Ned Notes (not blog): 20nov20 COVIData Sweep

 

B.L.U.F. (bottom-line, up-front): hospital admittances are at their highest since the epidemic began complemented by a 1-2% daily growth in the number of critical-care patients; daily mortality is at the three-quarters the peak-level of last Spring. American politics is imposing consequences.

NOTE: the basis for data now aggregates a half-dozen sources – Johns Hopkins, Microsoft, The New York Times, Worldometers, and The Atlantic.

NOTE: this longer essay accounts for pure data dumps the next two weeks because of Thanksgiving and the monthly cluster letter to my family.

INTRODUCTION
My base case death toll of 335,301 victims at the end of one year (i.e. at 28feb21 05mar21, to line up with the closing letter to friends and familiares), projected almost eight months ago, is and has been obsolete. The University of Washington has released fresh and comprehensive projections this week for first-year deaths into March 2021 totalling 470,974 souls. The university has also established milestone numbers of 317,000 in two weeks; 389,000 by year’s end; and, 400,000 by early February.

These projections are granular to the state level. Accordingly, below is the usual ‘34+’ table modified to display first year mortality projections for each state monitored; this table is in addition to the weekly table recording deaths and testing at the end of this essay. Currently, the rural states in Northern latitudes have the highest percentage of cases and rapidly increasing death tolls.

Nevertheless, the border states of Tejas and Arizona as well as Florida endure accelerating surges in cities and rural areas. El Paso is one of the hardest hit cities in the country, along with Los Angeles and Chicago. These surges may NOT be attributable to México. Politics still slows the policy response of the United States to the apparently exponential growth rates of the past month.

CONTINUED SUFFERING for PEOPLE of COLOR
Again, implicit racism in American health-care and society amplifies food security challenges and financial strain for the Black, Brown and Native communities. This phenomenon is widespread even among affluent counties. Paradoxically, consumer confidence remains stable, if modestly diminished, going into the peak buying seasons. Brands have lost cachet while on-line shopping, unsurprisingly, predominates.

THE WEEK: NOT EXACTLY GLAD TIDINGS
Given the current death toll of 257,718 people, the projection by the University of Washington equates to a little more than 2,000 deaths per day from now until 01mar21. The daily death tolls have exceeded 2,000 fatalities twice this past week, so the trend is unmistakably in place. The data confirm this more pessimistic view after daily hospitalizations started rising again two months ago.

Since then, daily hospitalizations have nearly tripled to 82,178; that level is 37% higher than the daily peak of last spring. Hospitalizations have grown 1.4% each day, pulling ahead of the 0.8% growth rate of people in intensive care units. Put another way, critical care patients comprised roughly 50% of the hospitalized COVID sufferers two months ago but now represent some 28%.

That is NOT good news since the rapid rise in hospitalizations requires a lag-time for the new patients to end up in critical care, implying an accelerating growth of victims in intensive care in the days and weeks ahead. The fact that daily hospitalizations have risen 187% and critical-care patients 63% augurs the latter statistic accelerating at least through December.

Combine those growth rates with daily mortality run rates of intensive care patients increasing from 4-6% to 10-12% in the last twelve days, and the outlook for this second wave looks grim indeed. In short, confirmed cases are growing at a near-exponential rate while extreme illness and death rates grow at geometric rates.

The evidence is stark when viewing the numbers for the five original bellwether states of Arizona, California, Florida, Texas, and Arizona. While Oklahoma typifies the rural states under siege, Texas, California and Arizona are also witnessing new, if less dramatic, surges. Florida may well be enduring a higher death toll than reported. 

(Truth in packaging: I distrust Governor DeSantis.)

The five new states now appended to the bellwether table below – specifically, Colorado, Idaho, Illinois, Missouri, and Wisconsin – hearken back to the troubles faced by the original five last Summer. The case-load is growing at a rate likely to overwhelm hospitals, particularly geographically remote facilities. These ten states could produce more than 100,000 additional deaths this winter.

(Truth in packaging: I disagree with Dr Birx in her assertion that surge has stopped in Southern states.)

Complicating the outlook is the reality exposed by data on the table of thirty-four states and five territories at the end of this essay: stalled testing; half the states recording more than 10% growth rates in positivity for at least two consecutive weeks; and, only three of the states reviewed and D.C. meeting the 5%-or-less two-week positivity rate needed to re-open per the World Health Organization. Of the states not reviewed on the table, only Hawaii meets that 5% criterion,

The reasons are familiar to us by now: cold weather taking people indoors where social distancing and masking breaks down, especially among asymptomatic carriers. A peculiar pattern has set in over the past few months in the U.S. The daily death tolls tend to start low in the first three days of the week, only to rise substantially in the second half of the week.

