Last week I wrote about how new cases in the five states we cover (Pennsylvania, New Jersey, Delaware, Virginia, and Illinois) were falling and falling rapidly. And this week that pattern continues to hold.
If we look at the Sunday-to-Sunday numbers, daily new cases were down in all five states. If we look at the seven-day averages, cases are down in all states. Pennsylvania and Illinois are now down below 2000 new cases per day, Virginia is just over 500 per day, New Jersey is below 400, and Delaware is over 100. These are all levels we last saw last autumn. In other words, we’re not quite back to summer levels of low transmission, but this time next month, I wouldn’t be surprised if we were.
Deaths remain stubbornly resistant to falling.
In fact, if we compare the Sunday-to-Sunday numbers we see that the numbers yesterday were largely the same as last Sunday, except in Pennsylvania where they were up significantly. The seven-day average?
Here’s where it gets interesting, because deaths are up slightly. Not by much, for example, Illinois was at 29.1 deaths per day last Sunday, this Sunday? 30.9. Illinois isn’t alone. Pennsylvania, Delaware, and Virginia all have reported slight upticks in their death rates.
But the biggest concern is the continuing slowdown in vaccinations. We’re perhaps halfway to the point of herd immunity in the three states we track. All three are between 37% and 38%. The thing to track this coming week will be if the rate continues to slow.
Last week I wrote about how, for new cases, we had seen a few consecutive days of increasing cases. Were we witnessing an aberration, a one-off “well, that was weird”? Or was this the beginning of a trend towards increasing new cases?
A week later and we have our answer. Just a one-off.
If we focus on just the seven-day average, in just one week the numbers in New Jersey have fallen by half. In Pennsylvania, Virginia, it’s by one quarter. Illinois is a little less than that, as is Delaware. Across the board, numbers are falling and falling quickly.
When we move to deaths, we’re beginning to see an improvement. As the lagging indicator, we would expect these to begin to drop a few weeks after new cases begin to drop. We have begun to see what might be the peaks of deaths in a few states.
Over this coming week, I’ll be closely watching these numbers to see if we can finally begin to say authoritatively that deaths are in decline.
Vaccinations drive all of this. And we continue to see the total number of fully vaccinated people climbing in Pennsylvania, Virginia, and Illinois. But, that rate is slowing down. Most likely we are entering a phase where those eager for their shots have largely received them. Now begins the challenge of vaccinating those who might lack easy access or have reservations.
But to be clear, we need those people to become fully vaccinated before we can truly begin to return to normal. Whatever normal is. It’s hard to remember anymore.
I didn’t write a post last Monday, but this Monday I am. A few things may have changed in the Covid situation. The most important is that we may have finally seen the peak of this current wave’s surge of new cases.
For the last few weeks we’ve seen cases rising in the five states. Only New Jersey of late had shown a return to declining cases. About the middle of the week before last, we began to see those numbers decline. And so in this past week we did begin to see cases decline in all five states.
The thing to watch this week will be that at the very end of last week, new cases ticked up slightly for two or three days in a number of states. It could be an aberrant one-off, but with full vaccinations still well below herd immunity and cases still at high levels, it isn’t difficult to imagine a scenario where the virus begins to surge once again.
Deaths on the other hand, they continue to climb. We aren’t seeing massive increases, instead these are largely marginal. But they are increasing all the same.
Encouragingly, if cases can continue to decline, deaths will begin to fall. As a lagging indicator, they will be the last metric we see decline. Consequently, it’s a question of when, not if, deaths begin to decline. On Saturday, we did see a small decline in deaths, but one day before the weekend is insufficient to determine whether or not we’ve seen the inflection point, after which deaths would fall.
Vaccinations remain a broad set of positive news. All three states are now reporting just over 30% of their populations as fully vaccinated. However, the rate of vaccination has begun to slow.
And that worries me and the professionals, because we are still far from herd immunity. Until we reach that level, the virus can easily spread among unvaccinated populations. The charts above don’t show the decline, as they look only at the total, cumulative effect. But the charts that I see make it quite clear the decline over the last week or two.
Moral of that story is, if you haven’t been vaccinated yet, please register to do so or visit a location that allows walk-up vaccinations.
