The COVID "Spike" Raises Alarm

A resurgence in the COVID 19 cases in the country has spooked health officials, the stock markets, restarted businesses and hospitals, triggering a knee-jerk reaction to put the struggling economy on a ventilator.  However, no one should be unsurprised by the the uptick with the ramp up in testing.

On March 25, the U.S. had conducted a cumulative total of 492,918 tests since the first test on February 28.  According to the latest data from The COVID Tracking Project the number of tests have soared to 23,984,592.  The average daily tests administered during the period rose 4,889%.

At the current daily run rate of 286,483 the country would test an additional 56.7 million Americans during the remainder of the year, raising the cumulative total to 80.6 million out of a total population of 326.7 million people.  No doubt the number of cases will climb right along with the tests.

The same politicians who were braying for more testing surely knew it was inevitable there would be a spike in cases.  This is particularly evident because the majority of testing has been done in vulnerable communities, such as prisons, nursing homes and businesses with large workforces.

Of the millions of tests, 9.6% of people are testing positive, which means the vast majority, 90.4%, have negative results.  And not all states are created equal when it comes testing results.  New York, the epicenter of the pandemic, and Texas represent dramatic extremes.

In New York state, 13% of those tested have positive results.  That means 1.9% of the state's population has tested positive. The state's fatality rate, based on the number of reported cases, is 6.4%.  A large portion of those deaths were patients in nursing homes and extended care facilities.

By comparison, less than one percent (0.67%) of Texans have tested positive for COVID.  Texas' death rate is 2.23% of reported cases.   New York, with 10 million fewer residents, has recorded more than 20% of the nation's fatalities, while Texas represents 1.7% of the national death total of 116,140.

Considerations for reopening businesses in the two states are undeniably different based on the data.  That is why it is best for the country that each state weigh the risks and set its own guidelines for reviving the economy and allowing people to return to their jobs. There should no single standard.

While acknowledging the surge in testing has spawned a hike in cases, it is illuminating to point out how the Centers for Disease Control (CDC) reports confirmed cases.  There are two methods of testing used.  One is what's known as a viral test, which measures for a current COVID infection.

The second method is an antibody test, which evaluates if you have had a previous COVID infection.  The CDC scientists admit being flummoxed about what it means for immunity.  They don't know if  having the antibodies will prevent someone from contracting the disease again. 

The issue to consider is that those with previous infections are counted in the confirmed cases total, even though they have no symptoms and are disease free.  This inflates the number of cases but obfuscates the actual number of people with current infections who may require hospitalization.

On that point, despite the rise in confirmed cases, the CDC reported on June 16 that the overall visits to hospitals and urgent care facilities have remained stable "a low levels" for eight weeks in a row.  The current hospitalization rate is 89.3 patients per 100,000 infected people.

Of course, this is national data and the hospitalization rate varies by state.  But the highest rates are for people 65 years and older: 273.8 per 100,000.  This means the virus has not changed its profile since the outbreak began, impacting mostly those 65-years and older.

The CDC data exposes another fact about the expanded testing: there has been a jump in the number of healthy 18-49 year olds testing positive.  In the earliest stages, this age group accounted for less than 5% of the cases weekly.  Now these Americans account for nearly half of all new cases.

Updated figures from the CDC confirm those aged 18-44 now account for 41% of the total confirmed cases. (Editor's Note:  Different age brackets are used by the CDC in reporting data.  It is confusing, but nonetheless, accounts for this reference {18-44} being different than one cited above {18-49}.)

This represents a dramatic shift.  In the earliest stages before widespread testing, most people visiting hospitals and emergency rooms were experiencing symptoms.  They were overwhelmingly the elderly, aged 55 and above, many with underlying health issues.  It taxed hospital facilities.

Now that has changed. There is no reliable data on how many people tested are asymptomatic, meaning they show no signs of COVID symptoms.  If you can believe China's epidemiologists, testing in their country finds 80% of positive cases are asymptomatic.

Assuming those figures are accurate, that would mean of the 2,103,549 confirmed U.S. cases, the overwhelming majority of people, 1,682,839 were tested and found having an infection, despite showing no signs of the influenza like illness.

While no data exists, there is anecdotal evidence this phenomenon may be playing out in the U.S.  Recently, 22 young, healthy Clemson (S.C.) football players showed up on campus for the start of workouts. As with all returning athletes, they were tested and found to have COVID.

What we may surmise is that while the number of cases are climbing, the least vulnerable group, younger people, account for the sharpest increase.  This does not mean there is no concern because the young can infect those at most risk.  But it decreases the likelihood of upward trend in deaths.

Health officials concerned about the surge in COVID cases should be directing their public education at younger people, aged 18-49.  Instead one official wrote the "public a large" was "letting their guard down."  Most Americans are following the guidelines and deserve applause not a reprimand. 

Even as cases grow, the CDC reports seven weeks of a declining percentage of deaths from COVID. On June 15, there were 402 deaths attributed to COVID.  That data point may not be cause for celebration, but it is a far cry from he 16,153 fatalities recorded on April 18, the deadliest day.

One fact remains constant as the weekly deaths continue to fall.  Those 55 and older make up the majority.  On April 18, 93% of those who died were in that age bracket.  Months later on June 15, nearly the same number (91%) were counted among the fatalities. The median fatality age is 80.

By comparison, those aged under 45 years make up less than 5% of the country's COVID deaths. A recent study by Stanford medical professor John Ioannidis discovered that for "most" people under the age of 65, the risk of dying from COVID isn't much higher than "driving in a car to work".

To add more perspective, researchers at the think-tank Foundation for Research on Equal Opportunity uncovered data that 42% of all COVID deaths in the U.S. have occurred in nursing and residential care facilities.  An estimated 2.1 million Americans are housed in these institutions.

Researchers based their finding on data from 39 states.  In at least 22 states, more than half the reported COVID fatalities were patients in nursing homes and other long term care facilities.  Only recently, the CDC has begun requiring states to report nursing home deaths. Before it was voluntary.

Extrapolating the data to the country, it would mean that of the 116,140 deaths 46,456 were patients who were infected in nursing home and long term care facilities.  And many health experts believe those figures are likely understated because of inconsistent state reporting protocols. 

In particular, older adults with underlying respiratory and cardiovascular conditions are at the greatest risk.  Data from the United Kingdom found 95% of the people who died had at least one underlying condition.  Public health officials in Italy reported 96% of deaths involved one chronic condition.

The data is unambiguous.  The elderly are the population that needs priority protection.  Younger patients, particularly those with no symptoms, will surely not require urgent care or swamp hospitals.  The biggest threat is these young people will unwittingly infect the most vulnerable. 

Scientists are still at odds over whether we are seeing a "second waves" of COVID cases or whether this is more likely part of the "original or first wave."  Influenza pandemics have historically struck in distinctive wave patterns with a second wave coming six months after the infections subside.

However, there are no guarantees this current pandemic virus will behave in the same manner.

That argues for no relaxing of vigilance and safety measures for the general public. At the same time, states and local governments need to continue to allocate more protective equipment to nursing homes and long term care facilities, while frequently testing the workers who serve the patients.

Protecting the elderly will assure America can safely reopen.  But young people also need to heed the guidelines.  Even as cases rise, America cannot afford to remain in lockdown mode for any longer without harming the lives and livelihoods of millions of its citizens.