Covid Epi Weekly: Turning the Corner on Covid in the US—Into an Oncoming Tsunami of Cases, Hospitalizations, and Death

You know what’s NOT tired of winning? Covid. Covid’s not tired of winning. Unless we up our game, Covid will keep winning, keep spreading, keep killing Americans—preventably.

Test positivity is increasing in ALL age groups. Positivity in people over the age of 65 increased from 3.6% five weeks ago to 5.2%—a 44% increase. Five weeks ago, the rate in young adults was 50% higher than in those over 65; last week the rate was just 20% higher. This confirms that what started in the young didn’t stay in the young.

Cumulative hospitalizations for adults over 65 in the US: 

• 1 in 300 White people
• 1 in 120 Native American people
• 1 in 110 Latinx people
• 1 in 87 (!) Black people.

The emergence of Covid has exacerbated racial injustice in health. Black and Latinx communities already had less access to health care. The inadequate protection of essential workers, many of whom are Black/Latinx, has also magnified inequities.

Years of life lost is a good way to measure the burden of a public health crisis, though it’s far from perfect. There have already been 2.5 million life years lost, more than 13 years for every one of the 225,000 people who have died from Covid. Think of the joy, happiness, and meaning lost for each of those 13 years. Each of those 2.5 million years.

A working paper published in June by former NYC Health Commissioner Dr. Mary T. Bassett showed the same pattern: Black and Latinx people in the US make up 33% of adults but 74% of early death. This is horrifying. Valid responses to this information include rage and action.

Other than Northeast, this map is bleak. 

Although it’s clear that there is a worsening situation in the US, we’re flying blind as to exactly how and where Covid is spreading. Test positivity is less informative than it was before. Case rates are an even worse indicator. The record 85,000 infections reported for Friday represent only about 20% of all infections. The failure of federal leadership means we’re not tracking the right indicators.

Take a look at the Dakotas. Neither state has a mask mandate. They are losing to Covid. The reported rates are slightly higher in North Dakota (1,000 vs. 800 per million a day), but when corrected for test intensity, South Dakota has about 4x the rate of North Dakota and 20x the rate of the Northeast. In other words, South Dakota looks not as bad, but it’s actually much worse.

Rural areas are getting slammed. These graphs from the New York Times show this clearly. Meat packing and agricultural outbreaks are part of, but only part of, the factors driving the increase. No place is immune to Covid.

Increasing cases in Alaska suggest that colder weather may favor the virus. In the classic Art of War, Sun Tzu defined five factors that determine success or failure in war: moral influence, weather, terrain, leadership, and strategy. In our war against Covid, the US is not organized for success in any of those 5 - we’re zero for 5 at present.

Parts of Europe are also getting hit hard. Places that didn’t drive cases down enough to find and stop clusters face the ever-present risk of explosive spread. Some countries didn’t flatten the curve sufficiently (Spain, France, Italy, UK, Belgium) and some did (Germany, Norway, Finland).

Economic pain is real, and deadly. We are all impatient to resume activities we miss, but the reality is there are things we won’t be able to do until we control the pandemic. Here’s more evidence the virus, rather than control efforts, is what’s suppressing economic recovery. “It has almost nothing to do with regulations.” Paraphrasing James Carville, to fix the economy, it’s the pandemic, stupid.

Balance is key in our response. We must apply more granularity to our “circuit breakers” to stop Covid. Yes, we’ll have to adapt our lives for the foreseeable future. But there are a lot of activities we can and should do, while taking steps to reduce risk. Schools, healthcare, workplaces, stores can open more safely. Spending time outdoors is great. On the other hand, travel from places with high Covid to places with low Covid is a recipe for spread. Restaurants, bars, and indoor get-togethers amplify the virus and we’ll need to figure out how to do this as safely as possible.

The higher the peak, the longer it lasts. The lower Covid goes, the longer it takes to come back. As we sow, so shall we reap. Hyperbolic discounting is not in our favor here. As night follows day, hospitalizations and deaths follow cases, which follow letting our guard down.

Civic responsibilities include not harming (e.g., infecting with coronavirus) others, staying informed, paying taxes, participating in your community. And VOTING. We released materials on voting more safely. I like the message below. Please spread the word.