Editor's Note: This is a complimentary research note published by Director of Research Daryl Jones on June 30th. CLICK HERE to get COVID-19 analysis and alerts from our research team and access our related webcasts.
“The greatest shortcoming of the human race is our inability to understand the exponential function.”
- Albert Allen Bartlett
- We are going to spend a bit more on the U.S. today as it really has become the most relevant “story” over the last week
- In aggregate in the U.S. there have been 2.7MM+ COVID-19 cases identified on ~33MM tests (8% positive test rate). Just over 129K Americans have been identified as dying from COVID-19 cases (obviously many had other serious health problems)
- Daily new cases in the U.S. have approximately doubled in the past two weeks, which, of course, roughly coincides (lagging by a few weeks) with the end of Stay-At-Home orders and the re-opening of the economy. There are also many local and geographic factors at play, though tougher to quantify
- Globally, daily new cases continue to make new highs largely driven by the U.S. and emerging markets. We have not seen much of a change in either Europe or developed Asia and both appear to have the pandemic largely under control
- China continues to react swiftly to any perceived out-break and yesterday shutdown a province just outside of Beijing due to a small break out (effectively locking down ~500,000 people)
U.S. Situation (focus for today)
We’ve been tracking the state-by-state R0 very closely. With the advent of stay-at-home orders and a massive reduction in mobility (along with social distancing and mask use), there were at one point only 4 States with a R0 over 1. There are now 36 States with a R0 over 1.
- R0, R Naught, is the transmission rate of a virus. Over 1 means, simplistically, that the virus is spreading and not dying out.
The States with the current highest R0 are as follows:
- Nevada – Current R1.64. Shelter ended on May 9th with a R0.91 and by May 18th was at R1.11
- Montana – Current R1.41. Shelter ended on April 27th with a R0.87 and by May 3rd was at R1.00.
- Florida – Current R1.40. Shelter ended on May 4th with a R0.96 and by May 11th was at 1.06
- Hawaii – Current R1.35. Reopening began May 7th with a 1.02 and by May 15th was at 1.22
- Idaho – Current 1.34. Shelter ended on April 30th with a R0.99 and by May 7th was at 1.03
The general theme with these states, and really most states currently with a R0 over 1, is that when mobility was extremely limited, the transmission rate (RO below 1) was completely crushed and then when mobility increased (stay-at-home orders lifted or the re-openings occurring) the R0 very quickly increased to over 1.
There are also of course many local factors at play like timing of opening bars and restaurants, work sites (meat packing plants, farm workers), larger gatherings such as protests, religious gatherings, rallies, and so on
In some ways, it may be more instructive for us to consider the states that still very much have COVID-19 transmission under control:
- The first point that jumps out of course is most of these states are in the Northeast or on the I-95 corridor down to Virginia. In effect, the states that were initially hit the worst and opened the latest. The vast majority of these states opened in late May and are still in early phases of opening.
- These states tend to be more Democratic, but obviously so, too, do the likes of California which is seeing a resurgence.
- If we narrow down this list further to exclude states in the Northeast and/or those States that opened later (Illinois) we are naturally left with more rural states → Alaska, Indiana, Nebraska, and North Dakota. States with low population density and that largely weren’t initially impacted by COVID-19.
Testing for COVID-19 has increased steadily in the U.S., so no doubt increased testing is naturally uncovering cases that are less symptomatic.
Conversely, we are also seeing the positive test rate steadily increase in the U.S. in conjunction with the rapid growth in new cases. The chart below looks at the growth of tests and gradual increase in the positive test rate.
- This trend of more tests AND higher positive test rates started in roughly mid-June coincident, of course, with positive cases accelerating.
In the chart below, we look at daily new cases over the past 6 weeks or so. As you can see graphically, the week-over-week growth rate is accelerating meaningfully. While certainly more testing is at play, the key factor is increased community spread.
- We’ve tended to stay away from projections, but absent a serious reduction in mobility and interactions nationally it seems likely that cases continue to accelerate. On this trend, 100,000 daily new cases is certainly in play by end of July.
Certainly, more cases are not apocalyptic if hospitals aren’t stressed and morbidity rates aren’t increasing. On the first point of hospitalizations, the data is weak at best. Below we’ve taken a look at the five states with the largest recent case increases to get a sense for hospital level stress:
- 45% of ventilators are in use, which is up from 33% on June 1
- 86% of hospital ICU beds are in use, which is up from 75% of June 1
- Governor Ducey said yesterday that Arizona could hit “surge capacity” soon
The chart below shows current patients in ICU units at the Texas Medical Center.
The chart below shows daily new hospitalizations. Obviously, there are also people being discharged, but the overall hospitalization rate continues to increase.
The State of Florida does not have overall COVID-19 admissions data, but Miami-Dade has been reporting daily admission as outlined in the chart below.
On the positive, would note that there appears to be meaningful ventilator and ICU capacity in Miami-Dade and also high daily discharges of patients.
The charts below look at California hospitalizations and percent of patients in ICU. Obviously hospitalizations are increasing at high rate, but on the positive the ICU rate is much lower than in April. This likely suggests that the age of cases is skewing lower (similar to Florida).
Hospitalizations are up for 9 straight days and currently there are more than 400 patients in Nevada hospitals, a new high.
In aggregate, the positive so far in this resurgence of COVID-19 is that deaths, and therefore the death rate, has not gone up. This is likely attributable to a few things: 1) new infections skewing younger, 2) more testing uncovering asymptomatic infections, and 3) a better understanding of how to treat the patient population.
- Caveat is that deaths are a lagging indicator, but so far we are looking much better on this front.
The chart below looks at daily deaths and morbidity rate over time, which have been steadily declining.