right now seeing hospital beds fill to capacity with COVID-19 patients amidst the surge in cases. If you have read this blog for a while, you know that I am keen to pay close attention to hospitalization rates because they provide a concentrated surveillance signal for the epidemiologist. Because the barriers to being identified accurately and reliably as a case differ for testing, death and hospitalization, each offers a different window into the workings of the underlying transmission dynamics. None is free of bias and distortion, but hospitalizations may be especially “clean” from a data quality point of view. Let’s start with a look at current hospitalizations by region over the last month (Figure D). These data come from our good friends at the COVID Tracking Project. These data show rising hospitalizations in all regions in the last week, except the Midwest. That suggests a general trend toward increasing transmission intensity that is not specific to the particularities of one place. These data tell us that on an absolute basis, there are more people hospitalized in the south than in the other three regions combined. The South and West have seen a net decrease in overall hospitalizations since a month ago, while the trend is rising in the Northeast and Midwest. Let’s look more closely at the situation in the Midwest in the states we highlighted in the case report above.
     Figures E and F, also from the COVID Tracking Project, show daily cases and hospitalizations for 5 Midwest states with the largest new daily cases per 100,000 now: Wisconsin, Iowa, Kansas, North Dakota and South Dakota. There are two views of the data here, one is absolute numbers (Figure E) and the other is rates per million (Figure F). This is vitally important for an apples-to-apples comparison between a populated state like Wisconsin (5.8 million) and South Dakota, which has no major cities and far few people (885,000). Both figures show just how intensely the epidemic is crushing Wisconsin right now. Since their previous peak of 944 cases a day on July 27, Wisconsin has tripled to 2,500 a day. North and South Dakota were at fewer than 100 day till mid-summer, now both are averaging over 400 a day. Hospitalization numbers are chilling. Wisconsin now has 853 hospitalized having not previously exceeded 443, with 261 currently in ICU beds. Iowa and Kansas have surging cases but hospitalizations have not exceeded previous peak levels. Like Wisconsin, the Dakotas have seen exponential and explosive growth in hospitalizations in recent weeks. Shifting to Figure F showing rates, the situation looks especially challenging in South Dakota. On a per capita basis, both cases and hospitalizations in that state are off-the-charts at 2.5 times higher than any of the other states. I can’t find any case where COVID-19 hospitalization exceeded 200 per 1 million since the pandemic began. Is this perhaps a ballooning in testing? Figure G says no. Testing has risen about 75% since July but remains lower than the peak in June. Every metric in South Dakota is showing exponential and explosive increases except testing.
     The bottom line: COVID-19 hospitalization data confirms what we see in the data stream for cases and deaths: a handful of upper Midwest states are ‘white hot’ with extreme transmission intensity. Hospitalization data offers a third leg in the information stool.
Figure D. Total COVID-19 hospitalizations by region for 9/2/20 – 10/6/20 from the COVID Tracking Project
Figure E: Daily COVID-19 cases and hospitalizations, absolute numbers for 5 Midwest states from the COVID Tracking Project
Figure F: Daily COVID-19 cases and hospitalizations, rates per million for 5 Midwest states from the COVID Tracking Project
Figure G: Key metrics from South Dakota, October 6
  1. Quirky Qorner: COVID-19 is infecting our dreams
     I read a fascinating article in Scientific American over the weekend about how COVID-19 is impacting our dreams. It came from a Montreal Psychiatrist, Tore Nielsen, who is the director of the Dream and Nightmare Laboratory. Fun place I bet. The article was banging around in my head for a couple of days when I woke up yesterday morning in the middle of, you guessed it, a COVID-19 dream. Has this happened to you? In the article, they describe several ongoing research efforts that point to a surge in dreaming as so many of us adapt to more time at home, more time in the sack, and altered sleep patterns. Qualitative content analysis also suggests the content of our dreams is being impacted as a growing fraction of dreams include themes of loneliness, isolation, loss of control, anxiety, insufficiently completed tasks, contamination and cleanliness.
    The bottom line: Studies show we are taking COVID-19 to bed with us.

