Covid Epi Weekly: Death Won’t Take a Holiday this Holiday Season

We have a divided government and a divided country, just when we most need unity to stop the pandemic. Covid is skyrocketing across the country, but some areas are being hit much harder than others. Correcting for how much testing is done, there’s a 100-fold difference between South Dakota and Vermont and 10-fold difference between the Northeast and Upper Midwest.

How bad is the increase we’re seeing? Bad. Cases are doubling, tripling, or more in many communities and states. Much of the US is in the exponential increase phase, and every day of delay costs lives. The basic 1–2 punch concept still applies. 1) Knock the virus down, minimizing societal harm, and 2) Keep it down.

First, let’s take a look at the numbers. They’re bad almost everywhere. According to the CDC, national percent positivity increased (from 7.2 to 8.2%), and increased among all age groups in all regions. Horrifying. This is a national tsunami. Hospitalizations are up 14% and deaths up 8%. Deaths follow hospitalizations by a week or two. These numbers will continue to rise.

Many thanks to Covid Exit Strategy for their great work tracking the situation in each state. I hope the site, and others, like it, will be put out of business by a competent federal response that gets us all on the same page and demonstrates that our only enemy is a virus. The more we work together, the more we can control Covid.

The increases in hospitalizations required the Covid Exit Strategy team to add a new color. The Upper Midwest is in the exponential increase phase. Here’s the key point: the per capita hospitalization rates for Covid range from 500 per million to <50/million. That’s a 10-fold difference. Policy matters! Covid can be controlled.

It’s been frustrating to see a continued focus on the wrong numbers. Detected cases are only about one fifth of total infections. A weighted ranking of test-intensity and incidence helps. As I mentioned at the beginning of this post, there’s a 100-fold difference between South Dakota and Vermont.

We’re waking up to the fact that we need to shut down. We can do this sensibly, keeping schools, childcare, universities, shopping, barber shops, and other places open — but ONLY with rigorous safety measures and modifications. We will need to reduce travel and risky indoor gatherings. Ireland’s approach is a great example.

Like oh-so-much-too-much in our society, Covid hurts the most vulnerable most. Rates of infection are vastly higher in Native American, Latinx, and Black communities. The virus doesn’t stay in any group — we’re all connected. The more safe we all are, the more safe we all will be.

Sooner or later, we’ll have to knock down the spread of the virus with strategic closures. But we need to vastly up our game in preventing household spread.

A stunning study found a very high attack rate among children in families with Covid: 77%!

Other studies have found lower rates, but the bottom line is not finding people who are infected fast and helping Covid patients relocate during maximum infectivity extends explosive spread by weeks or months. We must reduce the time from infectivity to isolation, offer paid sick leave for all, and make isolation more effective. Knocking down spread is the first punch, boxing the virus in when new infections emerge is the second punch.

We must discover more, such as how to avoid leaving infectious people at home, how to best use the tens of millions of antigen tests being sent out, and how to scale production of N95 (including safely reusable) and surgical masks.

Pandemic fatigue is understandable. We all feel it. The WHO Euro released a helpful report showing how we can help address it:

  • Understand and empathize
  • Engage communities to find solutions
  • Reduce restrictions but protect lives
  • Be transparent, consistent, predictable, and fair.

The virus isn’t giving up, and neither can we. Success is possible. It takes rigor, discipline, patience, and working together. This CDC article shows the positive impact of targeted closures and widespread use of masks.

The sooner we shut, the softer and shorter we can shut. We can minimize disruption to holiday shopping, jobs, education AND reduce major drivers of spread. To have happier holidays, we need to stay much safer for the next six weeks.

President and CEO, Resolve to Save Lives | Former CDC Director and NYC Health Commissioner | Focused on saving lives. twitter.com/drtomfrieden