Latest in COVIDView: Trends diverge in US, big rebounds begin in several states

I wish the CDC would host regular media briefings on the Covid work they’re doing but since they aren’t being allowed to, I will summarize what I see as the most important findings of their latest COVIDView report—the single best source of information on the pandemic.

The CDC’s publicly available data doesn’t provide the kind of granularity needed to look at states, but they did provide the code and we work closely with the great folks at Covid Exit Strategy so I use their analysis to look at states.

This week’s COVIDView tells the story of many epidemics. Trends are diverging within the US and globally. What will places do about travel from areas with lots of spread? Details matter, and this week’s data is particularly complicated. https://bit.ly/30Fj11C

Slight increase in positive tests

The proportion of positive tests continued to increase slightly for the second week in a row. Increases were driven by the Northeast, Southeast, South Central, Central, and Pacific Northwest. Positivity is a good indicator of increased spread—increased incidence.

Positivity in children continued to increase. Are any communities offering appealing, safe, voluntary housing to infected people so we can protect families and curtail transmission? Other countries do this routinely. We should do so as well.

Slight increases in Covid-like illness (CLI) in South Central and West Coast

Influenza- and Covid-like illness (ILI and CLI) visits as a percent of all visits continued to fall, but there were slight increases in the proportion of CLI visits in South Central and West Coast, likely representing increased spread. The absolute number of such visits also needs to be analyzed, particularly since visits to EDs are way down, and then will increase as people gain confidence in the healthcare system. Usually, proportions are more accurate reflections of trends than numbers, but this isn’t a usual situation!

Deaths continue to decline (so far)

Deaths are very close to baseline. But baseline could still mean hundreds of people a day dying from COVID-19. Have we become inured to this? Usually, a few deaths from a preventable infectious disease causes appropriate, intense concern.

Shocking impact on health care workers

Another part of the CDC website has total health care worker cases and deaths. Shocking, unacceptable. We MUST make health care workers and health care safer. Are we inured to this also?? When ONE health care worker died from tuberculosis, there was justifiable outrage.

Thanks to the Washington Post for this moving tribute to some of those who have died caring for others. It should be a must-read for those who set policy and budgets—and for everyone.

Racial disparities continue

Unacceptable disparities continue in COVID-19’s impact on Black, Latinx, and Native people. Are there any communities in the US that have avoided these inequalities? Factors behind this include more exposure to the virus, underlying health status, and lack of access to health care. Each of these must be addressed.

The situation in states

CDC has some state- and county-specific data, but there are better sources, unfortunately. Let’s do a deep dive looking at states, starting with Covid Exit Strategy. Look at both their tabs, but the CDC Beta is better for trends. Stay tuned to their site, more coming soon.

Only 8 states are green, and most are red. The most reassuring trends are in NY, NJ, VT, CT, DE, NM, IL, WI. All have stable or increasing testing, decreasing test positivity, and decreasing cases. Very low rates in Alaska, HI, MT, and WV. Keep it up, stick to the 3 W’s (wear a mask, wash your hands, watch your distance) and trace every case!

Here’s another good site. Note that positives across the US are increasing more than testing, showing that there is increased spread of the virus.

Steady progress in NY

New York State is showing steady progress. We can see that the case curve looks like a ski-jump, not a bell curve. Why the slower decline than increase? Three reasons: much of the increase was missed because of lack of testing, testing increased as cases decreased, and there has been continued spread during the decrease. (That last reason is one more demonstration that we should be offering safe, attractive isolation to people who are infected.)

Most concerning states

The combination of 3 factors are most concerning. 1. Large numbers of cases, 2. Increasing numbers of cases, and 3. Increasing test positivity rates. Here are the 5 states, so far, that have all those: AL, AZ, FL, SC, TX. Also worrisome although they don’t have all of those 3 danger signs: CA, GA, LA, NC, NV, OK, OR, UT. (AK is increasing testing a lot so it’s not on the list, some others e.g. WY, ID have increasing cases but low numbers overall.) Let’s look at the big 5 in the most trouble.

Alabama

Let’s start with sweet home Alabama. The Alabama Department of Public Health’s dashboard and its graph of Covid hospitalizations show trends that no state would like to see. Remember that hospitalizations lag spread by about two weeks, so expect at least another 2 weeks of increases.

Things are getting worse. Not so sweet, Alabama.

And not just one part of the state, but pretty much all over Alabama.

Arizona

We reviewed Arizona last week. The state has an excellent dashboard for epidemiological data, though I wish it also showed contact tracing indicators. Emergency visits, cases, hospitalization, ICU beds, and ventilator beds are all up. How high will it go?

Florida

In Florida the test positivity rate more than tripled, from 3% to 10%, and cases are spiking. People were asking why cases weren’t increasing in Florida. It was just a matter of time.

(Yes, median age is down...and that will mean that the increase in deaths will be slower than it would otherwise, but people don’t live in bubbles. The more spread you have, the more spread you’re going to have unless you make big changes. Remember the adage: doing the same thing over and over and expecting a different result is the definition of insanity.)

South Carolina

You can find nice data visualization on the South Carolina’s website, but the implications are frightening. Watch this 9-second YouTube clip showing how quickly the virus is spreading.

Texas

Finally, Texas. Covid is messing with Texas. Cases are up. Test positivity is up from 5.7% to 10.7%. Yes, testing increased by a third, but cases increased much faster. An increasing positivity rate combined with increasing cases means they’re having significant spread.

How do we match up globally? 

Poorly. Many countries are stopping Covid, some are making progress. It’s just starting to hit Latin America—hard. Then there are the laggards, like the US. EndCoronavirus.org is an interesting site that shows which countries are doing best in beating Covid.

Not all will hold, but trends are encouraging in these countries:

And these countries seem to be making progress, so far.

And then there are these…

Do we really want to be in the same category as Venezuela?

Big picture in US

Where people stayed physically distant, cases are decreasing but we need to stick to the 3 W’s—wear a mask, wash our hands, watch our distance—and ramp up quality and speed of contact tracing to prevent a resurgence as activity increases. 

Where distancing stopped too soon, big rebounds have just begun. There will be another 20,000 US deaths in the next month, at least.