Daily COVID-19 Briefing: Sunday


Top news, reports and insights for today:

  1. Daily deadline summaries for Sunday:
  • Florida reported 4,049 new COVID-19 cases on Saturday, another single-day record as the number of statewide infections has surged to at least 93,797 (CBS News)
  • Michael Osterhom (a trusted source) said on Meet the Press he does not think coronavirus is behaving like influenza and does not expect multiple waves, instead likening the epidemic to a forest fire that he believes will burn continuously through the summer and fall (Axios)
  • Despite everything that we know from the data, President Trump says COVID-19 is ‘dying out’. The President told the Wall Street Journal recently that testing was ‘overrated’ because it reveals large numbers of cases which ‘makes us look bad’. The federal attitude of dismissiveness will make it harder to further contain the epidemic which shows no sign of slowing (STATNEWS)
  1. U.S. daily cases spike to levels not seen since May 1, 10 states set new record highs in new cases
     The U.S. added more than 31,000 new COVID-19 cases yesterday, after a week in which 175,979 new cases were reported nationally, an increase of almost 20,000 compared to two weeks ago. On Friday and Saturday, new record high daily case totals were reported in Arizona (3,246), California (4,317), Nevada (445), Utah (643), Missouri (389), Florida (4,049), Georgia (1,800), South Carolina (1,148), Tennessee (1,188), and Texas (4,430). Records were broken on both days in Nevada, Utah, Florida and South Carolina. The leading edge of the 7-day moving average of daily cases has reached 25,000 daily cases for the first time since May 9. The overall surge in new cases is due to escalation of transmission intensity (percent growth in cumulative cases in last week of 15+ percent) in 20 states, most notably Arizona (+45%), California (+16%), Idaho (18%), Oregon (+22%), Utah (+22%), Oklahoma (+24%), Alabama (+20%), Arkansas (+25%), Florida (+28%), North Carolina (+20%), South Carolina (+32%), Tennessee (+17%) and Texas (+25%).
    The Bottom Line: The U.S. is trending back toward exponential growth at a pace not seen since early April. The White house is in complete denial. The rest of the world looks on in horror. U.S. deaths will begin following suit in the next two weeks.
  1. Change in U.S. State COVID-19 incidence rates vary astonishingly: some states rose 1,000%
     I thought it would be useful to take a look at overall trends in the incidence rates across U.S. states. That means confirmed COVID-19 cases per 100,000 population. Of course, we know those rates have been going up due in part to more testing but the shear spread in those rates and how much they have changed shocked even me. Have a look at the graph below. For each state, there are 2 bars; the dotted bar to the left is the COVID-19 case incidence rate 2 months ago on April 20; the solid bar is the rate as of yesterday. As expected, the incidence rates in the Northeast remain the highest, with 8 of 12 states over 1,000 cases per 100,000 population. New Jersey and New York stand at over 1,900, higher than any other country on earth with more than 100,000 total cases. You might think New York is way ahead of other Northeast states, but Connecticut, DC, Delaware, Massachussetts, Maryland and Rhode Island have closed the gap and are now at more than half the rate in New York. More importantly, while incidence rates doubled in the last two months in New Jersey, they rose more slowly in New York and Vermont. Maryland had the biggest rise in the northeast increasing 367%.
     I see at least 4 general patterns here. First there are a small number of states that saw their rates rise by less than 100%, including Hawaii, Montana, New York and Vermont. These are the states that should serve as models of best-practices. Second are states where rates roughly doubled, performing better than the national average. This includes Alaska, Colorado, Idaho, Washington, Wyoming, Michigan, Louisiana, Missouri, West Virginia, Connecticut, New Jersey, and Pennsylvania. Third are a group of states that did what the nation did as a whole, increasing 3 or 4-fold. Lets call that California, Nevada, New Mexico, Oregon, Utah, Illinois, Indiana, North Dakota, Ohio, Oklahoma, South Dakota, Wisconsin, Florida, Georgia, Kentucky, Mississippi, South Carolina, Tennessee, Texas, Delaware, Maryland, Maine, New Hampshire, and Rhode Island. Perhaps these are the states that performed about average. Finally, there are a group of states that saw rates rise from 500-1200% in two months. These low-performing states include Arizona (+883%), Iowa (+707%), Kansas (+507%), Minnesota (1,215%), Nebraska (+974%), Arkansas (+668%), North Carolina (+661%), and Virginia (+517%). These are states where we have seen large outbreaks at meat processing plants and prisons. Keep in mind that two months ago was late April, so there are no states that hadn’t had time to prepare and execute mitigation strategies. By April 20, all states had time to set up robust testing programs. It is shocking to think some states have seen more than 500% growth in cases in just 8 weeks. The northeast saw rates double overall, but both the West and South saw overall rates triple.
    Bottom line: Rates continue to vary wildly across states. The hardest-hit states in the U.S. now have rates of infection that exceed any country on earth. While some states have been effective at controlling the growth of infection rates, the lowest performing states have seen rates explode with Minnesota leading at more than a 1,200 percent rise. The West and South are now catching up to the extraordinary rates of infection seen in New York and New Jersey.