Last week I wrote about how we may have been beginning to see divergent patterns in new cases, i.e. how New Jersey in particular had seen its new cases numbers falling whilst other states continued with increasing case counts.
One week later, that may still broadly hold true.
Emphasis on may.
If we look at the new charts, we can see that broadly, New Jersey did continue its downward trend as Pennsylvania and Delaware experienced significant rises in new cases. Virginia remained fairly stable, but with a slight trend towards increasing numbers of new cases.
But New Jersey and now Illinois present some interesting trends to watch this coming week. Illinois reminds me of New Jersey in that despite rising numbers most of last week, the last few days (and of course the weekend) saw numbers lower than preceding days. You can see from the slightest of dips at the tail of the line the trend has flipped direction. Will the direction hold, however, once we start receiving weekday reporting figures starting Tuesday?
Back to New Jersey, though. The downward trend continued most of the week. But, the last several days could portend a reversal of sorts. For most of the last week, the state saw daily new case numbers increasing day after day. But the trend line, as it should, remained heading downwards. Until just a few days ago. If you look at the tail of the line there, you will see a slight uptick. This too will be something to watch in the coming week.
Deaths also need careful attention this week.
Last I asked the question, will deaths follow rising cases? After a week of data, the answer is unmistakably yes. However, unlike new cases, the increases are largely of a marginal number. Look closely at the ends of the lines for Pennsylvania, New Jersey, Delaware, and Illinois and you will see last week’s shallow rise continued.
Virginia bucked the trend with decreasing numbers of deaths. And of course marginal increases could easily give way to marginal decreases. Now I try not to mention too many daily numbers in these posts because I take the weekly view, but I will be closely following Pennsylvania this week. For the last several weeks, the Commonwealth regularly reported deaths on Sunday and Monday in the single digits. Yesterday Harrisburg reported 40. Is this a one-day surge of reports? Is the state resuming reporting more deaths at the weekend? Or does it portend something worse, a mores significant rise in the number of deaths?
Vaccinations continue apace. Although, I would expect to see some slowdown as the Johnson & Johnson vaccine pause ripples out across the vaccination programme.
For now though we continue to see increasing numbers. Indeed, the three states I track have now all reached or should reach today 25% of their population as fully vaccinated.
One, that is good news.
But, two, this is just the beginning.
Last week in some tense questioning about when we can expect resumption of “normal”, Dr. Fauci provided a figure of 10,000 new cases per day across the US. (Currently we are about at 60,000 or so.) Vaccines will impede the transmission as they become ever more widely administered and fully implemented—remember that a first dose of a two-dose regimen does not mean you should be heading out and socialising.
At present, we have Pennsylvania averaging 5,000 new cases per day. In other words, Pennsylvania alone represents half of Dr. Fauci’s target. We are clearly far from that reopening level.
What I will be curious about in the coming weeks though is that interplay between new cases and vaccinations. If Illinois does begin to see a downward trend in new cases this week, how much of it is due to the state being 25% fully vaccinated?
That’s a complex question to answer, but at some point, increasing vaccinations will force new cases to reach an inflection point. First they will begin to bend downward, increasing more slowly instead of exponentially. Then with even more vaccinations a second point will be reached at which this new surge begins to finally turn and new cases drop.
This time last week I wrote about how we should not be surprised at rising levels of coronavirus in the states of Pennsylvania, New Jersey, Delaware, Virginia, and Illinois. After all, our elected officials reopened economies despite data saying they should do otherwise. On top of that, people have been engaging in reckless behaviour and seemingly abandoning the very behaviours that had been leading to declining rates. With those two failures, our last hope is that vaccines will come quickly and be widely taken by the public.
A week hence.
Well, we are beginning to see some divergent patterns, especially with new cases.
Last week there was some evidence that New Jersey might be bucking the trend and headed downwards after weeks of rising new cases. And now that appears to be a more sustained trend as the line for the Garden State’s seven-day average clearly began headed the right direction this past week.
That’s the good news. The bad news is that we continue to see rising numbers of new cases in Pennsylvania, Delaware, and Illinois. Although if we want to try and find the positives in the bad, we can see that Delaware’s upward trend remains fairly shallow. Illinois, while steeper, is rising from a lower base as the Land of Lincoln managed to reach low, summer levels of new case spread earlier this year. And in Pennsylvania, there is a bend in the curve, an inflection point, that could indicate growth in the number of new cases is slowing. We still need to see it turn negative, but slowing growth is better than increasing growth.
