Covid Epidemiology This Week — Worse and Worse Every Week

Dr. Tom Frieden
5 min readNov 21, 2020


By Dr. Tom Frieden

Cases are increasing exponentially in most of the US. The current epicenter is the Midwest. Diagnosed cases have been in the 150,000–200,000 range, but there are likely at least half a million new infections each day. In South and North Dakota, an estimated 1 in 11 people have Covid. This figure from the Covid Tracking Project shows key trends.

As per CDC’s CovidView weekly, test positivity, which remains one of the most important indicators of disease spread, increased from 10.8% to 11.9%. One of the analysts I follow closely is @youyanggu, who just launched a nowcasting site. He estimates that there are 3.3 infections for each diagnosed infection. In other words, the case detection rate (CDR) — the proportion of all infections diagnosed — in approximately 30%. The CDR is difficult to estimate, but it is very important, and I’ll return to this topic in the future article.

Although not all people who are estimated to have illness are infectious (maximum infectivity starts about 2 days before and continues for about 5–7 days into illness), nationally approximately 1 in 100 people, and possibly more, are infectious today. The analysis and map by Youyang Gu gives estimates.

The US has the highest rate of hospitalizations from Covid ever. Deaths are increasing. Further increases inevitable — but continued increases are not (more on this later). Excellent graphic from the folks at Covid Tracking Project. Midwest is having a crescendo. Cases in the Northeast are increasing. In the South, cases never decreased much, and now are increasing. Cases in the West are increasing

Hospitalizations are increasing steadily. Already many are stretched; it’s likely we’ll see another 30,000+ increase in coming weeks, increasing from 70,000 to 100,000. The scarcest resource: trained healthcare staff. PPE remains insufficient. Nursing home cases are increasing. And all of this will get worse. 4/10

If our plans don’t change, Thanksgiving will be the Super Bowl of super spreader events, accelerating an epidemic already out of control. Good guidance from CDC. Better a Zoom Thanksgiving than an ICU Christmas. Read my latest op ed about where we are and what we can do for the holidays. At Resolve, we created the graphic below — important to understand that degrees of separation and connection are much broader than we realize.

In President Obama’s book, he writes:

“The pandemic we’re currently living through is both a manifestation of and a mere interruption in the relentless march toward an interconnected world.”

There’s continued and very encouraging news on vaccines. But there are still many unknowns. It remains to be seen how rapidly supply will increase, how long immunity will last, whether there will be strong protection of frail elderly people such as many who are in nursing homes, and whether there will be rare safety problems identified when millions of people are vaccinated. And as distribution begins, it will need to be fast, fair, and transparent. Nursing home staff and residents should get first, and it’s encouraging that the current administration seems to be planning for this. It’s crucial that there be a smooth handoff to the incoming Biden administration — this is going to be the most complicated vaccination program in the history of the United States. Good report by the Kaiser Family Foundation, with some key findings below. States have made some progress but much more is needed, and states need money to prepare and implement. Congress must act.

A vaccine won’t be widely available for many months — so we need to have much better control for many more months. The New York Times has a GREAT graphic presentation showing that policy matters.

Here’s a sad tale of 2 states. Vermont is 6 times more densely populated than South Dakota, but has 16 times fewer cases and 10 times fewer deaths. Following science saves lives. I outlined how we can make progress using a one-two punch strategy with more nuanced closures and more effective testing and isolation.

Hong Kong and Singapore created a travel bubble. If there are more than 5 unlinked infections per day, they will stop travel. Yesterday there were approximately 500,000 unlinked infections in the US — an astounding 100,000 times more. With a new approach based on science, organized response, and honest communication, together we can make steady progress.

Masks and mask mandates work! Important report from CDC. Impressive graphics — the line graph is worth careful study. Freedom includes freedom from disease. That should not be hard to understand.

I wish you all a happy, socially connected, physically distanced Thanksgiving!

“Wear gratitude like a cloak and it will feed every corner of your life.




Dr. Tom Frieden

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