COVID Diaries, 16 August 2020

Less Data, Less Virus. Right?

The coronavirus surge that began in June continues on a steady downward glide path. New cases, hospitalizations, and deaths are all lower than last week. While that’s certainly good news, there are multiple signs we should continue to proceed with great caution.

For the week ending this past Friday, 366,200 more Americans tested positive for coronavirus, a 3% decline over the previous week. Note also, however, that testing has declined over the past 14 days for the first time since the pandemic began; more on this below.

All key coronavirus metrics are in decline, which is a good sign after the June surge. But there are plenty of caveats too — testing is down 9% over the past 14 days for the first time since the pandemic began, and the US still has more cases than any other nation.

So far, the US has seen around 5.3 million cases, leading the world in absolute and per-capita terms.

As of Friday, there were 45,826 Americans in the hospital with confirmed coronavirus cases and 9,277 ICU patients. These are respectively 11% and 4% declines compared with the previous week’s numbers.

Also this past week, 7,339 Americans died as a direct result of the virus. That’s a 1% decrease from the previous week’s death toll, but still represents at least 1,000 Americans dying from the virus every day.

By some accounts, the daily death toll has remained above 1,000 per day since mid-July. For reference, on the deadliest single day of the Vietnam War — January 31, 1968 — there were 246 US personnel killed.

Deaths declined less than other metrics because death is a trailing indicator, the last sign of the surge that first appeared in June. To be clear, this doesn’t mean the surge is over; it’s still growing, but at a slower rate than before.

The virus is still widely distributed around the nation. States as disparate as Nevada, Kansas, Mississippi, Georgia, and Delaware all suffered extremely high rates of per-capita new case growth. Kansas this week claimed the “honor” of most infectious state, with 459 new cases per million residents, and that number may be underreported.

The virus is widely distributed, and on a per capita basis is just as infectious (often more so) in sparsely populated states. Kansas this week earned the “honor” of being the most infectious state as the virus continues to move northward out of the South and West.

In California and Ventura County, the numbers are also steady or declining — but there’s a big catch with case data. As reported last week, system failures starting around July 25 created a large backlog of test results.

California testing and case data is subject to data errors dating back to July 25. These numbers should be considered minimums and not a complete description of testing or case rates. Hospitalization and death reporting are not affected by the data error.

The state says it has now worked through the backlog of up to 300,000 test results, but there are still results outstanding. I agree with computational biologist Mike Bass, who says we should treat recent county and state case reports as minimums, and not necessarily of accurate descriptions of the current situation.

For the week ending this past Friday, 62,659 more California residents tested positive. That’s nominally a 40% jump over the week-ago total. However, the percentage difference isn’t meaningful because last week’s totals were depressed by the system failures.

Mike reports that even with the state data errors we’ve seen a slight increase in new cases, both locally and statewide, averaged over the past 14 days. He adds that hospitalization and ICU numbers (neither of which were affected by the outages) are trending downward.

As of last Friday, the state had 6,364 confirmed COVID-19 hospitalizations and 1,850 ICU patients. Those are respectively 13% and 6% decreases over the previous week’s totals. There may be a trend in increasing Ventura County ICU patients, but it’s too soon to say for sure.

Also this past week, 985 more Californians died of the virus, a 2% decrease over the previous week. Averaged over 30 days, Mike Bass reports that Ventura County now experiences 1.5 deaths/day from the virus, with 128 deaths/day statewide.

This chart, from computational biologist Mike Bass, shows deaths statewide are rising slightly faster than the 30-day trendline would predict. On average, Ventura County sees 1.5 deaths/day from the virus; statewide, it’s 128/deaths/day.

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While I am cautiously optimistic about reductions in key virus metrics, I also think letting our guard down now is a lousy idea, for several reasons.

First, testing is down for the first time since the pandemic began. Over the past 14 days, there were 9% fewer total tests nationwide (positive, negative, and pending), according to covidtracking.com. Every previous two-week interval saw an increase in testing.

This is a troubling development in that it blinds public-health and elected officials as they decide where to direct resources to fight the virus. This is sort of like expecting pregnancy to decrease because there are fewer pregnancy tests.

One positive development this week was the announcement that the FDA granted emergency approval to Yale University for a saliva-based viral test that’s claimed to be about as effective as nasal swabs. Emergency approval means the test, called SalivaDirect, hasn’t yet undergone FDA validation. But a simple, less intrusive test has the potential to be far more widely deployed, something that’s sorely needed.

Second, there may well be thousands, and potentially many thousands, more new cases in California yet to be reported due to the system failures over the past few weeks.

Gov. Gavin Newsom says the state will have “resolved” the backlog by tomorrow (Monday), August 17. However, “resolved” is not a synonym for “reported.” Until there’s better clarity, consider the county and state new-case reports as preliminary, and subject to data errors.

On a more positive note, the state has data visualization tools that help understand reporting for each county. The site isn’t new, but it was new to me this week.

Finally, I see far too many #covidiots out and about in daily life. It’s not just institutional threats like local public-health hazard Rob McCoy, though he’s certainly part of the problem.

Perhaps, because “American problems demand American solutions,” we need something like a mask gun to deal with covidiots (kidding, maybe).

Equally worrisome are business owners pushing too fast to reopen, and parents wanting their kids back in school because there’s been a slight dip in the numbers. Both sentiments are understandable, and in some sense healthy in the long run. But now? How did reopening work for us in June?

In an interview this week, Dr. Fauci re-emphasized that a concerted public-health approach has to come first. “The quicker you pull together and get it down, the quicker you get back to normal,” Fauci said. “To think that you can ignore the biologic and get the economy back, it’s not going to happen. You have got to do both.”

We need to get the virus under control first. Then let’s talk about reopening.