Virginia splits the difference between those sets. It remains at an elevated level of new case transmission, but the upward tick we saw—unlike the other states—was not followed by a general surge in new cases. The little rise we did see, in fact seems to have perhaps shifted back downward.
One of the big questions in this current wave of new cases is will deaths rise? We are seeing increasing numbers of new cases and hospitalisations, but will deaths follow? The hope is that we have vaccinated enough of the most vulnerable populations to prevent them from suffering the most serious of results.
So far so good. While death rates remain slightly elevated over summer levels, we do not yet see any signs of rising numbers of deaths. The only possible exception is Virginia, where cases bottomed out after the state added delayed death certificates from the holidays, but have risen in recent days.
Finally we have vaccinations. Here is the best news at which we can look. We can now say that at least 20% of the populations of Pennsylvania, Virginia, and Illinois are fully vaccinated. To be clear, that is still a long way from herd immunity levels, but that’s 20 percentage points more than we had four months ago.
One big outstanding question is how much, if at all, can vaccinated people spread coronavirus? This is why we need to continue to wear masks and socially distance even those who have been vaccinated. But at some point—I don’t know when—these increasing levels of full vaccination should begin to flatten the new case curves. Could that be what’s flattening the curves in New Jersey, Virginia, and Pennsylvania? It’s too early to say, but one can hope.
Last week I wrote about how the inevitable rise in new Covid-19 cases was occurring in Pennsylvania, New Jersey, Delaware, Virginia, and Illinois. Now, one, in the last week, we saw no evidence of states preparing to reinforce their public health and safety restrictions. And two, whilst we have no data on people not following guidelines, anecdotally a large group of people threw a party in my building’s common amenities space so it does seem like people are feeling less inclined to wear masks, socially distance, and isolate to their own households.
Those two conditions, of course, do not help reduce the case count. Instead they add to it. So it should come as no surprise that Covid-19 continues to rapidly spread in our five states, though some are doing worse than others.
New Jersey and Pennsylvania arguably performed the worst. If we look at the peak to trough decline from early winter’s surge to late winter’s nadir, we can see that New Jersey has reached 40% of that peak. Pennsylvania enjoyed a better decline and so has a large gap, but is still nearing 20% its previous peak.
Illinois is also remarkable—again not in a good way—as its peak to trough fall was even greater than Pennsylvania’s, however it’s also now clearly rising. The Land of Lincoln, however, did manager to reach late summer levels of new cases—good. But those are now rising—bad. Delaware too is seeing a rise, albeit at a slower rate than its two tristate neighbours.
Only Virginia’s rise remains slight, barely discernible in the chart.
Deaths, while not exactly good news, aren’t exactly good news either. Last week I mentioned how they had stalled out and stopped declining. That is better than rising death rates, but the levels of deaths per day is still higher than we saw last summer. In other words, things could be significantly better even in pandemic terms.
Last week? Deaths continued to stubbornly persist at those elevated levels. We remain vigilant, looking for any indication that deaths will follow the rates of new cases and hospitalisations and begin to climb.
The hope, of course, is that we have vaccinated enough of the most at risk populations to prevent a surge in deaths. But, we just don’t know yet. The only good news is that vaccinations continue to progress.
Illinois has surpassed 18% of its population being fully vaccinated. Virginia is not far behind at 17.75%. Pennsylvania, because of the bifurcated nature of its data reporting, remains unclear. It sits at 17.8% fully vaccinated, but Philadelphia has not posted updated data since late Thursday. It’s likely that the Commonwealth has joined Illinois in surpassing 18%, but it’s not fully certain.
Also this past week, the CDC updated its guidance for the fully vaccinated, saying that it was safe for them to travel. I take some issue with this, primarily on the messaging front.
