Good News, Bad News: Why Aren't Spiking Coronavirus Cases in Emerging Hotspots Crushing Hospitals?

Posted: Jun 23, 2020 1:05 PM

As new coronavirus cases surge across a large swath of the country, with real spikes occurring in certain states, what are we to make of what's happening? It's undoubtedly true that increased testing is leading to increasing raw numbers of people testing positive, which helps explain a significant portion of this effect. But that's not the whole story, as infection rates are also up in places like Florida (though they're roughly stable nationally). Gov. Ron DeSantis has conceded this point, which was echoed by one of the state's GOP Senators, himself a former governor. That said, there are less worrisome statistics that mitigate the serious jumps in cases we're seeing. What's going on? Let's start here:

The trend looks similar in one of the largest states in the country, whose Republican governor started opening the economy back up on May 1:

The Trump administration is also highlighting the fact that daily US coronavirus deaths fell in recent days to the lowest number since the month of March. That's welcome news, no doubt, but COVID deaths lag several weeks behind infections, so the current snapshot on that metric could deteriorate shortly down the line. These data points, however, appear to be more hopeful:

This chart and this chart also suggest that part of a brief spike in hospitalizations last week may already be abating and that the number of ICU beds filled with COVID patients have also been steadily dropping. Sure enough, even as one key county in Florida has entered "red flag" territory on cases and infection rates, hospital capacity measurements are still in 'green' territory -- via a Miami Herald journalist:

There are flare-ups that merit extra concerned attention, and public health officials will be watching overall trajectories like hawks -- and rightly so. But if new cases and infection rates are bouncing up across a number of key states, why aren't we seeing dangerous, corresponding crunches hospital systems (preventing such pressures was the original purpose of "flattening the curve")?  To be clear, hospitalizations are absolutely rising considerably in some places, and it's a worrisome metric that must be tracked carefully.  But it's not reaching overwhelming levels at this point.  This looks like a very important part of the answer to the question posed, which we touched on late last week:

"Some of trend reflects testing moving away from hospitals (where older individuals are more likely to present) and into community," adds Dr. Scott Gottlieb, the former FDA chief. In other words, the median age of infected Americans is declining significantly in these new and emerging hotspots. It's not good news that more younger Americans are contracting the virus, but it's certainly better news than older Americans doing so, because younger people are far more likely to experience zero-to-mild symptoms (see this), and are far more likely to survive the disease. Because younger people's bodies are much better equipped to recover from COVID relatively painlessly, otherwise-expected jumps in hospitalizations and (hopefully) deaths aren't materializing. On the other hand, this possible dynamic on more rampant community spread may be concerning. Also, as Gottlieb notes, where the testing is occurring (out in the community vs. inside hospitals) also impacts the overall picture of infection rates versus human damage.

These trends also suggest that governments are getting better at protecting the most vulnerable populations, such as elderly people living in nursing home-type facilities. That's also heartening news, at least for now. Higher numbers of young people becoming infected is not necessarily a disaster if they can be prevented from transmitting their mild illness to those for whom infection would be significantly more grave. This data out of Mississippi is just another reminder (along these same lines) of why taking dramatic steps to safeguard older Americans, particularly those with co-morbidities and living in long-term care facilities, is such an urgent and ongoing priority:

Incidentally, what do Florida, Texas and Arizona (and southern California, for that matter) all have in common? They're very hot places. Isn't hot weather supposed to help prevent outbreaks, you ask? Yes, but besides heat, what is also ubiquitous in hot places? An intriguing hypothesis, which aligns with previous red flags about ...air conditioning:

The hottest states, where air conditioning is in high demand and use, tend to be governed by Republicans. But California and Nevada are also on the 'wrong' side of the infection line -- Democrat-led states with high temperatures. I'd be fascinated to know what the implications of this might be, from a public health perspective. Would shutting off central air in public places, while uncomfortable, help crush upward trajectories of infections? And if the answer is "maybe yes," would negative health impacts related to people overheating be more or less severe? It currently appears as though areas of America that were relatively unscathed by the first few months of coronavirus are now experiencing their own "first waves." That's the unfortunate news. The more fortunate news is that this portion of the first wave looks to be less lethal than what New York, New Jersey, Michigan, etc. experienced, for a variety of reasons.

Leaders must keep a careful eye on patterns and data, vigilant for deteriorating conditions and trajectories. And while the Trump administration is reportedly bracing for a potential second wave in the fall, I'll leave you with a much better case scenario that may be likelier than ever -- via a military official who is helping to lead Operation Warp Speed: