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100 Days Into COVID-19, Where Do We Stand?

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May 7, 2020 -- The United States saw its first confirmed case of COVID-19 on Jan. 20. By the end of February, we had our first American death. We’ve now passed the 100-day mark, and the numbers are alarming, with 1.2 million confirmed cases here. More than 70,000 people have died here. And because testing has been limited, experts say those numbers are really much larger. So obviously, it’s bad. But is it getting better?

“We’re not doing well at all,” says Jeffrey Shaman, PhD, a professor of environmental health sciences at Columbia University Mailman School of Public Health, who has led work to model national projections. “We had our first confirmed case the same day as South Korea. We have six times as many people, but 100 times as many cases.”

Even though some states have been relaxing social distancing restrictions, not one has met federal guidelines for being able to do say, says Caitlin Rivers, PhD, a researcher from the Johns Hopkins Center for Health Security who testified before the House Appropriations Subcommittee on Wednesday.

Here’s the latest. As Shaman said, it’s not good:

  • The United States has one-third of the confirmed cases worldwide, but we’re less than 5% of the world’s population. And we’re adding new cases at a faster daily rate than most other places on Earth.
  • Death projections vary, depending on which assumptions researchers make about social distancing and other factors, but most show us at around 100,000 COVID-19-related fatalities by the end of May.
  • The curve is flattening, but slowly. And if you take New York, the hardest-hit part of the country, out of the equation, it’s not flattening at all.
  • Some areas, like New York, Seattle, and New Orleans, seem to be past the worst of the outbreak.
  • Don’t expect life to get back to “normal” any time soon. Without firm federal guidance and a national testing policy, outbreaks will continue to pop up.

The Latest Projections

The Institute for Health Metrics and Evaluation (IHME) at the University of Washington has been making and updating projections based on the latest available data as well as the effects of efforts to ease the pandemic, like social distancing. They now project we could have more than 134,000 total COVID deaths by early August. That number nearly doubled in less than a week, due to the way some states are relaxing their restrictions.

The statistics-focused website FiveThirtyEight tracks five models (including IHME’s), each of which makes different assumptions about social distancing behavior and the way the virus will behave. Those models show anywhere from 93,000 to 111,000 total deaths by May 30.

President Donald Trump said recently that as many as 100,000 Americans could die, twice as many as he’d predicted previously. But a preliminary interagency report from the departments of Homeland Security and Health and Human Services offered a much bleaker assessment, saying we could have 3,000 deaths and 200,000 new confirmed cases every day by early June.

“It’s important to realize that the administration’s model was from Johns Hopkins and was not a full model and not intended to be a forecast,” says Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security.

Are We Flattening the Curve?

That curve refers to new cases, not the number of deaths. It’s about making sure our health care systems don’t get overwhelmed.

“We’re on a very slow decline on a national scale, and it’s highly variable from state to state. Some places are still growing, some are flat, some are in decline,” says Shaman. “But you want to quash it, not flatten it -- you’d like to see a sharp decline.” That gives hospitals some breathing room, in case the numbers spike back up after restrictions are lifted.

Adalja agrees. “The purpose of flattening is to keep the peak below hospital capacity,” he says. “It’s not about the number of deaths. And for that, I do think we’re in a better place than we were in March.” So even though the number of cases is still increasing in some areas, most experts aren’t worried about hospital capacity.

This flattening doesn’t mean we’re ready to start reopening the country, both men say.

“It’s a fact that when you lift social distancing, you’re going to see an increased number of cases,” says Adalja. “Hopefully we’ll find that states like Georgia aren’t inundated with cases, putting their hospitals back into crisis mode.”

Adalja points out that the outbreak hasn’t been uniform. Some areas, like New York, Seattle, and New Orleans, are on the other side of substantial outbreaks already, while elsewhere, new cases have come in a trickle. Smaller Midwestern cities and towns, particularly those connected to the meat processing industry or prisons, are now having full-blown outbreaks.

Most rural areas have had fewer cases, in part because they’re naturally socially distanced. But even there, some places are worse than others. The rural southwest corner of Georgia has some of the highest per-capita COVID-19 death rates in the country, for example, due to high levels of poverty, less access to health care, and an older, more vulnerable population.