First, we need to be clear about what fully vaccinated means. It means two weeks after your final dose. For Johnson & Johnson’s vaccine, that means two weeks after your shot as you only receive one. For both Pfizer and Moderna, you are only fully vaccinated two weeks after your second shot—not before. And keep in mind with Pfizer you need to wait three weeks between first and second dose. With Moderna it’s four weeks. In other words, with J&J you need to wait two weeks after your first (and only) shot before you can begin to follow the loosened guidelines. If you receive Pfizer’s, you need to wait five weeks from your first shot, assuming you do receive your second three weeks later, and with Moderna it’s six weeks, again assuming the recommended four week gap.
The problem is that only about 20% of the US population is fully vaccinated. And with the virus spreading at high rates and at high levels, it poses a significant risk as the newer, more lethal, and more infectious variants could take root in the United States and overwhelm the healthcare systems of the 50 states. We do not yet know if fully vaccinated people can spread the virus if they do become infected.
I think the advice should have remained to refrain from all but essential travel until we reached a high percentage of fully vaccinated folks. I ballparked earlier this week something like 2/3 the estimated amount of full vaccinations required for herd immunity (est. at 75%). In other words, keeping restrictions on travel until at least 50% of the US becomes fully vaccinated.
We remain several weeks away from that milestone, unfortunately. I understand the desire/urge people have to get out and do things and enjoy spring after a year of isolation. Sadly, if winter was the darkest/hardest part of the pandemic, I think that makes spring and early summer the most challenging. Because we see progress, we see the light at the end of the tunnel, and it coincides with warmer weather and we want nothing more to get out and do things and see people. But that is the last thing we need to be doing at this point.
I’ve often described the vaccination as the marshmallow test. In a study, scientists presented kids with a marshmallow. They could eat the marshmallow immediately, but if they waited 15 minutes, unsupervised, they could then have an additional marshmallow. We are all just grabbing that first marshmallow whilst the promise of a more normal summer is ours if we can wait just 15 minutes.
Two weeks ago I wrote about how new cases in the states of Pennsylvania, New Jersey, Delaware, Virginia, and Illinois were stalling out, i.e. no longer declining. Additionally, with the exception of Illinois, they were stalling at rates far higher than what we saw last summer. I wrote
This means that the environment is ripe for a new surge of cases if people stop following social distancing and begin resuming indoor activities with other people. Sadly, both those things appear to be occurring throughout the US.
Two weeks hence, one of one thing inevitably occurred.
New cases are now rising in all five states. I wrote about the flat tails of the curves for the seven-day averages. A quick look at the chart shows those have swung upwards, in some cases sharply.
Two weeks ago I referenced Europe as a cautionary tale. Governments there eased up on their restrictions, cases surged, and then as hospitalisations rose, governments had to reimpose restrictions and effect new lockdowns. Europe has typically been 3–4 weeks ahead of us throughout the pandemic. So that we are now at a point where we are seeing rising cases, absolutely none of this should be surprising.
The evidence has been in our faces for weeks, plus we have the European example to look at. Reopening makes no sense until we can get case numbers lower, especially with new more virulent and lethal strains of coronavirus now circulating.
Deaths too have been trending the wrong way over the last few weeks.
We have seen the curves largely bottom out. And if you look closely, these bottoms are higher than the rates we saw last summer, in some cases more than 3× as much. This flattening occurred just a few weeks after cases began to flatten. The question becomes, will they rise in a few weeks time? Or have we vaccinated enough of our most vulnerable populations?
That’s the real wildcard.
Right now, we have only fully vaccinated about 15% of the populations of Pennsylvania, Virginia, and Illinois.
Is that enough to prevent hospitalisations and deaths in what looks like will be a fourth wave?
Last week I wrote about how our progress in dealing with Covid-19 was stagnating. To put it simply, this past week did not get any better on that front.
In Pennsylvania, Delaware, and Illinois we see that the flattened tail I described last week, well remained a flattened tail. In Delaware, we see more movement, but the average of the average, if you will, is flat over the last two weeks. And in New Jersey, where I mentioned some signs of rising numbers, we see a clearly rising number of new cases over the last week. Only in Virginia are numbers heading down, and those are shallowing out.
The problem here is that in Pennsylvania and Delaware, the new case rate, whilst flat, is well above the summer rate of low transmission. This means that the environment is ripe for a new surge of cases if people stop following social distancing and begin resuming indoor activities with other people. Sadly, both those things appear to be occurring throughout the US.
