On October 28, 2020, about eight months after COVID-19 brought the world to a screeching halt, the United States reported a whopping 81,000 cases in a day, and a record 500,000 coronavirus cases in a week.
After taking a moment to let the enormity of those record-breaking numbers sink in, it’s important to step back and consider what those numbers mean. After all, numbers without context are generally meaningless. On a broad scale, for the United States, posting record breaking numbers nearly a year into a pandemic means we are still nowhere near containing the virus. More than that, we’re in our third wave. And experts expect this wave will be the largest and most long lasting of any surge we’ve seen yet. But what do these numbers mean on a smaller scale—for local communities and for the upcoming cold weather and holidays—and what can we do, both on a national and local level?
Experts from COVIDEXITSTRATEGY.Org, Resolve To Save Lives, COVID Act Now, COVID19StatePolicy.Org, and the Duke-Margolis Center for Health Policy hosted a webinar recently to discuss case trends and explain the impact of mask mandates and social distancing initiatives.
I attended the webinar, and here’s what I learned …
Yes, we’re in a third wave, and no, it’s not because we’re testing more.
Two things are true. One, we’re in a third wave. According to Debbie Lai of COVID Act Now, “We’re at a level now matching COVID’s highest peaks back in July.” And also, we’re testing more. While it would be comforting to dismiss the high numbers of infections in this third surge based on the higher testing capabilities, it would also be wrong.
It’s true that more testing leads to more detected cases, but more testing has nothing to do with actual infections that exist, according to Cyrus Shahpar of Resolve to Save Lives, who also estimated that we’re detecting only about 1 in 5 people who are infected. If we tested half the amount of people, the infections would still exist, and chances are, the infections would flourish.
To better explain the concept, Shahpar used the analogy of wildfires. More smoke detectors would detect more fires, but the fires will burn regardless of the number of smoke detectors. The value of the detectors is in letting us know there’s a problem and where that problem is so we can begin to minimize the damage. In this case, COVID is the wildfire and the tests are smoke detectors.
To control COVID and minimize damage, an increased testing ability is not creating the surge. It’s letting us more adequately understand where the surge is.
Unlike in past surges, the third wave is hitting the Midwest and rural counties—places that were largely unaffected by the virus in the past.
There’s a misconception among many Americans that COVID-19 is a problem for coastal and large urban areas. Early on, that was true in that places like California and New York and the surrounding urban and suburban areas were being devastated by the virus while rural towns were largely unaffected. But it’s true no longer. Many states that were hit hard during the first waves are doing comparably better than states that weren’t hit as hard early on, according to Lai.
Midwest states that remained largely unaffected by the virus in the spring and summer are now seeing surges. South Dakota, North Dakota, Wyoming, Montana are seeing cases loads in record breaking numbers—over 500 cases per million, according to Wosinska. This puts them in the level of uncontrolled spread based on an analysis conducted by COVIDEXITSTRATEGY.org.
Rural communities are at the heart of this third surge, which is troubling, not just because forty-six million Americans live in communities that are considered rural, according to Lai, but because rural communities tend to have older populations, who are more likely to require hospitalization if infected by the virus, and who tend to have higher rates of cigarette smoking, high blood pressure, obesity, and also less access to health care.
States with the highest case numbers are not necessarily the most dramatically impacted COVID states.
When it comes to states, there’s significant variability in testing. According to Shahpar, some states are testing 5-10 times more than others. If looking at case numbers alone, it would appear that states like North Dakota and South Dakota, which have high case numbers, have more alarming spread compared to a state like Mississippi. However, Mississippi is testing significantly less than other states. When the testing rate is adjusted to account for this, it becomes clear that Mississippi is in a more precarious position than it would seem.
Test positivity rate is another metric to determine how much spread exists within a community. A positivity rate that is high probably means that testing is “inadequate in terms of ability to see how much virus spread there is,” according to Marta E. Wosinska, Ph.D, of the Duke-Margolis Center for Health Policy. This likely means, for example, that the situation in Wyoming, where the positivity rate is about 55%, as compared to Montana that has a higher case number but a positivity rate that’s at about 14%, is worse.
Mask mandates work, but we need strong national messaging.
With numbers rising and a federal government that has all but surrendered to the virus, it may feel as though we have no tools available to fight this virus. But, we do. We know that masks work.
A recent study from the Vanderbilt School of Medicine found that there are a smaller number of hospitalizations in places that pull from areas where mask mandates are in place as compared to places where no such mandate exists. John Graves, PhD, director of the center and associate professor of Health Policy at Vanderbilt, noted, “it’s very clear that areas where masking requirements have remained in place have seen much lower growth in COVID-19 hospitalizations.”
Mask mandates are also easier and more economic than social distancing mandates, which are effective, but would require at least targeted shutdowns in places with widespread transmission and where hospitals are at risk of becoming overrun.
There is a bright spot in all the grim numbers.
Watching the numbers spiral out of control and seeing the map that tracks COVID around the nation turn from green (good) to dark red (yikes) and hearing the way a measure as simple and effective as mask-wearing has become politicized, it may feel as though everything is just hopeless. It’s not. There is one bright in all the numbers—and that’s the infection growth rate.
Infection growth rate “tells us how fast COVID is spreading. The value of R(t) represents the number of people that a single infected person goes on to infect in a specific area, at a specific time.” For example, an infection growth rate of 3 means that each infected individual is infecting 3 others.
According to Lai, as of the webinar, Kansas was the only state where COVID is not actively increasing, but in the 49 other states where the growth rate is over one, it’s only slightly so. That means each person is infecting just about one other person. That’s uplifting because it means there are things we can do to keep this situation from getting worse. There’s room to fail, but there’s also room to improve.
With the holidays coming and with cold weather in the northeast forcing people indoors, more than ever it’s important to remember the 3Ws: Wear a mask, wash your hands, and watch your distance.