Wednesday COVID-19 Briefing


Top news, reports and insights for today:

  1. Curated headline summaries for Wednesday:
  • New study finds since mid-May, U.S. has the highest COVID-19 death rate of any country with a large outbreak. Since June 7, U.S. COVID-19 deaths per 100,000 were more than twice the next highest countries (Israel and Sweden) and 6 times higher than Canada (JAMA, see Figure A below)
  • Sweden’s experiment to avoid shutting down is a “disaster” and should not be a model for the world (Time)
  • For the first time, the U.S. has now hired more than 50,000 contact tracers according to Johns Hopkins data. However, the push to grow a COVID-19 workforce is still less than half way to what experts say we need (NPR)
  • Harvard study finds that patients who survive severe COVID-19 infection retain high antibody levels for up to 4 months. This is as close as we can now come to President Trump’s unsubstantiated claim that he now has lifetime “immunity” to the virus (Daily Mail)
  • A 25-year-old man is now the first in North America to have a documented second infection with SARS-CoV-2. His second infection identified in June was more severe than the first found in April. The true extent of COVID-19 reinfection is not currently known (CBS News)
Figure A: Figure created by me based on https://jamanetwork.com/journals/jama/fullarticle/2771841
  1. U.S. daily cases continue to track upward, surges seen across all regions. Three Midwest states remain white hot and getting hotter
     As we move into a new week, the daily U.S. case data shows a continuing trend toward rising transmission intensity with the 7-day moving average lurching over 45,000 daily cases (Figure B). In the last week 340,470 cases were reported, the first time we have seen more than 300,000 weekly cases since mid-August. At my weekend briefing, cases were rising in all but 8 states. The numbers now look worse (Figure C); all but 5 states are now on the incline. There are numerous states in all regions where cases rose 20% or more week-over-week with the largest number in the Midwest: Iowa (+23%), Illinois (+41%), Indiana (+42%), Kansas (+26%), Michigan (+27%), Minnesota (+21%), North Dakota (+31%), Ohio (+26%), and South Dakota (+33%). The situation in the Dakotas remains especially alarming as things have gone from bad to worse. After weeks of very high transmission, both states saw new cases rise by more than a third. North Dakota added another 3,881 new cases raising its overall incidence rate to 3,706 per 100,000, second only to Louisiana. The largest weekly jumps in new cases actually happened in the West where Colorado (+41%), Montana (+63%), and New Mexico (+55%) are potential new hot spots.
     Switching to the rate of new infections, similar states stand out (Figure D). A week ago, North Dakota had 56 new daily cases per 100,000, now they are at 73. South Dakota, then at 47 is now 62. Montana jumped from 35 to 57 in a week. These are big increases in states that have been hot for some time. All but two Midwest states are now over 20 new daily cases per 100,000 and none are below the 5 benchmark. In the South, only Arkansas, Mississippi and Tennessee remain “hot”. The situation is holding steady in the Northeast although new cases are creeping higher in Rhode Island, now at 22 per day.
     The bottom line: The overall picture is toward rising cases across the board and in all regions. The Dakotas remain the hottest of the hot spots, followed by Wisconsin, and Montana. Thankfully, deaths have not yet started to rise appreciably but it is only a matter of time.
Figure B
Figure C
Figure D
  1. Is the current surge in U.S. cases due to flu? Not yet!
      I want to talk about influenza. There has been a lot of discussion lately about what we should expect given the impending rise of flu cases and what that will mean for the COVID-19 pandemic both in the U.S. and throughout the Northern hemisphere. Some people are suggesting that the kickoff of the flu season may be behind the recent surge in cases.
     I decided to go back and look historically at the time course of influenza in the U.S. in the fall over the last three years. Thankfully, the CDC has a great tool for this called interactive FLUView. It shows trends in influenza-like illness (ILI) across the U.S. by tracking patient visits to doctors with flu-like symptoms each week. Figure E below is my best effort to show you what the U.S. maps look like every two weeks from the middle of October till early January over the last three years. My goal was to answer a very simple question. When does the flu season really start to intensify? If it is late October, it might be true we are already seeing the impact of flu on COVID-19 numbers.
     Have a look at Figure E. There are at least 3 main lessons I take from this picture. First, it is exceptionally unlikely that the surge we are seeing now is the result of early flu activity. Over the last three years, the intensity coming in January through March won’t actually get started until somewhere between late November (last year) and late December (2018-19). The second thing that caught my eye was that flu-like illness intensifies first geographically in the Southeast and works its way north. I don’t know why but it is an interesting epidemiologic puzzle. I will be looking carefully at Louisiana, Texas, Alabama and Georgia as the states most likely to show early flu intensity. Third, last year was a high-intensity flu season months before COVID-19 was on the radar screen.
     The bottom line: It is hoped that with good vaccine uptake, mask wearing and social distancing, this year’s flu season will be less severe. If it is, COVID-19 will be more manageable. If, however, we drop the ball on flu prevention, the co-occurence of influenza and COVID-19 could create a double whammy of tremendous death and suffering.
Figure E
  1. Quirky Qorner: Cyberchondria! Social media and internet browsing are driving COVID-19 fear and anxiety
     I started reading this week about cyberchondria, defined on Wikipedia as the unfounded escalation of concerns about common symptomology based on review of search results and literature online. It’s a very pretty word for a not-so-pretty facet of the COVID-19 pandemic. We all like to believe that having access to more information at our fingertips is a good thing. More and more we are realizing that this is often not true. Researchers find that google search trends can actually predict where outbreaks are heating up. Now, a team from the Netherlands has published a study in the Journal of Anxiety Disorders. The study, based on a survey of 439 adults conducted in March, found that the coronavirus outbreak is causing fear and worry to increase. That’s hardly surprising. The interesting part is that even after controlling for other factors, time spent regularly looking up coronavirus information online, through social media and through regular media increased fear. You would think it is the opposite. Regular intake of social and traditional media heightened people’s fears rather than empowering them. Of course, that can’t apply to my blog. Right? Well in their analysis, looking up information on “professional” websites was not associated with increased fear! Whew!