Daily COVID-19 Briefing: Tuesday

Top news, reports and insights for today:

  1. Daily headline summaries for Monday:
  • As Americans celebrate Memorial day, new cases continue to rise in 17 states, stay flat in 13 and are going down in 20 (CNN)
  • All eyes remain on Georgia where cases have declined slightly since reopening began with a slight uptick since May 12. So far there has been no spike of cases and test positivity rate are falling and daily tests are rising (CNN)
  • Largest study yet published in Lancet of impact of antimalarial drugs hydroxychloroquine and chloroquine in COVID-19 found the drugs had no benefit and were associated with higher risk of death in hospital patients (CIDRAP)
  • Recent study shows that state-level stay-at-home orders were consistently followed by reductions in daily infection rates in 42 states and DC studied (American Journal of Infection Control)
  1. U.S. cases remain flat, deaths continue to trend downward, midwestern and southern hotspots remain
     Over the last week, U.S. cases (top graph) show a generally flat trajectory adding more than 152,000 infections, a rise in cumulative cases of 10%. The U.S. now has a third of all cases on the planet, more than 1.3 million more cases than Brazil, now at #2. Among nations with more than 100,000 cases, the U.S. now ranks second in cases per 1 million population at 5,098 behind Spain (6,050) and ahead of the UK at 3,825.
     As always, we pivot from the overall national numbers to what is happening in states. The middle graph shows 7-day change in cases by state and region. Seven northeast states had less than 10% case increases and none had more than 25% increases. Similarly, 7 of 13 western states saw slow case growth and none rose more than 20%. As was true last week, the epidemic has shifted to the midwest and south. Among the states that saw cases grow more than 25% (a rate of doubling in 4 weeks), 2 were in the midwest (Minnesota and North Dakota) and two were in the South (Arkansas and North Carolina). Kentucky, Michigan and Louisiana were the only states in these two regions with less than 10% growth in cases (although Kentucky hasn’t reported new cases since Saturday).
     The bottom figure shows the overall trend in COVID-19 deaths by day. In contrast to the steady continued rise in cumulative cases, the trend in deaths is more clearly toward decline in daily deaths as evidence by the 7-day moving average line. Sunday and Monday again saw new deaths below 1,000, although in the past 3 weeks, similarly low numbers were followed by substantial jumps on Tuesday as the weekend lag ends and state authorities catch up.
    What this means: Despite warming weather, the epidemic continues to yield rising cases, especially in the midwest and south, even as deaths drop. Minnesota, North Dakota, Arkansas and North Carolina continue to be the U.S. hotspots. Experts brace for new surges in cases and deaths.
  1. The new front line of the coronavirus epidemic is in rural America: a deadly ‘checkerboard’
    A recent article in the Washington Post by Reis Thebault and Abigail Hauslohner highlights a theme that I have stressed over the last week. Two months ago, many were convinced that COVID-19 was a crisis for big coastal cities in densely populated places like Los Angeles and New York. In the whack-a-mole story of this epidemic, a very different picture emerges as May comes to a close with the U.S. poised to pass 100,000 deaths and 2 million cases in the next few days. We are reminded that viral outbreaks spread like water from area to area, seeking a favorable ecology for transmission even as barriers to transmission succeed in the places initially attacked. The top graphic, taken from the Washington Post article shows the whack-a-mole effect. Until the middle of April, the majority of cases were in the 14 counties that were initially impacted, while the fraction of new cases over the last 6 weeks are in the rest of the country. As of this week, there are now twice as many cases elsewhere than in New York, Washington, Detroit and New Orleans. The bottom graphic from the same article shows that while death rates have dropped substantially in large cities and their suburbs, those rates are largely flat in small cities, towns and rural counties. The shift to small towns and rural communities is fueled by a variety of factors very few thought of in the epidemic’s earlier days. Of the 25 rural counties with the highest per capita case rates, 20 have a meatpacking plant or prison where the virus took hold and spread rapidly, then jumped to the surrounding community when workers took it home. Like all other health scourges, the coronavirus has capitalized on the spatial patterning of poverty, racism and inequality to find cracks in our epidemic control measures. Take for example Texas County, Oklahoma, where predominantly Hispanic workers from a local pork processing plant started filling the local hospital with symptoms. Two weeks ago, state health officials finally tested everybody at the plant and found 350 positive cases among the 1,600 asymptomatic plant workers, roughly 4-times more cases than had been known.
    What it means: Lack of adequate health care resources, language and cultural barriers, poverty, lack of testing, low adherence to social distancing measures have all conspired to create the conditions for the coronavirus epidemic to seep into high-severity pockets across rural America. At the same time, there are still 180 counties across 25 states that report no positive cases. This has made middle-America look like a checkerboard of risk.