“It’s not that rural areas won’t be impacted, it’s that they’ve had a lot of time to prepare,” Adalja says. “But sometimes rural hospitals don’t have access to specialists, they don’t have many ICU beds. Hopefully, they’ve taken this time to think about what they’re going to do.”

The fact that a huge metropolitan area like New York was hard-hit so early means that as that region’s numbers decline, it obscures what’s happening in the rest of the country.

“If you include New York, it looks like a plateau moving down,” Andrew Noymer, an associate professor of public health at the University of California, Irvine, toldTheNew York Times. “If you exclude New York, it’s a plateau slowly moving up.”

Compared to the World

The United States alone accounts for roughly a third of the world’s confirmed cases, though we’re less than 5% of the world’s population. And the data shows that we’re still adding confirmed cases at a faster rate than other countries.

“We have plenty of examples of countries doing a lot better than we are. Iceland, New Zealand, Taiwan, Australia, Japan. South Korea is the shining example,” says Shaman. “We’re doing pretty poorly.”

One thing those successful countries have in common: They acted quickly to contain their outbreaks. “We had a very late start, with 2 months where nothing really was done other than travel bans and quarantining of travelers, even while the virus was spreading,” says Adalja. “The main theme of this pandemic in the U.S. has been us playing catch-up.”

Without a national testing strategy and firm federal guidelines on social distancing, we’re unlikely to get ahead of the virus, both men say. “We still haven’t implemented the kinds of logistical support that’s needed to effectively control this while we wait for a vaccine or therapeutic treatment to come out,” says Shaman. Among his recommendations: Lots more testing, an army of people to conduct contact tracing, rules that allow local jurisdictions to compel people to be quarantined, and the resources to make quarantine realistic and safe.

100 Days From Now

If you’re hoping life will be back to normal by mid-August, we have disappointing news. While some restrictions might be eased, we’ll still be dealing with coronavirus outbreaks.

“The virus isn’t going away. It hasn’t infected enough people for herd immunity, and we still don’t know if it can infect people multiple times,” says Shaman. “We have to find a new kind of normal that allows us to function as a society and keep people safe and able to feed themselves, pay rent, educate their kids.”

In terms of dealing with the virus, Adalja sees room for optimism. “I would think we’ll be in a better place with diagnostic testing, and we’ll have more data on whether antivirals work,” he says. “The danger is that some individuals will take this as an acceptable risk and adjust their behavior.”

Soon after the next 100 days, the seasons will change. And autumn ushers in flu season. “We’ll have to be preparing to deal with this virus at the same time as influenza, so we’ll be worrying again about hospital capacity,” Adalja says. As social distancing measures ease, we’re sure to have more outbreaks. “Hopefully, now we’re in a position to reset and start over. We’ve gotten hospital capacities increased, we’ve got testing ability, we’ve got our health departments ready. It came at a cost of tens of thousands of deaths and countless illnesses, but we’re now poised to take on coronavirus the way we should have in January.”

WebMD Health News Reviewed by Arefa Cassoobhoy, MD, MPH on May 07, 2020

Sources

Johns Hopkins University: “COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE),” “Cumulative Cases By Days Since 50th Confirmed Case.”

The New York Times: “U.S. Coronavirus Death Toll Is Far Higher Than Reported, C.D.C. Data Suggests,” “Trump Foresees Virus Death Toll as High as 100,000 in the United States,” “Coronavirus in the U.S.: An Unrelenting Crush of Cases and Deaths.”

Jeffrey Shaman, PhD, professor, environmental health sciences, and director, climate and health program, Columbia University Mailman School of Public Health.

Institute for Health Metrics and Evaluation: “COVID-19: What’s New for May 4, 2020.”

CNBC: “Coronavirus deaths projected to hit 3,000 per day by June, internal Trump administration analysis says.”

FiveThirtyEight: “Where The Latest COVID-19 Models Think We're Headed -- And Why They Disagree.”

Amesh A. Adalja, MD, senior scholar, Johns Hopkins Center for Health Security.

NPR: “Fact Check: Trump Administration Document And Its 3,000 Deaths A Day Scenario.”

AP News: “Coronavirus cuts ‘deep scars’ through meatpacking cities,” “'It's gone haywire': When COVID-19 arrived in rural America”

Business Insider: “Researcher testifies to Congress that not a single state meets Johns Hopkins Center for Health Security criteria to reopen safely.”

White House: “Opening Up America Again.”

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