FAMILY CLUSTER-BOMBS
The deteriorating conditions have continued this week as rural areas become increasingly infected and urban centers are starting to surge as well. Almost all states now mandate behavioral mitigants to slow the spread.  Republican Governors, reticent in the past (due to cultural aversions to mandated mask-wearing and wariness of President Trump's political wrath), have started stepping up. Many, like Iowa, do so now in a bi-partisan manner.

Currently, the United States has the more than a third of the fifty worst global hot-spots in the pandemic (i.e., places like cities in Spain, Italy, Brazil, and India) in terms of confirmed cases. In actuality, the Dakotas are the top two global hot spots. At least part of the problem remains the ineffective screening for coronavirus carriers among travellers and at transportation centers.

New York City, its vigilance in place, has closed its schools since the positivity rate (i.e., the percentage of people tested who display the presence of the virus either currently or in the past) now exceeds the extra-prudent level 3%, versus the W.H.O.’s 5%, threshold of containment. Currently, the leading spike is in Buffalo and among up-state counties.

Governor Whitmer’s controversial actions in Michigan have paid off. Though the State is facing its second wave, this outbreak is dispersed with the Detroit area accounting for a third of the cases rather than the 80% dominance of last Spring. Nevertheless, hospital capacity may well be quickly filling up for critical care patients.

Philadelphia is cracking down on its second wave by, for example, by prohibiting any indoor activity involving any guests during the holidays. While such a measure can not be enforced, the local government seeks to forewarn the City of Brotherly Love of the severity of this spike.

Baltimore and Philly lead the second wave in the Mid-Atlantic region, notwithstanding a stalwart effort by Governor Larry Hogan (R-MD) over the last eight months. Pennsylvania lags her contiguous neighbors in response and effectiveness.

Here is a typical infographic, in this case issued by Michigan, on mandates to slow the spread of the virus.

POLITICS and CONSEQUENCES
While the Trump Administration had done a reasonably effective job in executing a strategy despite being late to the game and reports of corruption, the President appears to have checked out over the past month (e.g., no work-place COVID guidance from O.S.H.A., leading states to scramble to address these issues) as he contests the election results. Fortunately, Vice President Pence has continued his leadership of White House Coronavirus Task Force.

The Pence commission stresses vigilance during the holidays. On the good news side are two vaccines that are 90-95% effective in controlled testing. The U.S.G. appears to be prepared for a rapid roll-out of these vaccines, to the most vulnerable people first (i.e., elderly people and medical first responders) in late December, with more general distribution starting in the Spring.

Half the country suspects that the program aiding the production of the vaccines, 'Operation Warp Speed', represents a politically driven rush-to-failure. In a new study, hopefully, the periods of acquired immunity from (remember, mostly asymptomatic) cases may be as long as eight months, rather than the eight-to-sixteen weeks currently reported. Thus, herd immunity may still be possible notwithstanding a less than ideal absorption rate of the vaccines by the populace.

Meanwhile the incoming Biden Admin., undeterred by denied access to planning or sensitive information, has its own task force studded with well-known epidemiologists, medical professionals, and others. This group appears to be planning for the national scaling of Governor Andrew Cuomo’s (D-NY) ‘zip-code’ response strategy currently operating in the Empire State.

OTHER NEWS
Denmark has run into a political stumbling-block in her plan to neutralize a menacing mutation of the coronavirus borne by minks. In starting to kill off up to seventeen million minks, a backlash has ensued creating a stalemate. Germany has succeeded in slowing the community spread of the coronavirus through her four-week ‘lock-down lite’ of shutting down entertainment venues for a month.

The U.S. and Canada have complained to the World Trade Organization that China has used the spread of COVID-19 to impose non-tariff trade barriers against North American food products. Good news for the failed testing in the United States: an affordable do-it-yourself coronavirus test that produces results within half an hour is ready for mass production. The F.D.A. looks likely to use emergency authorization to speed distribution.

On a less fortunate note, a Lancet-published study indicates that one in very five people recovering from full-blown COVID develops mental health problems, primarily depression and anxiety, within ninety days of apparent recovery. This finding recalls another study by Northwestern University reporting attenuated cognition, at least temporarily, among COVID-19 survivors published six weeks ago.