Ned Notes (not blog): Friday the 13th meets COVID the 19th

NOTE: Worldometer mistated the critical care patients last Friday, likely by entering the infections per million calculation into the critical care patients column. The real calculation was approximately 19,838 (as an interpolation between 12nov20 and 14nov20). The text has been revised.

B.L.U.F. (bottom-line, up-front): the U.S. epidemic’s second wave has accelerated shockingly, though the sharp rise in leading indicators of Friday have yet to be confirmed by subsequent performance. The numbers from this week alarm many people, including President-elect Biden as well as Drs Fauci and Birx.

WEEKLY OVERVIEW
The coronavirus contagion migrated from crisis to catastrophe this week. Friday the 13th lived down to its name with truly sobering numbers as the number of critical care patients has been climbing almost every day for the last month, now reaching a daily rate of 1-2%. Hospitalizations have risen consistently at a 2.2% daily clip for the past month. The tricky, ominous, part here is that testing has slowed. 

That slow-down in testing combined with growing infection and hospitalization rates mean that a higher percentage of new cases could be diagnosed only after symptoms appear. That level is roughly even with the next three nations combined. These countries have a total population of 1.7 billion souls. Excluding India as an outlier, Brazil and Iran total 297 million people versus 333 million for the United States. 

The second wave is hitting Europe and the Americas hard. With the White House, distracted by contesting the 2020 election and with one of ten citizens testing positive for the virus, the American second surge has swelled into a tidal wave. The Trump Admin. argues otherwise, announcing possible mass distribution by a Pfizer-developed vaccine in the next five months. President Trump’s claim of his Administration’s above-average performance is challenging to support.

The hurdle for the Pfizer vaccine remains logistics and the threat of the virus mutating: the formula must be cooled at -73 degrees centigrade (-100 degrees Fahrenheit). Though my take is not as optimistic as that of the White House, late Summer appears to be the most realistic time-line for mass distribution in cities, perhaps the Autumn for more remote areas. Additionally, this time-line depends upon the ease of rolling out more clinic-friendly vaccines.

For now, at least, President Trump argues that a second lock-down would likely compound the tragedy engulfing the country. With the daily death tolls expected to exceed two thousand on average over the next three weeks (per the Centers for Disease Control), the projections I made more than seven months ago for 336,000 fatalities through 05mar21, appear to be headed upwards to 400,000. Though now enduring an outbreak herself, my belovèd Tunisia labours with a 2.8% mortality run-rate but ranks sixty-fifth among nations in deaths-per-million.

STATES and CLUSTER SUMMARY
Across the countrywide ‘red-zone’, states either require or strongly encourage the standard behavioral restrictions of washing hands for twenty seconds; social distancing; limiting numbers in gatherings; and, masking in public. The fearsome rise in critical patients and the mortality rates across the land challenges rural areas of larger states (i.e., Wisconsin, Michigan, Illinois, Missouri, Minnesota, North Carolina, Pennsylvania, and Texas) while menacing rural states in general (e.g., Idaho, New México, Kentucky, the Dakotas, Colorado, Iowa, and Utah).

Of the states and territories reviewed, covering 95% of the U.S. population, only six and D.C. have positivity rates (i.e., the percentage of people tested confirmed to have or to have had the coronavirus infection) below the two-week ‘re-opening’ threshold of 5% for viral containment set by the World Health Organization. The states, left to their own resources, are stepping up restrictions as many face the prospect of being overwhelmed with patients. The rural states, lower on resources, face a grim time ahead. The concern circulating through urban centers focuses on the harsh impacts suffered by citizens of color. 

1. Of the densely populated Northeastern states coming off a rough Spring 2020, Pennsylvania’s position currently is the gravest with three-quarters of the counties reporting positivity rates above 5% level of significant spread. Specifically, the counties in the two clusters range from 5-9% positivity rates. Low testing rates in Pittsburgh warrants special attention. After a difficult eight months, medical first responders in Philadelphia are pushing back for hazard pay and more support.
2. Illinois has taken preliminary steps toward a second lock-down as infection rates accelerate above a 17% weekly growth rate. For this week, at least, the growth rate in deaths has levelled off at 4.2%. 
3. Michigan has faced a tripling of hospitalizations over the last three-to-four weeks; intensive care admissions and ventilator use have risen 2-2½x over the same period. The State is emerging as the most challenging repeat among urban states devastated by Spring’s epidemic with deaths up 5.4% and positivity rates exceeding 10% over the past week.
4. Buried in a 25% growth in cases during the last week alone, Colorado has braced herself for the second wave by upping hospital capacity and laying out quarantining guidelines for holiday gathering.
5. Staten Island has finally succumbed to the second wave. While New York continues to practice vigilance, schools in N.Y.C. may need to close if positivity rates (i.e., the percentage of testing results that confirm an infection) break the Mayor’s stated 3% decision-rule.
6. Maryland appears to be heading toward a second, at least partial, lock-down, despite a better second wave containment than most other states. The limits on indoor group activities is constricted to ten people – and twenty-five for outdoors – as positivity rates trend above the W.H.O.’s 5% re-opening threshold.