Daily COVID-19 Briefing: Tuesday


Top news, reports and insights for today:

  1. Daily headline summaries for Tuesday:
  • Coronavirus hospitalizations grow in 23 states, Texas admissions soar to over 8,000 on Sunday (CNBC, see graph below)
  • President Trump’s approval rating has fallen fastest in the 500 counties where per capita COVID-19 deaths have been highest says new Pew poll (Bloomberg)
  • Study finds that people with blood Type O were less likely to develop severe COVID-19 symptoms than people with Type A (NBC News)
  • A study from British Office for National Statistics (ONS) finds that only a third of patients who test positive for the virus report symptoms on the day of the test (BBC News)
  • 239 scientists sign an open letter to the World Health Organization (W.H.O.) calling for greater focus on the possibility of aerosol (airborne) transmission of coronavirus (New York Times)
Screen grab from CNBC.com
  1. All but 3 states in the West, Midwest and South had >5 new cases per 100,000 per day last week. Arizona’s infection rate has risen 508% since Memorial day
     Sunday and Monday saw new cases drop below 50,000 after 4 straight days above that threshold. This may signal that the upswing in daily new cases has begun slowing. On the other hand, we know that reporting lags on Sunday and Monday and it was a holiday weekend. We will need to be patient to see what the numbers look like for the rest of the week. Daily deaths remain exceptionally low with less than 300 a day reported over the last 3 days. It’s not clear when deaths will follow suit and start rising but a glimpse comes from Arizona where triple digit deaths (117) were reported for the first time today. In the last 7 days, the U.S. has added more than 348,000 cases, compared to just 216,000 weekly cases just 5 days ago.
     The bottom chart shows new daily cases per 100,000 population by state. The good news is that in the Northeast, all states except Delaware saw fewer than 5 new daily cases per 100,000 last week.
     The South was the inverse: all states except West Virginia were above that benchmark. Alabama (22), Florida (40), Georgia (24), Louisiana (28), Mississippi (23), South Carolina (33), Tennessee (21) and Texas (23) saw cases rise more than 4-times that benchmark.
     Cases rose more slowly in the Midwest, although again, all states except Michigan were over 5.
     The epidemic continues to surge in the West, with more than 20 new daily cases per 100,000 in Arizona (53) and Nevada (23). Colorado, Hawaii, Montana, and Wyoming remain under control.
    Arizona continues to be the nation’s top hot spot. The overall rate of infections will this week pass 1,400 per 100,000, placing it 7th nationally behind Louisiana (1427), The District of Columbia (1,490), Massachussetts (1,506), New Jersey (1,955), New York (2,044), and Rhode Island (1,604). To put this in perspective, the case incidence rate in Arizona was 274 per 100,000 on Memorial Day, while New York was at 1,906. In the intervening 5 weeks, the rate of COVID-19 infections has risen by 509%. The total cumulative cases in Arizona grew by 34% last week with 27,000 new cases.
    The bottom line: Caution dictates that its too early to say that the surge in cases is slowing. The Northeast is in the eye of the storm. Three states are now experiencing hurricane force winds: Arizona, Florida and South Carolina.
  1. U.S. ranks 1st on the planet in cases and deaths, 25th in testing
    Let’s review where the U.S. now ranks in terms of basic COVID-19 statistics. I will use the data from the WORLDOMETERS site based on yesterday’s numbers. This site collates data from 213 nations and territories based on multiple sources and is relied upon by many for keeping score during the pandemic in a way that maximizes comparability of data. According to this site, the U.S. has now passed 3 million total cases. We rank worst (meaning 1st) in total cases, new cases, total deaths, active cases and cases that are serious/critical. Relative ranking on population rates are adjusted for the fact that the U.S. has a population of over 330 million. In total cases, the U.S. now ranks 13th, a number that has been rising in recent weeks. Deaths per 1 million now stands at 9th. What is particularly striking is that given all these dismal rankings, the U.S. still is 25th among nations in tests per 1 million. That shows how disproportionate our national response remains given the relative size of the outbreak. The top 5 countries in testing rates are all above 340,000 per million population or twice the U.S. rate. If we were in the top 5, that would no doubt mean that our case totals would be significantly greater than current numbers reflect.
    What this means: Our low performance in testing undoubtedly hides the true magnitude of our inability to control the spread and reach of this virus.
StatisticRankCurrent value
Total cases1st3,040,192
New cases1st50,584
Total deaths1st132,979
Active cases1st1,528,266
Serious, critical1st15,198
Total case per 1 million13th9,184
Deaths per 1 million9th402
Tests per 1 million25th115,449
Numbers based on yesterday’s totals from WORLDOMETER’S rankings of 213 countries and territories.

