Covid Epi Weekly: New Highs, New Lows

More cases in more places than ever. More people being hospitalized. Sadly, we’re also seeing as much division as ever. There’s been encouraging news on vaccines and immunity in the past few days, but we have many hard months ahead of us. Together we can reduce spread, save lives, and protect jobs.

Across the country, there’s been a stunning increase in cases, a dangerous increase in hospitalizations, and a tragic increase in deaths. 

On March 10, Dr. Cyrus Shahpar and I estimated how many Americans could die with .5% fatality rate. Sadly, our projections are on track. Unless we act now, a half million people could die. 

Test positivity increased from 8.4% to 10.5% in a week. Cases are increasing exponentially and hospitalizations lag cases by 1-2 weeks. Here’s some simple, depressing math. Hospitalizations will pass 100,000 within a month. Deaths will reach 2,000 a day by the end of the year.

PCR test positivity is still the best single indicator of risk in communities. This national map gives a good sense of the enormous variability of Covid rates and risk across the US. This information and more should be publicly available in real time.

The Northeast and Hawaii continue to do better, with California and Louisiana also better than most. But as we travel and gather over Thanksgiving, the risk is that we all increase to the HIGHEST common denominator—that’s how infectious diseases work. Travel accelerates spread.

In NYC, the northern part of Staten Island generally has the worst health status, but the southern part is having a large Covid outbreak. Support for Trump and lack of safety precautions against the virus are highly correlated, as The New York Times describes.

Cases and deaths are increasing in nursing homes, homeless shelters, and prisons. Outbreaks at these congregate facilities can be prevented and stopped as demonstrated by quick, hard work. Good article on unacceptable risks in correctional facilities.

We’re hitting new highs of Covid and new lows in our response. This article describes the various worsts of the pandemic—the places where rates, cases, and deaths are highest. A good article on the various worsts of the pandemic. Unfortunately, the worst is yet to come.

Now, let’s take a look at some research developments. The most encouraging thing I learned this week was in a new MMWR study about a large Covid outbreak in a summer camp. 

It’s clear that testing doesn’t replace safety strategies. The camper tested negative the day before the event, but more than 100 people were infected. 

So what’s encouraging about the study?

Of the 24 people who had antibodies before camp, none became infected. Of the other 128 people tested, 116 were infected. Odds this happened by chance? More than a million to one. Reinfection happens, but most people with antibodies are protected, at least for some time.

Two big mysteries: Why do kids get less severely ill than adults, and why is there such variation in severity of illness even in people of the same age with the same risk factors? Back in May, I reviewed theories and evidence on the second question. 

We still don’t know the answer, but there’s some new evidence—a theory, not proof!—that cross-reacting antibodies to other coronaviruses may protect from Covid. One study from London and another study from Africa give us clues.

On the other hand, this study suggested prior infection with other coronaviruses didn’t help. Confused? So is the world. Want to learn more? Read this excellent, clear (and open-source) summary of knowledge of Covid immunology.

Which brings me back to why the Wisconsin outbreak is so encouraging. In this case, the equivalent of Sherlock Holmes’ “dog that didn’t bark in the night” clue is that 24 antibody-positive people did not get Covid. If Mother Nature can protect us, vaccines can too. Immunity passports are coming.

There’s been a lot of well-founded excitement about mRNA vaccines based on very encouraging reports from Pfizer and Moderna. These reports offer hope if long-term efficacy, including in elderly, with safety is confirmed as vaccination is rolled out. To a great extent, we owe these vaccines to one woman who for 30 years didn’t give up: Katalin Karikó.

Here’s a good explainer on the history and details of the vaccine and Dr. Karikó’s role. The vaccines turn your body into a factory for the antibodies you need, and could be important for vaccination and treatment for many diseases beyond Covid.

The article also outlines the role of finance and venture capital in drug/vaccine development. In 1900, the NYC Health Department produced antitoxins for diphtheria and other life-saving products; Lederle Labs was formed by an Assistant Commissioner (Lederle) who learned at the Department.

This started a long tradition of taxpayer money funding inventions that the private sector then makes and charges the taxpayers for. Innovation of the private sector is a great engine of productivity, but we have to make sure that public funds are used to protect the public.

What are we learning about fighting Covid from all of this? I summarized that in an article for The Atlantic. The virus will force us to close many things, but we can fight it more safely, and with less collateral damage.

How much do we have to close? This modeling article shows that the smaller the group size, the less the spread. But there’s no threshold, and where people come from, how long they stay, and whether they wear masks all make a difference. Thanksgiving plans need to change.

As cases rise, restaurants and bars will need to close for indoor service. Let’s work together so we can keep our kids in school, our parents alive, and, if we’re really careful, still be able to shop for the holidays and get a haircut.

Outdoors remains healthy and safer from Covid. Unless gyms are very, very careful, they will need to close. That’s unfortunate because physical activity is the closest thing we have to a wonder drug. Here’s a good example of careful measures preventing spread in a gym.

In this encouraging new brief, CDC shares that masks not only protect others but also likely protect the wearer. No one thing will make the pandemic go away, but masks are one of our most important tools. It’s great that nearly everyone understands this now.

A new low in our fight against Covid is the blocking of transition work. This is a relay race, and anything that prevents a smooth handover can cost more lives to Covid. January 20, 2020 was the date of the first case of Covid in the US. January 20, 2021 can mark the beginning of a much more effective response.

I’m horrified to see case increases and delays in dialing back indoor contact. In March, I felt like Cassandra: able to foresee impending disaster and unable to stop it. Now, the impending disaster is plain for all to see. There will be 1 million diagnoses in the coming week.

Have we become hardened to deaths? Can we personalize what this means? Would it help to point out that Betty White is at risk? Won’t we forego an indoor get-together to save her life and the lives of 100,000 of our neighbors? Must we wait for mass death to change our behavior?

Flu activity is still low, but could increase. Get your flu shot if you haven’t already. 

Dr. Bill Foege quotes Lincoln Steffens, and it couldn’t be more true about our Covid knowledge and what we need to keep in mind. All the best to all for the holidays. The more we work together, the better we will pull through.

“The best picture has not yet been painted; the greatest poem is still unsung; the mightiest novel remains to be written; the divinest music has not been conceived, even by Bach. In science probably ninety-nine percent of the knowable has not yet been discovered.” -Lincoln Steffens