The Next Surge

Think of vaccines and various non-pharmaceutical interventions as surge protectors that protect healthcare as well as economic and political stability. Unfortunately, many Americans seem to disregard these measures and overload the system, putting all of us at risk.

People have asked me why I think October will see another climb in cases. The main reasons are due to the final pushes toward summer travel (especially Labor Day weekend) and the opening of schools. In addition, as fall settles in, people tend to be indoors together much more. Lower humidity will also drive more airborne spread as opposed to droplet spread of the virus. The big piece though is that a number of people seem to live under the false notion that this is done.

I had to go into a big box hardware store this week. I generally have done everything curbside but needed a key made. I had my N95 mask on when I went in, but was dismayed at how few people were wearing masks or just had them on around their necks (employees). I’ve heard similar stories about the behavior of the public from others I know. That behavior will contribute as well, whether it’s due to the discounting of the reality of the pandemic or pandemic fatigue among those who do understand the facts.

While some may think that we should be in much better shape this year compared to last year, I don’t think that is the case at all. While vaccines certainly help reduce the spread and severity, we simply do not have enough people vaccinated in this country to make that effect work for the population as a whole.

The other piece is that we were dealing with alpha last year, this year we are dealing with delta, which has a much higher transmission rate.

I think a year over year comparison is worth making, since many of the societal forces that drive transmission show up in these numbers.

First, look at cases each year. There is some concordance between the peaks. It’s a bit harder to know if there are similar factors driving the ones in early spring since that is when SARS-CoV-2 first emerged in the US. That is why I’m relying on my rationale I’ve already described.

The other thing I’ve puzzled over is the cause of the delay during the summer this year. I’m beginning to think that is a result of an incomplete sample of cases in many states. Some simply aren’t testing children as much as they had last year. That’s a complete disservice to the public because it delays the implementation of public health interventions, much in the same way that Florida only provides data once per week. That’s part of the reason why I waited to write this today instead of earlier this week. It wouldn’t have painted a very accurate picture with an entire state excluded.

There are a couple of other important things to note when comparing cases year to year. First, look at how the peaks more than doubled that of last year and that the baseline valleys are much higher. Those baselines are very important when it comes to exponential spread of a disease. That’s a big part of why influenza was so minimal last year. High influenza vaccination rates combined with mask use and other non-pharmaceutical interventions prevented influenza from gaining a foothold.

It’s also important to think about positivity rates in relation to cases every time that cases are assessed. It helps answer the question of whether the prevalence in a community is truly rising or falling or if it is just an artifact of more or less testing. This data is easy to find for every state from Johns Hopkins.

You can see in both graphs that the recent rate of the downward trend in case number and positivity is slowing. That is part of the reason that I have used a three-week slope to assess the rate of change in case increases or decreases. Oddly enough, this graph had the current slope well below zero until I added the last two days of data. Now, the slope is just hitting the X-axis at zero, indicating either we are reaching a flat plateau, or in my opinion, we will see cases climbing very obviously again in the next week or so. If I’m right, especially if case numbers more than double that of last year, we are in for a world of hurt. Much of the country will need to implement crisis standards of care. This is what I’ve really wanted to avoid and why I labored so hard writing and sharing across platforms.

The interest rate on our actions is insanely high and our next payment is coming due. I think it’s going to bankrupt us in a number of ways.