COVID DIARIES, 6 SEPTEMBER 2020
Declining Numbers, But 2x the Virus
We’re going into fall with far more COVID-19 than we had in June
On the face of it, things are looking better on the coronavirus front. Locally and nationally, new cases, hospitalizations, and deaths all decreased this week. Testing increased, especially in California, after a nearly a month of declines. These are all positive signs that the summer surge is nearing its end. (See the complete numbers at the end of this post.)
This week also saw positive news in the use of cheap, widely available corticosteroids to combat the risk of death among critically ill COVID-19 patients. A study found up to 35% reduction in the risk of death among patients. Essentially, the study found that the sicker a patient is, the more steroids can help.
As encouraging as it is to see the summer surge coming to an end, this past week also saw at least three warning signs: Confusion over vaccines, concerns about risks from widespread virus, and the story of a super-spreader bus ride.
First, there was confusion over vaccine availability. The CDC notified states to prepare for a vaccine by early November, with the president then saying a vaccine would “probably” arrive by October.
In response, leading US drug makers Pfizer, Johnson & Johnson and Moderna — nominally rivals — quickly issued a joint statement committing to adhere to safety standards before releasing any vaccine. The drug makers have a common interest: Effective vaccine distribution requires trust.
Second, there is concern among epidemiologists and public-health officials that we’ve merely reached a plateau, and that we’re nowhere close to defeating the virus.
Ashish Jha, dean of the public-health school at Brown University, noted that we’re going into fall with far more virus than we entered summer. Further, Jha warns, the national positivity rate is higher now than it was June 1. This means we are missing more cases, Jha says.
Indeed, while we’re clearly better off than the peak levels of June and July, national test positivity increased from 5.4% to 5.5% this week, driven by more infections among patients aged 18–49 years.
It might not seem obvious in this record heat, but fall will bring with it cooler temperatures, more time spent indoors, and the beginning of flu season. Jha and other public-health officials say it will be a huge challenge to control the virus given the current high levels of infection.
Third, community outbreak remains a concern. This week JAMA published a study showing a high risk of infection for all passengers on a bus with one asymptomatic rider. The tl;dr version of the study is that caution in shared public spaces is merited: There was no safe place to sit on the bus.
The study focused on two buses in Eastern China carrying Buddhists on a 50-minute ride to and from a worship event. One asymptomatic passenger boarded one of the buses. The median age on both buses was 58.6 years. Both buses had air conditioning in recirculation mode.
On the “bad” bus, 24 of 68 riders seated throughout the bus became infected. On the “good” bus, none of the 60 riders tested positive.
There are some caveats around the study. Passengers didn’t wear masks. The event was in January, at a time when virus awareness was limited in Eastern China. On the other hand, it’s also likely this outbreak involved the original L strain of the virus. The most common mutation in the US, the GH variation of the G strain, appears to spread far more rapidly.
Masks and hand-washing certainly would have helped here, though it’s impossible to say in hindsight to what degree. What the study does make clear is that airborne spread is a risk, especially indoors in places with recirculating air.
The summer surge was the result of us not doing very well over the Memorial Day and Independence Day weekends. Here’s hoping we do much better this Labor Day, and come closer to getting the virus under control.
Here are this week’s numbers.
US stats for the week ending Friday, September 4 (with % change from previous week):
Total tests (positive, negative, pending): 5,153,361 (+6%)
New cases: 284,240 (-2%)
Cumulative US cases: 6,168,994
Confirmed COVID-19 hospitalizations: 34,099 (-8%)
Confirmed COVID-19 ICU: 6,924 (-8%)
Deaths: 5,983 (-9%)
Cumulative US deaths: 179,740
CA stats for the week ending Friday, September 4 (with % change from previous week):
Total tests (positive, negative, pending): 786,333 (+15%)
New cases: 33,425 (-13%)
Cumulative CA cases: 722,283
Confirmed COVID-19 hospitalizations: 4,401 (-16%)
Confirmed COVID-19 ICU: 1,235 (-16%)
Deaths: 800 (-8%)
Cumulative CA deaths: 13,490