Daily COVID-19 Briefing: Thursday

Top news, reports and insights for today:

  1. Daily deadline summaries for Thursday*:
  • Scientists at University of Oxford say that an inexpensive and widely available steroid medication, dexamethasone, reduced deaths in patients with severe COVID-19, highlighting the dangers of inflammation and offering an unexpected glimmer of hope (New York Times)
  • Coronavirus cases rise sharply in prisons even as they flatten elsewhere. The number of prison inmates infected has doubled during the past month to 68,000; deaths have also risen by 73% since mid-May (New York Time)
  • New Chinese study of the immune response over time to SARS-CoV-2 virus suggests it is possible that immunity may only last for 2-3 months. Also, asymptomatic patients had a weaker immune response and had a quicker reduction in the key virus-fighting antibodies. This raises the possibility that people who were infected but didn’t have symptoms may be at risk for re-infection more quickly than previous coronavirus (NatureMedicine)
  • The next U.S. hot spots look to be these 7 states: Arizona, Arkansas, Florida, North Carolina, South Carolina and Texas (VOX)

*For anyone who wonders, I was away for a few days this week and will restart blogging every day or every other day.

  1. U.S. cases are now clearly on the rise, deaths remain on a declining trend but may be ticking up in the last 3 days
    Last week the U.S. reported 158,164 new COVID-19 cases, a rise of 8% in the cumulative total, with daily increases above 23,000 on Tuesday and Wednesday. The 7-day moving averages are clearly now on the rise since June 9, demonstrating a rate of increase not seen since the first week of April. The second figure shows daily deaths, revealing a slowing in the rate of decline over the last couple of weeks. As usual, we see the weekend lag in reporting of deaths on Sunday and Monday, with over 700 daily deaths reported Tuesday and Wednesday, which could signal that deaths will plateau and potentially begin to follow cases and rise. Last week, 4,520 Americans lost their lives to this virus, a weekly increase of 4.3%. The U.S. continues to have the largest number of cases and deaths on the planet, with Brazil now in second place in both.
    The bottom figure shows what’s going in states, focusing here on new daily cases per 100,000 population. Arizona continues to be the most extreme and worrisome with 22 new cases per 100K per day last week, more than 4-times higher than the 5 per day per 100K benchmark. The 1-week growth factor there is 1.45 showing that while new case growth has been high for a while, it is still 45% higher last week compared to the week before. Other states of considerable concern include Oklahoma, a state that doubled its cases last week. In the south, Alabama, Arkansas, Florida, Louisiana, Mississippi, North Carolina, and South Carolina, all reported more than 10 new daily cases per 100K last week, indicating strong resurgence of cases in these states. Only Utah and Arizona had high transmission intensity outside the South.
    What it means: Arizona, Utah and 8 southern states are now experiencing dramatic intensification of the epidemic, which has been sufficient to tip the balance in the U.S. toward rising cases at levels not seen since the first of April. The first wave is far from over.

Daily COVID-19 Briefing: Sunday

Top news, reports and insights for today:

  1. Daily headline summaries for Sunday:
  • New study from the South Korean CDC finds no evidence that “re-infection” cases resulted in a new secondary case. Crucially, they also did viral cell culturing in 108 such cases finding that all were negative. Taken together, this is the strongest evidence yet that getting infected a second time is not happening and that those who re-test positive are not passing the disease to others. The vast majority of these cases are test errors or a period of prolonged recycling of viral waste that cause a positive test result, not a true second infection in the same person (KCDC)
  • Social distancing measures aimed at COVID-19 have stopped influenza in its tracks 6 weeks early (Nature)
  • New study from China (not yet peer reviewed) examined 319 outbreaks in detail finding most occurred at home and on transportation. Importantly, they find evidence of only 1 outbreak that occurred outdoors. Study may provide important evidence of substantially lower risk of transmission outside (medRxiv)
  • CBS News and others have reported that CDC guidance has been updated to say that COVID-19 is “…not caught easily” from touching surfaces and that “…40% of transmission occurs before people feel sick”. I can’t find either of those statements on the CDC website (CBS News)
  1. Map check, 4 weeks later: the epidemic has shifted to places nobody notices or wants to talk about
    I am a map fanatic. I enjoy staring at them. It actually is a pretty useful fetish if you are a disease detective because the spatial patterning of disease is often among our most vital clues. I last showed you a U.S. map of incidence (confirmed COVID-19 cases per 100,000 residents) back on April 30, just under 4 weeks ago. I grabbed a picture from a similar map today from my colleagues at coronashutdown. Comparing the 2 maps tells us where we have been in recent weeks. Here are my take-home messages from this comparison:
    1. The epidemic has shifted from the east coast to the midwest, south and southwest.
    2. Epidemic radiation from last month’s hotspots can be seen from southwest Georgia all the way to Eastern Texas and Northern Florida, Southern New Jersey into Delaware and eastern Maryland, southern Utah and western New Mexico, the Texas panhandle, and Ford county in southern Kansas.
    3. New hotspot counties include (marked on map) Franklin Parish in Louisiana (1433), Liberty County Florida (2442), Duplin County North Carolina (927), Buckingham Co. Virginia (2560).
    4. Continuous corridors of higher infection can be seen along major transportation routes. Compare for example the area from New Orleans all the way to Chicago. Or note the increasing connection of high incidence counties going west from Chicago into parts Illinois, Wisconsin, Iowa, Minnesota and South Dakota.
    5. Ford County Kansas was a hotspot on April 30 at 2,088 per 100,000. That county has now more than doubled to 4,634, which is twice the rate of infection in the county containing part of New York City. The rates have gone to more than 1,000 in 5 surrounding counties.
    6. The bottom line: while many congratulate themselves on winning the battle against COVID-19, these maps tell us that what has really happened is that the epidemic has shifted to places nobody notices or wants to talk about.
  1. Severe illness similar to Kawasaki disease impacting children
    Recent articles in Science, the Lancet, and Nature have drawn attention to a rare and severe post-infection syndrome associated with coronavirus that is occurring in children. While children are at lower risk of severe illness during the pandemic, it now appears that a small number are becoming very sick with a condition that looks similar to Kawasaki disease – a rare condition affecting about 1 in 10,000 children in Western countries, characterized by a hyperactive immune response to viral infection leading to rash, fever, and dangerous inflammation in blood vessels (also called vasculitis). The disease named after a Japanese physician who was the first to describe it is associated with dangerous heart complications, most notably aneurisms. Hot spots for this newly recognized Kawasaki-like illness have been noted in Bergamo Italy and New York city. A study in the Lancet found a 30-fold increase in the incidence of Kawasaki-like illness in one region of Italy. New York state is investigating about 157 cases. Outbreaks have also been noted in the UK (where it was first noticed) and Los Angeles. Kawasaki disease is not new. It is generally assumed to be a post-viral syndrome involving an immune system “overshoot”. Currently, experts are not certain whether the outbreak of cases is Kawasaki disease or something similar. In Europe they are using the term paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), or multisystem inflammatory syndrome (MIS-C) at the CDC. So far, children treated for MIS-C have had good survival, but when it occurs, it requires urgent and comprehensive medical intervention. The condition has been seen mostly in children under age 18 but is increasingly appearing in somewhat older ages. There is no certain diagnostic test for Kawasaki or MIS-C and more will be learned in the coming weeks.
    What this means? While it’s scary to think that we have to add very sick kids to the list of things to worry about, the disease detective in me believes at this point that the emergence of super-rare autoimmune reactions to a novel virus is an inevitable development in a disease impacting almost 5.5 million people. At this time, I do not believe this is cause for concern. Having said that, it is urgent that experts determine whether children and young adults with a previous history of Kawasaki disease should be considered at elevated risk for MIS-C.

