Covid Epi Weekly: Harrowing Holidays

It’s hard to imagine a worse confluence. Cases are surging in much of the US. People are tired of the limitations the virus is imposing. Economic harm is real, painful, and persistent. And White House communications have continued to mislead, divide, and deny.

Bottom line (almost) up front: there IS one thing that can stop Covid. For months I’ve said there isn’t one thing, but there is. Not masks. Not travel limitations. Not staying home. Not testing. Not contact tracing. Not isolation. Not quarantine. Not even a vaccine.

It’s TRUST.

Around the world, the best predictor of controlling Covid is social cohesion: the understanding that we’re all in this together. We’re all safer when we all mask up, stay home when we’re sick, support contact tracing, and, eventually, get vaccinated. No group can get the infection without endangering other individuals and groups.

That’s why the unspoken advocacy for herd immunity by this White House is so revealing. “Protect the vulnerable” sounds great. But doing that while allowing the virus to spread among the young is an impossibility. It’s a scientific blunder emanating from a philosophical error.

When we understand we’re all connected, we can win. Let’s prioritize getting services to people and communities most in need. Let’s protect ourselves, our families, our community. There’s only one enemy: a virus. White House divisiveness is the best ally the novel coronavirus could possibly have.

Now, the disheartening numbers. Detected cases are up three times more than testing. Testing is up 8.6%, while cases are up 24%. What’s more, test positivity has risen from 6.6% to 7.1%. Saying cases are up because of more testing is like saying gravity isn’t real. This is an informative, though depressing graphic from The Covid Tracking Project.

Here’s a good way to show that cases are increasing much faster than testing by state. Case growth has been much higher than test increases in all states. (The published data from Mississippi has been whipsawing.)

Reported cases fluctuate by day. Generally, see lower case numbers over the weekend because of fewer office visits and tests. The weekends are time off for many people, but not for the virus. Paying attention to the seven-day average of reported cases is more useful.

Hospitalizations are, of course, increasing following case increases. It’s shameful and inexcusable that the federal government is not publishing data it has on the pandemic. NPR obtained a recent daily report from the US Department of Health and Human Services, and here’s a screenshot showing hospitalizations increasing:

Will deaths increase? Does night follow day? Of course. We ardently hope that deaths won’t increase as much as in the past, due to better care, fewer overwhelmed hospitals, and the use of dexamethasone and possibly other treatments. But only time will tell. Deaths follow case increases by about three weeks.

Wisconsin is a bellwether … including for Covid deaths. The state has seen a huge increase in Covid deaths. Many other states, sadly, aren’t far behind. 

As an epidemiologist, I think a lot about numbers. This week, two numbers made a big impact on me: 13 and 9. 

• 13 is the number of years of life lost on average for each of the 230,000+ Americans killed by Covid. 
• 9 is the number of people, on average, grieving for each of those deaths.

These represent millions of tragedies, most of the preventable.

We public health specialists must never underestimate the health and social impact of economic harm. We’re heading into a dark winter. We can limit harm with more outdoor activities, open schools, social connections, and shopping. And by reducing indoor maskless contact in poorly ventilated spaces.

I’ve shared some bad news so far. Here’s some good news. 9 of 10 people understand the importance of masking up. Those who don’t are a small, misguided minority. Masking up correlates well with lower case counts. Mask mandates, if done well, boost mask use and save lives.

The increase in telemedicine is also good news. Primary care is the most important part of our health care system, but it’s also the most underfunded and neglected. If we get regulation and reimbursement right, telemedicine will be an important part of fixing primary care and our health care system.

An interesting data survey summarized by Covid Exit Strategy shows that in states with more than 90% mask wearing, less than 20% of people know someone who is sick. In states with 80% or less mask wearing, 30-54% know someone who is sick. Look at the top and bottom places here—the gap is striking!

One of the many, many failures of this administration’s response to Covid has been insufficient protective equipment for health care workers. It makes me SO ANGRY. We’re sending our troops into battle without the armor a competent government would have provided.

Case increases lead to a vicious cycle: longer test turnaround, overwhelmed public health, less isolation of infected patients, more cases. If we reduce cases by wearing masks, watching our distance, washing our hands, and avoiding risky indoor spaces, we can create a virtuous cycle: fewer cases, better contact tracing, and enhanced ability to stop spread.

Why harrowing holidays? Thanksgiving in Canada. The country has struggled with case increases, division, attempts to undermine science, and denials of reality. Even countries which have done relatively well are now struggling. The US, with a completely failed federal response, faces potential devastation.

“Ending the COVID-19 pandemic”? The claim in this White House letter is Orwellian. 

The reality is the pandemic won’t end anytime soon. But maybe, soon, there will be an end to the completely dysfunctional national response.