This is a complimentary research note by Healthcare analyst Tom Tobin and Healthcare Policy analyst Emily Evans on March 18th. CLICK HERE to get daily COVID-19 analysis and alerts from our research team and access our related webcasts.
As Hedgeye DOR, Daryl Jones, has noted in his regular global update on COVID-19, US data has been a little difficult. Testing did not ramp until last week and what data is collected is not being reliably and regularly reported by the CDC as is the case with other flu data.
Complete understanding of regional and local impacts, a pre-requisite for analyzing implications to the health system has been difficult. Being homebound has a few benefits and one of those is extra hours to pour through state and local health department data. That extra time has allowed us to construct a time series of cases in major Metro areas.
The data has a few limitations:
- We are tracking data through the previous day. Things are moving too fast intra-day to update on a same day basis. Like you, we hope that changes very soon.
- We have noticed cases are always being re-classified by county as more information becomes known about each patient. So, numbers may shift in unexpected ways from day to day
- Some jurisdictions are not reporting as quickly as others. Again, this makes the data jump around a bit
- Testing has been bumpy which contributes to uneven daily counts
Of the roughly 6,500 cases through Tuesday night, 3,200 are located in one of seven Metro areas. Hardest hit are New York-Newark, San Jose-San Francisco and Seattle-Tacoma which account for 40% of confirmed cases
The case counts reflect early and multiple introductions of COVID-19 into the community. Trevor Bedford, a computation biologist at Fred Hutch, has published sequencing data that suggest the introduction of the disease in Washington began in mid-January and likely involved at least four vectors.
Other Metros with significant infection include Boston-Worcester, Atlanta-Athens and Los Angeles-Long Beach.
Although it still has a dearth of tests, we have added Chicago to the tracker today and expect it to take a larger share of the growth in case load.
Boston’s unusual curve can be attributed to the identification of 108 cases from the Biogen Conference.
The growth in cases until within the last week also reflects the absence of mitigation strategies, like constraints on public gatherings and events. That changed late last week and throughout the weekend. However, the case count is expected to grow over the next week and a half as transmissions prior to mitigation measures show themselves.
The value of looking at case load in Metro areas is that health care demand and supply are delivered at that level. If the health care delivery system is overrun (we disagree that impact will be widespread or uniform - more on that later) as many predict it is likely to happen first in the three Metro areas currently ahead of the curve. We are watching carefully the tactical responses in these three hard hit communities and will update and augment the data regularly.
As bleak as the data may be, we see some signs that extreme mitigation strategies are working. Today was the first day of updating the tracker data that I did not add a new reporting jurisdiction to Washington State's data. I only added one to California's. Health department orders limiting gatherings and public awareness would show itself first in the transmission of the disease from an affected county to one that is not. At least for now, there seems to be less proliferation across these two states than there was a week ago.
On a rate of change basis, Boston offers some hope as well. Most of their cases are attributed to the Biogen conference, as I noted. However, they appear, the data suggests, finding some success managing the rate of growth.
Lastly and off topic, I know many of you reading this have never encountered in your personal or professional lives days quite like the last week. I have had the pleasure of enduring 1987, 2000-01, 2008 and now 2020 and what I know is this: our industry and the people in it are resilient in ways you can only imagine. It won't be fun and it won't be easy but we are all going to come out the other side, smarter, tougher and hopefully, better looking. Thank you for supporting our work and do not hestiate to sign up for more information and updates HERE.