Daily COVID-19 Briefing: 5/10/20

Top news, reports and insights for today:

  1. Daily headline summaries for Sunday:
  • Question: Where is the epidemic growing fastest? Answer: New cases rising in 20 states, fastest growth is in Nebraska (+57%), Minnesota (+155%) and Puerto Rico (+231%). (Axios – see graphic below)
  • The maker of Clorox wipes has boosted production by 40%. But don’t expect to find them until the summer (The Wall Street Journal)
  • As White House clamps down on coronavirus messaging, Drs. Fauci and Birx have been pushed further to the sidelines at a critical time (Politico)
  • Dangerous trend: Conservative commentators are casting doubt on official death counts, calling them inflated despite all evidence pointing to the reverse. The President’s election strategy may be to create doubt about the work epidemiologists do (Forbes)
  • New deaths and hospitalizations fall to lowest level since mid-March in New York (CBS News)
Screen grab from article by Nicholas Johnston in Axios: https://www.axios.com/coronavirus-caseloads-states-b24899a3-286e-4ea9-bd71-0e88ed645e68.html
  1. New U.S. cases and deaths fall on Saturday
    Yesterday, 25,544 new cases and 1,555 new COVID-19 deaths were reported in the U.S., a small drop in both. The week-long trend shows that cases are falling and deaths are flat (see graphs below). In the last week, cases rose 15% and deaths increased by 20%. Despite the overall trend, sharp increases in new cases were seen in Minnesota (+73%), Nebraska (+55%) and Kansas (+42) suggesting that the mid-West continues to be the region of greatest concern. On a more positive note, new case growth was below 10% in Alaska, Hawaii, Montana, Michigan, Louisiana, New York and Vermont.
    What this means: The trend toward declining new cases is encouraging. However, since states will have been open for 2 weeks shortly, most epidemiologists believe that this decline will be short-lived as new infections are likely to start rising again when the impact of reopening starts to surface. The overall trend is masking intense hot spots, especially in the mid-West.
  1. Important antibody study from Geneva suggests infections may be 10-times higher than confirmed cases, herd immunity is not close
    Many of my colleagues were enthusiastic about a new study posted on medrxiv by Stringhini and colleagues from Geneva Switzerland. The study involved a population-based survey of 1335 residents from 663 households. They used an ELISA-based test of antibodies to determine the underlying seroprevalence of exposure to SARS-CoV-2 in the population over a 3-week period starting April 6. Results showed that the population seroprevalence was 3.1% in week 1, rising to 6.1% in week 2, and 9.7% in week three, a pattern that mirrors what was seen in the rise of confirmed cases. While this study has not yet been peer-reviewed, it adds an important new piece of evidence. There are four major take-home messages that come from this study:
    1. Their results indicate that there are roughly ten infections for every confirmed case of COVID-19 in Geneva. In my opinion, this is the best evidence we have so far about the seroprevalence.
    2. Children had about the same prevalence as those 20-49 years, suggesting there may be more infections in children than previously known.
    3. Only about half as many older people (51+) had been exposed to the virus compared to those 20-49. This is consistent with greater mixing in younger people, and may reflect the effectiveness of social distancing in more vulnerable people.
    4. Taken together, this study tells us that even in a hard-hit part of Europe, herd immunity is still very far away, given that just under 10% of the population is estimated to have produced antibodies.