Latest in COVIDView: Just when you thought it couldn’t get worse…

Here’s where we are in the US with Covid now. This is based on CDC’s latest COVIDView report, Covid Exit Strategy and other sources.

Outbreaks in the US have gotten so bad, the folks at Covid Exit Strategy added a “bruised red” to their map, signifying states where the virus is out of control. The bruise is spreading.

In the past week, overall test positivity increased slightly, although positivity in commercial labs decreased slightly. Something odd is going on with the commercial lab data—the number of tests reported is way down and we’ll have to wait until next week to know if these trends are reliable. 

Look carefully at the public health lab results. Lines are positivity rates, on the Y axis. Note the yellow—young adults—increasing for more than a month. Older adults (blue and green lines) increased sharply last week. That’s not good. Because there’s a lag in deaths we’ll first see an increase in cases. The deaths follow 2-3 weeks later.

Test positivity trends are revealing, but don’t be fooled by test numbers. I don't know why people are wondering if we will have more than 100,000 infections a day in the US. On Saturday there were at least 200,000, possibly many more than that. We diagnose only a small fraction.

Many tests take more than 2-3 days to come back, which means they are of little value. We should know testing rates for each race/ethnic group and ensure all results come back within 48 hours. 

Influenza-like and Covid-like illnesses are continuing to increase in much of the country. This syndromic surveillance is an important early warning system that first sounded the alarm in Arizona in late May…

Death rates have declined to near baseline. Hans Rosling got it right: we have a hard time conceptualizing that a situation can be better, but still very bad. We’ve seen a dramatic increase in the use of Remdesivir and a steady increase in plasma treatment in hospitalized patients with Covid. These are promising though unproven treatments.

Here are the most alarming states, with high rates of Covid and high and rising test positivity: Florida, Texas, Georgia, Louisiana, South Carolina, Alabama, Nevada, and Idaho. 

Arizona has stabilized at a high rate. California, Utah, and many other states are seeing intermediate levels of spread; the population of California means large numbers of cases there. 

Reassuring so far, but still at risk: Northeast, Wyoming, South Dakota. Hawaii and Alaska have low rates with small increases.

Where does the epidemic go from here? This modeling site has performed better than most, using solely deaths and machine learning. Nationally, Youyang Gu estimates there are 4.8 million people with Covid today—1 of every 78 people.

The same site projects 211,500 deaths in the US by the end of October. Leaving Belgium (which counts deaths differently) aside, that would put the US death rate ahead of France, Sweden, Italy, and Spain and about tied with the UK for worst in the world.

Better care and newer treatment can decrease death rates (maybe: plasma and remdesivir early, steroids for some patients late). Even with a vaccine, the virus is here to stay. We need a comprehensive response that will minimize deaths and get to the new normal soon and as safely as possible. 

There’s a lot at stake. The chance for our kids to go back to school and for us to get back to work. The chance for our economy to recover. The chance for us to save tens of thousands of lives.

Stay tuned for news Tuesday about a better way to get a nationwide approach despite lack of national leadership.

It’s not about opening schools or our economy, it’s about opening them and keeping them open. We know what to do: follow the 3 W’s—wear a mask, wash your hands, watch your distance (e.g., close restaurants and bars), and box the virus in with strategic testing, isolation, tracing, quarantine.