Wednesday COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Wednesday:
  • Researchers combined information from 32 studies of COVID-19 risk in children, finding that children and adolescents had 44% lower odds of secondary infection with SARS-CoV-2 compared with adults (JAMA Pediatrics)
  • Moderna CEO says its coronavirus vaccine won’t be ready until spring of next year (CBS News)
  • The White House coronavirus task force again this week strongly recommending mask usage in some states like Iowa and Georgia that still do not have statewide mask mandates (CNN Politics)
  • Hospitals feel the squeeze as cases spike in upper Midwest states Wisconsin, North Dakota (ABC News)
  • Facebook removes 38 versions of Trump campaign ads claiming (without evidence) that admitting refugees increases COVID-19 risk (NBC News)
  • Largest study yet of COVID-19 transmission in India published in Science highlights the role of super-spreaders, a small subset responsible for a high percentage of infections. Study also finds that children transmit the disease as easily as adults (Los Angeles Times)
  • Remember how COVID-19 exploded on a cruise ship? The Trump administration has again over-ruled the CDC recommendation to extend the “no-sail” order on cruise ships to next year (ARS Technica)
  1. U.S. passes 7 million lab-confirmed COVID-19 cases. Last million cases added in 26 days
     Let’s start with the big picture today. Over the weekend, based on the Wikipedia data, the U.S. passed 7 million cases (See Figure A). On average, the U.S. has added a half million cases every 12 days. We went from 6.5 to 7 million in exactly 12 days. On average, each million cases has been accruing every 26 days. The jump from 6 to 7 million was just that (26 days). That’s a million cases a month. The more important idea here is that the COVID-19 outbreak is now steady-as-she-goes in terms of the pace of growth. On a big picture basis, the epidemic is locked in to an oddly consistent, even robust degree. Seasonality has been less than expected, surges and falls have been less steep than might have been predicted, and overall, the epidemic curve looks more like an endemic than a pandemic.
    What does this mean: Buckle up for the long hall because SARS-CoV-2 is not going away.
Figure A
  1. U.S. daily cases holding largely steady. Transmission intensity highest in the Midwest, growing fastest in the West
     Figure B shows daily cases; the 7-day average remains just over 40,000 a day. We are now adding cases about twice as fast as the nadir of the epidemic in the first week of June. Today, I wanted to point out how different ways of looking at the same data are needed to address different questions. What questions? First, where are infections being generated most intensively right now? Second, where is the rate of new infections growing the fastest? Sometimes the answers will be the same. But, if a particular state has high sustained transmission intensity for a long time, the rate of growth of new cases will be very low. Conversely, a state with very low transmission intensity might be growing the fastest through regression to the mean in a natural cycle of change.
     Take a look at Figure C showing new daily cases per 100,000 residents by state over the last week. Let’s remind ourselves that the benchmarks we care about are a) less than 5 indicating “low” transmission intensity, and b) greater than 20, or 4-fold higher, indicating “high” transmission intensity. As has been consistently true for weeks, the Northeast is in the best shape with 5 states in the low category and only Delaware is over ten. The South is, thankfully, also relatively quiet with only Arkansas reporting high spread. The region that is clearly most hot is the Midwest with eight of thirteen states in the red zone. Three stand out in particular: North Dakota (54) is 10x higher than the “low” benchmark, while South Dakota (45) and Wisconsin (39) are surging at a white hot pace. Michigan (9.6) and Ohio (7.8) are the only “warm” states below 10. Iowa (29), Kansas (32), Missouri (22), Nebraska (24) and Oklahoma (26) are all hot. In the West, while Arizona remains coolish, Idaho (25), Montana (27) and Utah (32) are all hot.
     So what about the second question? Have a look at Figure D showing 7-day growth factors in cases. The picture is different. Intensity is low in the Northeast, but growth in new cases is strong with five states seeing a week-over-week increase of 10% or more: Delaware, Massachussetts, New Jersey, New York and Pennsylvania. New cases are falling in nine of thirteen states in the South. The region where the most growth is occurring is the West. Cases are rising fastest in New Mexico (+58%), Wyoming (+53%), Nevada (+46%), Washington (+41%), Alaska (+39%), and Montana (+39%) in that order. Whereas transmission intensity is highest in the Midwest, case growth is over 20% in only Michigan (+21%), South Dakota (+28%), and Wisconsin (+23%). Let’s take special notice of the states that pop out of both figures. Montana, South Dakota and Wisconsin, all regionally propinquitous, all have both high intensity and rapid growth.
     Bottom line: Something big and scary is going on in the upper midwest plains states!
Figure B
Figure C
Figure D
  1. Quirky Qorner: Republic of Kazakhstan social influencer Borat tweets praise for U.S. coronavirus handling: “Because of Trump, 350 million Americans still alive”
     If rumors are correct, the long awaited followup to Borat is on its way to Amazon Prime Video sometime soon. According to this piece in Vanity Fair, twitter was shaken by a video appearing just before the first debate, handle @KazakhstanGovt, congratulating “Premier Trump” for his handling of the crisis. Very Nizzzze!

Top pick of the day: Thursday

How To Know When You Can Trust A COVID-19 Vaccine

Article by Maggie Koerth, online at FiveThirtyEight , September 23, 2020.