Daily COVID-19 Briefing: 5/11/20

Top news, reports and insights for today:

  1. Daily headline summaries for Monday:
  • Coronavirus deaths in Western nations: most look to have peaked, Canada and the U.S. show continued sustained mortality (Mother Jones, see graph below)
  • Doctors without borders deployed to the Navajo nation in New Mexico, signaling inadequate resources on tribal lands (CNN)
  • Experts now recommend waiting 72 hours before opening packages (Independent)
  • FDA grants emergency use authorization (EUA) to Abbott Laboratories coronavirus antibody test, which boasts 99% specificity and 100% specificity, 30 million tests to be delivered in May (Axios)
  • SARS-CoV-2 virus found in some patient’s tears, suggesting one more way the virus may be spread and supporting the importance of eye-related symptoms (Ladders)
Screen capture taken from Mother Jones on May 11: https://www.motherjones.com/kevin-drum/2020/05/coronavirus-growth-in-western-countries-may-10-update/
  1. U.S. deaths and new cases are down, hot spots in the mid-west persist
    On Sunday, both new cases and deaths dropped in the U.S., however hot spots persist in the mid-west in particular. Just over 20,000 cases were reported on Sunday, a lower total than we have seen since March 31. For the first time since May 4, fewer than 1,000 deaths were reported. Overall, cases are declining, while deaths remain fairly stable pending the expected rise in deaths from the Tuesday report. The overall trends are being driven by the clear declines seen in the hard-hit states of New York, New Jersey and Michigan (see graph below); all reported less than 10% cumulative case growth last week. Very low case growth was also reported in Alaska, Hawaii, Idaho, Montana, Louisiana and Vermont. These are the states where the evidence in favor of reopening is strongest. On the other side, wide-spread community transmission remains in place in 35 states and Guam. The region of greatest concern continues to be the mid-west where 5 states reported 30% growth in new cases last week (Iowa, Kansas, Minnesota, Nebraska and South Dakota).
  1. The top hot spot in the U.S.: A closer look at Minnesota
    Minnesota has seen the most intense growth in new cases with a cumulative increase of 69% last week. Minneapolis leads the state with 3,744 cases, however the map below shows 2 standout counties with more than 1,200 cases each (Nobles and Stearns Counties). According to the COVID TRACKING PROJECT, Minnesota has done over 115,000 tests, about 2% of its population, which ranks in the bottom third of states. The test positivity rate remains about 10%, an indication that more testing will be needed to more accurately reflect the scope of the outbreak. The stay-at-home order has been in effect since March 27 and is set to expire on May 17. The epidemiology says this would be a mistake. Some offices and certain agricultural and industrial businesses have reopened. The lower plot shows states in the mid-west as of yesterday on Aatish Bhatia’s site. It shows that Minnesota is among a cluster of mid-west states with vigorous transmission. Minnesota and South Dakota are growing the fastest among these states, with Oklahoma, Missouri, Iowa, Nebraska and Kentucky looking like they have turned a corner. Wisconsin, Indiana and North Dakota may go either direction in the next week.
    What this means: It’s not clear why but Minnesota is the top hot-spot of virus transmission at the moment. There is no sign the epidemic is slowing there or in South Dakota. Deaths grew by 38% last week, a number we would expect to rise substantially given that deaths lag new cases.
Screen grab taken 5/11/20 from Minnesota Department of Health: https://mn.gov/covid19/data/covid-dashboard/index.jsp
https://aatishb.com/covidtrends/