July 23 covid-19 update

The U.S. has now had more than 4 million people test positive for the novel coronavirus (SARS-CoV-2) and will likely reach 150,000 deaths from covid-19 in the coming week. South Africa has more than doubled its cases and deaths in the past 3 weeks; cases have doubled in just 18 days, to nearly 350,000. There is some good news from Western Cape, where the number of active cases has been declining for the last couple weeks, meaning that the epidemic has reached a turning point, at least for now. South Africa now ranks 5th in the world in terms of cumulative cases, and the U.S. still leads the world in cases and deaths.

Daily death counts are still not as high in the U.S. as I would have expected, given the surge in cases over the past month or so, but for the last 3 days there have been around 1,000 deaths per day. As I've said before, the fact that we're still at 1,000 deaths a day rather than 2,000 deaths per day in the U.S. is likely due to better treatment outcomes and lower average age of those infected. Still, I don't see much reason for optimism regarding the U.S. epidemic. We are not decreasing the case or death count, and a thousand deaths a day is still a massive death toll for an entirely preventable disease.

Here are some interesting visualizations from worldometers.info showing 7-day averages, which smooths out the "noise" in the daily counts. (If you've been following for a while, you know that I use data from University of Virginia rather than worldometers.info to produce my graphs as I have a bit more confidence in its day-to-day accuracy - but there is not much difference in the numbers from the two sites and I think these visualizations from worldometers.info are accurate.) The interesting thing to me in these graphs is that the 7-day average of cases reaches its lowest point and then starts climbing almost exactly 4 weeks before deaths start climbing (the dates are June 9 and July 5, if you're curious) - BUT so far deaths per day don't seem to be climbing nearly as steeply as cases. So there's a bit of good news there.

The reason for cases climbing more steeply than deaths is not because the U.S. is doing such a stupendous job of testing, despite what certain ill-informed political leaders are saying. We are seeing the percent of tests that are positive continue to climb, which means that testing is not keeping up with new cases. Take a look at the graph below, which is from covidtracking.com. If we were testing enough, the blue line would be staying flat and the percent positive would be staying low. We are not testing enough. Furthermore, I keep hearing horror stories about how long it takes to get results. A family member in Texas recently paid $100 out of his own pocket to get tested when he wasn't feeling well, and then waited FIFTEEN DAYS to get results. I know testing isn't this bad everywhere, but the point is it's completely unacceptable for it to be this bad anywhere. The U.S. government is now debating a massive spending package to address testing. (Just now. Five months into the pandemic. I find the lack of leadership and political will mind-boggling.)

Now let's talk about South Africa, which during this pandemic has a national testing strategy, and I would argue much better leadership than the U.S. at the national level. Daily cases seem to have peaked a few days ago, perhaps drive by declines in Western Cape. (And let's hope it's not just a little blip in the data, before cases keep climbing.) Deaths likely won't peak for a few weeks. Don't be too alarmed by the count of almost 600 deaths today - I'm sure it just has to do with data reporting and does not mean there was a sudden surge in deaths today. But do expect that unfortunately there's no near end in sight for the wave of covid-19 deaths.

Brazil is another country I've been watching, as it's now second in the world in terms of cases and deaths and has been registering around 1,000 deaths per day for almost 2 months, with no sign of the pandemic slowing. This is a tragic but unsurprising outcome of disastrous leadership: President Bolsonaro laughed off the virus for months, waded into crowds without a mask, refused to enforce quarantine or other infection control measures, and has ousted not one but two Health Ministers since April. Now Bolsonaro has tested positive (and is finally wearing a mask). These pictures of mass graves and grieving families in Brazil are heart-wrenching, and as everywhere in the world, it's crystal clear that the virus it taking the cruelest toll on the poor and people of color. The title of this New Yorker piece, How Jair Bolsonaro and the Coronavirus Put Brazil's Systemic Racism on Display, says it all, but it's worth reading for the excellent reporting and horrific evidence presented. I'm sharing the article in part because much of the argument about systemic racism and disease applies equally to the U.S. and South Africa. I also think Brazil is an interesting counterpoint to South Africa because they are both upper middle income countries with high amounts of poverty and inequality, so similar challenges and resource constraints.

Leadership matters. South African friends, I know some of you probably have concerns about your government's leadership during this pandemic, and you all have had to live under onerous restrictions and make big sacrifices. I'm sure many of you are dismayed by the news that most learners are being sent home from school for another month. But as I read about Brazil I can' t help but be very, very grateful that South Africa has a president like Ramaphosa rather than one like Bolsonaro. I am grateful that Ramaphosa is taking the threat seriously and acting decisively, even if he may not be steering a perfect course through a minefield of hard decisions and devastating outcomes whatever choice is made.

Before I close, some further comments on schools. Recent research from South Korea found that children under 10 were at much lower risk of acquiring and transmitting the virus, but children 10-19 did not have this benefit. I know this is good news for some parents and teachers, and not for others. This New York Times article quotes Michael Osterholm, a veteran infectious disease epidemiologist who is one of the greatest experts we have. I'm currently reading his book, written several years ago, in which he basically predicts the current pandemic. At any rate, I find him to be a voice of reason regarding the fact that this pandemic will be with us until we get a vaccine, but we need to do our best to live with the virus with a minimum of sickness and death. He says about kids returning to school, “There will be transmission. What we have to do is accept that now and include that in our plans.”