Few things are as confusing as the vaccine development process during this pandemic. Until now, the development, testing and delivery to market of vaccines has been done in the shadows, watched carefully only by specialists and nerds like me. A recent poll shows that 62 percent of Americans are worried that the Trump administration would pressure the Food and Drug Administration to release a vaccine before it’s ready. About half of us say we wouldn’t take a vaccine even if it were free. Here is a well-done article that walks you through the things we all should know and be looking for in evaluating a new COVID-19 vaccine. There is a lot riding on this so it makes sense to build up some natural immunity to fear and misinformation about this previously mysterious process.

Today’s bite-sized, handpicked selection of important news, information or science for all who want to know where this epidemic is going and what we should do.

Saturday COVID-19 Briefing

Top news, reports and insights for today:

  1. Curated headline summaries for Saturday:
  • “Uncle Tony” Fauci warns 7 states to take extra precautions over the Labor day holiday to prevent COVID-19 surge (Huffington Post)
  • Up to two-thirds of Americans say they won’t get COVID-19 vaccine when it’s first available, new poll shows (USA Today)
  • After facing criticism for high cases and a go-it-alone strategy, now Sweden has one of the lowest COVID-19 death rates in Europe (CNN)
  • Widespread COVID-19 vaccines not expected till Mid-2021, WHO says (Reuters)
  • A new study (not yet peer reviewed) reports on experiments that show when SARS-CoV-2 was introduced to heart muscle cells, it resulted in “carnage” on the slides, providing clues to explain widespread evidence that COVID-19 does lasting harm to some hearts (STATNews)
  1. U.S. COVID-19 cases spike to 50,000 on Friday, total cases exceeds 6 million. Big spikes seen in the Midwest
    Things were looking good for a slow-down in new cases in the U.S. for about 10 days. I said on Wednesday it appeared the slow-down might be stalling. Like a cold slap in the face, Friday’s numbers leapt to over 50,000 for the first time since August 15 (Figure A). Driving this spike were large rises in several key states increasingly in the epidemic’s cross-hairs (Figure B). Of the nine states with a rate of new case growth of 20 or higher, six are in the Midwest where conditions continue to deteriorate. They include Iowa (+5,851 new weekly cases), Kansas (4,172), Missouri (+9,223), North Dakota (+1,863), Oklahoma (5,780), and South Dakota (2,079). Growth factors in that region showed increasing weekly cases in all states except Michigan and Iowa. The Northeast and West both remain relatively calm although notable surges in cases were reported in Hawaii. Although new cases fell for the week in California, that state still reported over 33,000 new cases in the last 7 days.
    What does it mean: We are still in deep whack-a-mole in the first wave of the U.S. outbreak. We get lulled into a false sense of progress when cases slow in one region, only to see big surges happen in another (in this case the Midwest). Figure C shows the big picture as we eclipse the 6 million case threshold. The most recent 500K cases were added in 12 days (compared to 11 days in the previous half million). The big picture remains largely stable as the U.S. outbreak enters a seventh month.
Figure A
Figure B
Figure C
  1. How is the U.S. doing compared to other nations in the Western hemisphere? Not great.
    As disease detectives, we seek to make apples-to-apples comparison to see how things are changing in different countries. The best way to do that (as I have explained before) is to use Log-log plots showing standardized growth trajectories of cases and deaths setting each country to a time metric indexed by days since a fixed number of cases (as opposed to calendar time). Figure D below does that for cases. The diagonal reference line shows the rate of growth if cases are doubling every week. Countries where cases are growing faster will be above that line, slower nations are below it. The U.S. is the pink line. This figure paints a particularly grim picture. Almost all the nations in our hemisphere saw rapid growth for the first 10,000 cases (on or above the 7-day doubling line). After that, every nation except the U.S. managed to react in a way that slowed the pace of new cases. After about 20,000 cases, every other country managed to get under the 7-day doubling rate. The U.S. didn’t get there until 500,000 cases. This tells us that the first half million cases were especially costly and put us substantially behind the 8-ball. The pace of the US epidemic slowed between 500K and 2 million. Then, things went very badly again: the rate of growth spiked severely between 2 and 4 million. Even compared to Brazil, the U.S. trajectory shows an inability to react early and to maintain epidemic control measures at critical points. While new case growth has been extensive in Argentina, Columbia, Peru and Mexico, none of those nations saw the prolonged unregulated growth seen in the U.S. Canada, which shares exposure to colder weather in the Northern hemisphere, is hidden here among a second cluster of countries that have dramatically better profiles.
    One might argue that the U.S. was testing more than these countries so perhaps cases are the wrong thing to look at. Plus, the U.S. has far more sophisticated health care systems so certainly we won’t see the same pattern for deaths. I’m afraid that picture is equally discouraging (Figure E). Between 100 and 100,000 deaths, even Brazil out-performed the U.S..
    Bottom line: The U.S. has done worse than any other nation (including Brazil) in the Western hemisphere in controlling the speed of the epidemic both in terms of cases and deaths.
Figure D: created by me using COVIDTrends website showing standardized rate of case growth among Western hemisphere nations as of Sept 4.
Figure E: created by me using COVIDTrends website showing standardized rate of growth in reported deaths among Western hemisphere nations as of Sept 4.