US COVID Update - Sharp increase in cases but deaths continue to trend down.

First, I will be visiting family (and making sauerkraut) over the July 4th weekend. I'll be mostly offline from Wednesday night until probably the next Monday. I will be keeping up with the data as well as I can.

Now, to the data. Despite a very sharp increase in new cases the 7 day MA in new deaths is still trending down at the previous rate and is now as low as it has been since March 31 at 3650 or about 525/day. This is important to note for several reasons. Remember that increasing new cases in Mar through mid-Apr were followed rather quickly by increased hospital admits and ICU/ventilator admits and then by deaths. Also, there were predictions in late May that we would have 3000 new deaths per day by the end of June. Well, here we are at the end of June.

The first thing to note is that the increase in new cases has not really mimicked the increase in new tests. While it is true that new tests have increased by 65% or so since June 1 and new cases have doubled in that same span, that is an artefact of the 'base' or beginning numbers. Tests have grown in June from a 7 day MA of 400K to 650K (almost 700K yesterday) while new cases grew from 21K to 41K. IOW with 250K more new tests we found only 20K more new cases (per day for each) than when we were testing 400K new tests. That is a 65% increase in new tests. That is reflected in the fact that the % of new cases found in testing grew from 4.4% to now 6.8% (although it topped 7% briefly). That is new cases as % of tests increased by about 55% (or 65% at the just over 7% rate attained briefly). Roughly speaking, over the span of the month of June new tests and new cases increased at the same rate. Most of the “surge” can be accounted for by the increasing number of new tests. (With some caveats noted later.)

The second thing to note is that overall the rate of hospitalizations is pretty flat (except in some cases I'll discuss later) and hospitals are taking in patients who they would have sent home two months ago. Likewise ICU admits are flat and ventilator cases generally down while except in a few cases (discussed later). This all ties in with new deaths down.

The third thing to note is that hospitalizations/ICU/ventilator/deaths are a lagging indicator and if the new cases were that serious all 4 should be trending up from around June 5-12/8-15/8-15/10-17 for those 4 things. That is the median time for the appearance of symptoms, admit to any type of hospitalizations, and death from the discovery of the new cases. That is simply not happening. If it's not happening now, 4 weeks after the “surge” started, when can we expect it, and why? We really should be seeing at least a slight uptick in deaths no later than June 20 and probably should have seen it begin by June 15 IF the virus was following the same path as in March through mid-April. Instead new deaths have continued to decline in the same linear fashion since it began in late April.

The fourth to note then is really a question: But what about those localized “surges” in some areas? I've discussed before the examples of the counties that border Mexico. In every case I looked at the surge could be explained by people legally crossing the border from Mexico seeking testing and/or treatment. That alone accounts for about 20% of the surge in new cases. Then, whether or not the media reports it, much of the surges in CA, TX, and FL is in large cities with a lot of protests, and the surges began right on schedule about 5-14 days after lots of people began marching close together and yelling a lot. I tested this by looking for largish cities in those states that didn't have large protests and then checking their new cases by the county the city is in (not a perfect surrogate but I think adequate). For instance, Miami had big protests almost every day and lots of new cases. Jacksonville had smaller weekend marches (I couldn't find any after June 13) and many fewer new cases. Same for Houston and Austin compared to various not very many protesters middle-sized cities. LA and other CA cities were the same. So many, maybe as much as 40% of new cases sure seem to correlate to big marches in big cities. The surges in northern cities also follows the pattern of increases coming in predictable time frames following protests. In NYC the contact tracers are not allowed to ask those who test positive if they were at a protest although that is recorded if it is volunteered.

Finally, what about young (<40) people and bars/restaurants/clubs/beaches, etc. That surely had an effect, but many of those people are also getting tested on the job as well. Still, if you told me that most of the remaining 40% of any surge was young people in those circumstances I'd be hard-pressed to argue the point.

I have pointed out before that shutting down the economy and keeping sheltering in place only delays, not stops infections and deaths. We won't get that until/unless we have herd immunity or a really working vaccine. So any opening at all is/was bound to lead to an increase in cases and should have led to an increase in deaths, but the deaths haven't happened. Why not?

There seem to be several factors. One is that by massively increasing testing. We have really massively increased finding those who are asymptomatic or have mild cases and few of them are likely to die of COVID. Another is that a solid majority of the new cases overall are of the least vulnerable population. It may be that the vulnerable have learned how to take steps to avoid infection reasonably well. Still another is the CDC's belief that at least 10 times as many (and maybe 50 times as many) have caught the virus as previously believed. That would mean that lots of the connections that lead to infections has been broken. Yet another is that it may be that the virus doesn't spread as easily as we thought. Casual contact doesn't appear now to be all that dangerous. It may also be that we need fewer to have had the virus to get to herd immunity, The CDC now thinks that 40% rather than 65-70% may be enough. And just getting out into the sun and getting some Vitamin D may be helping people fight it off.

And except in localized cases the hospitals aren't hitting capacity for ICU or ventilators yet. Even in Houston, only one hospital is near capacity, and it has the ability to almost triple its ICU/ventilator capacity if needed.

At any rate, unless the new deaths show a really big increase in the next week it is hard for me to believe that mere new cases mean much. Common colds can lead to death, but we don't obsessively count new cases of common colds. We are seeing twice as many new cases per day as we did only a month ago and yet deaths are still falling. Think about that.