Daily COVID-19 Briefing: 5/6/20

Top news, reports and insights for today:

  1. COVID-19 headline summaries for Wednesday:
  • Scientists at Mount Sinai in New York show that COVID-19 patients treated with blood thinners had better survival adjusting for other factors. This was not a randomized clinical trial but strengthens the case for using established treatments to improve outcomes in very sick patients (Journal of the Am College of Cardiology)
  • 48 hours after pledging to have a vaccine by the end of the year, President Trump backpedals (Politico)
  • FDA revised its policy regarding antibody testing, now requires companies to seek Emergency Use Authorizations (EUAs) including submitting validation data (FDA website)
  • SARS-CoV-2 found to have infected at least one person in France in December, a month earlier than first official case (Intl. J Antimicrobial Agents)
  1. Anyone who thinks this is just like the flu hasn’t seen this graph!
    I continue to hear people justify their resistance to social distancing measures by comparing COVID-19 to seasonal flu. A couple of weeks ago, I posted a graph comparing the U.S. COVID-19 death toll to other major mass casualty events in history. Below is an update of that graph. A month ago (April 5) the U.S. had reported just over 9,500 deaths. As of Tuesday, 55,000 deaths were added in that month. That is nearly as many as all American deaths during the 20 years of the Vietnam war. The U.S. has now eclipsed 65,000 deaths in a period of just over two months (if Puerto Rico and Guam are included). To put this in perspective (see graph below), as of yesterday, more Americans have died of COVID-19 than died from Ebola, SARS, The Las Vegas shootings, the Gulf war (Operations Desert Shield & Desert Storm), Hurricanes Andrew and Katrina, average deaths from the flu in March and April, H1N1 Swine flu and the Korean War. Combined.
    Bottom line: This is not the usual flu.
  1. U.S. records fourth highest death toll on Tuesday
    Yesterday, 2,435 Americans were reported to have died of a confirmed COVID-19 case, the fourth highest daily total thus far, an increase of 4%. U.S. deaths rose by 24% in the last week. Yesterday, 7 states met or exceeded the highest daily death toll including Arizona (87), Utah (6), Iowa (19), Illinois (176), Mississippi (32), Maryland (74), and Pennsylvania (554). Pennsylvania had a particularly sharp increase. The PA department of public health posted this in their press release: “As a result of our continued work to reconcile data from various sources, the state is reporting an increase of 554 new deaths today bringing the statewide total to 3,012 deaths in Pennsylvania. These deaths have occurred over the past two weeks.” Several of the states that set record deaths are nevertheless moving towards reopening including Pennsylvania. The lower figure shows rate of change in deaths over the last week. Seven states saw deaths near or above 50% last week. Midwest hot spots continue in Iowa, Montana and South Dakota. To that, additional states with high growth rates emerged in the south (Arkansas, South Carolina and Virginia). According to the CDC, 35 U.S. states plus Guam are reporting widespread community transmission.
    That this means? Weekend lag in reporting continues as deaths spiked on Tuesday. Hopes that the worst is over appear to be premature as the U.S. remains just below 2,000 daily deaths. The 7-day moving average is flat over the last week. This is especially troubling given that we have not yet confronted the effect of states that reopen due to the lag between increased behavioral mixing, infections, illness and deaths. Those effects won’t be seen for another 2-3 weeks.