Daily COVID-19 Briefing: Wednesday

Top news, reports and insights for today:

  1. Daily headline summaries for Wednesday:
  • The U.S. death rate from COVID-19 per 1 million people just passed 340. That’s more than 100 times the rate in China (Time)
  • A trend toward a “second U.S. virus wave” emerges in 22 states after reopening (Bloomberg)
  • As harvest season nears, outbreaks seen among migratory farm workers in North Carolina, Florida and Washington. The federal government has not made safety rules mandatory, leaving it to farmer’s discretion (Politico)
  • Half the states (including California, Florida, North Carolina and New York) are failing to follow CDC guidelines and reporting probable coronavirus cases and deaths, leading to inconsistent and inaccurate surveillance (Washington Post)
  1. Back to where they started: Epidemiologic deja vu in 14 states that have matched or exceeded daily cases compared to April/May peaks
    The President continues to say and do things that suggest he believes the epidemic is over and behind us. A journalist sent me an inquiry yesterday asking my opinion on whether a second wave might be in our future now that the first one is over. A new poll suggests that about half the country thinks it’s time to get back to normal life.
    Huh? I remain puzzled and wonder what information people could possibly be looking at. Internationally, we have seen the epidemic move from country to country, rising and falling in the global whack-a-mole pandemic we are in. Months ago it was Italy, France and Spain in the hot seat. Now it’s Brazil, Peru, India, Russia and Chile. The same shifting is occurring in the U.S. as one state grows quiet as another surges. What strikes me when looking at the New York Times tracking data is just how many states seem to be right back where they were during the peak period of April and May. After looking closely, I believe there are 14 states that now meet or exceed the high water mark of daily cases. Take a look at the two image galleries below. The first one shows the 8 states where the recent 7-day moving average for daily new cases is higher (and in some cases much higher) than the peak in April/May. The second gallery is the 6 states where recent average daily cases are about the same as they were at the April/May peak. Some of these states are quite striking. Arizona averaged under 300 cases a day throughout April and May, and is now above 1,000 after an alarming rise starting May 27. Arkansas peaked at under 200 a day April 26 and has now risen to over 300 a day. California, North Carolina and Utah are all essentially on a continuous rise since the start of the outbreak with little notable drop off in new daily cases. Texas and Oregon both appeared to peak twice, with a corresponding dip in new cases in late May, but in both states, cases have surged to all time highs with continued transmission intensity. In the lower gallery, we see that Florida, Kentucky, Nevada, New Mexico and Tennessee, all had noticeable peaks in April/May, and all have seen resurgence of new cases back to about the same peak levels in recent days.
    The bottom line: Overall, new cases remain close to flat in the U.S., as many states are seeing sustained declines. However, the rest of the story is that 14 states are right back to where they were in the peak period of April and May and 8 of those states are setting new records. Texas, Arizona, Florida, Nevada, South Carolina and Mississippi were the most aggressive in reopening 2-3 weeks ago.
  1. Not just increased testing: COVID-19 hospitalization rates rising in reopening states, mirroring trend in rising cases
    A story in Bloomberg highlights what the article calls a “second U.S. virus wave” emerging in reopening states. They mention that hospitalizations in Texas jumped 6.3% on Tuesday to 2,056, the highest total since the pandemic emerged. California hospitalizations are at their highest point since May 13 and have risen 9 of the last 10 days. This nudged me to go back to my favorite source of state-level data on hospitalizations from the COVID-19 Hospitalization Tracking Project at the University of Minnesota Carlson School of Management. While their data doesn’t cover all states, the figure and table below captures a few that have surging cases. The graph shows daily COVID-19 hospitalizations per 100,000 adults for 6 states. Since May 17, the largest increase has been in Arizona, where rates rose by 56%. North Carolina saw the second highest rate rise and 57%. Rates are up nearly a third in Kentucky, Texas and Utah. California is back to where it was in late April.
    Why does this matter: Tracking hospitalizations may be a more accurate window into the epidemic than other measures that depend on testing. These data show, I believe, that hospitalizations are rising in line with expectations of post-reopening increases in transmission intensity. The situation in Arizona is especially extreme.
StateMay 17June 9Change% Change
Arizona14.923.3+8.4+56%
California10.311.4+1.1+11%
Kentucky11.415.7+4.3+38%
North Carolina6.39.9+3.6+57%
Texas7.49.4+2+27%
Utah4.85.9+1.1+23%
From the COVID-19 Hospitalization Tracking Project, University of Minnesota, Carlson School of Management, captured 6/10/20