In Europe we see a cautionary tale. They too saw their holidays peaks decline and the national governments began easing restrictions on their populations. Within the last several days, however, new cases have begun to surge. Italy has gone so far as to announce a new lockdown. Other governments are considering the same.
If the United States cannot resume pushing its numbers of new cases down, it could well follow Europe into a new wave of outbreaks that would threaten lockdowns and push back our eventual return of normalcy.
None of this would be an issue if vaccinations were nearing herd immunity levels. However, in the states we cover, nowhere is above 12% fully vaccinated.
Pennsylvania now lags behind the other two states. But at least the Commonwealth is over 10% fully vaccinated.
And of course, the problem under this dire scenario is that deaths could rise once again, though at this point the most vulnerable are in the middle of being vaccinated. Indeed, if we look at the last week, we see the good news for the week, that deaths are headed down in all five states.
Previously, Virginia had been working through a backlog of death records, but those appear now cleared. We are not quite back to summer-level lows, but we are steadily approaching them.
The big question this week will be what happens to those new cases numbers. Today’s data, Monday, will likely show lower numbers because of lower testing on the weekend. But starting Tuesday, what do we see over the course of the next five days?
Last week I wrote about some signals indicating a potential stagnation in terms of declining numbers of new cases. I also wrote about some potential signs of reversals, or increasing numbers of new cases.
This week, what we saw signs of came to pass.
At the tail ends of each chart, you can see that the last week was broadly stagnant. In Pennsylvania and Illinois the seven-day average was itself remarkably flat. Delaware is now where it was this time last week; a slight rise in new cases was met with an equal magnitude decline.
In reversals, we have New Jersey. New case numbers there increased throughout the week. With lower weekend data, those numbers have fallen slightly.
Only in Virginia did we see good numbers in new cases. Numbers there fell over the last week, though notably at a slower pace than in previous weeks.
Deaths presented broadly good news. Last week we had mixed signals with increasing numbers in Delaware and Virginia. We knew the increase in Virginia was due to the state processing a backlog of death certificates with Covid.
But in the last few days, those numbers have also fallen though the state reports it is still processing the backlog. And in Delaware, the daily number of deaths has also fallen again. I think it’s too early to say this peak has crested, but it could well be.
And in the other states, we continue to see slowly falling numbers of deaths. There are some potential signs of that bottoming or stalling out in Illinois, but we’ll have to see how this week pans out.
Finally, the best news we had over the course of last week was with vaccinations.
Last week I mentioned that we can see the lines moving upwards as we approach 10% fully vaccinated in Pennsylvania, Virginia, and Illinois.
This week, well let’s start here: as I’ve pointed out in the past, Pennsylvania does not have a centralised reporting system. Most notably the state reports figures for all but Philadelphia county (coterminus with the city). The city reports its own figures. I aggregate the two. But for the last several days, the Philadelphia data site has been broken, so we don’t know the progress of vaccinations in the city. And as the largest city/county in the state, Philadelphia is an enormous part of figuring out the statewide numbers.
So looking only at Virginia and Illinois, the numbers look good. Virginia is at nearly 9.5%. Illinois is on 8.92%.
But we really need Philadelphia to get its act together.
Last week we saw some positive trends with respect to new Covid-19 cases in the Pennsylvania, New Jersey, Delaware, Virginia, and Illinois area. What did we see this week? Curiously, we saw stagnating figures and, in some instances, slight reversals.
This stagnation can be seen by the small flattenings at the end of the lines for Pennsylvania, Illinois, and Virginia. And if you look at Delaware and New Jersey, you can see the reversals as little upward hooks.
I do not think this means we will be returning to the levels we saw earlier this winter. In fact, if you look a little ways back in Delaware and a bit further back in both Pennsylvania and Illinois you can see a similar pattern. Slight reversals appear as jagged little outcrops on the slope. New cases do indeed climb for a week or so—probably isolated to specific geographies within those states tied to outbreak clusters, but that’s pure speculation on my part.
These reversals, therefore, are something we should pay attention to this week when the weekday data resumes on Tuesday. But I am not worrying about this breaking the overall trend of falling numbers of new cases.
Deaths, on the other hand, while still a bit mixed, are broadly positive. Last week we were in a similar position as we are with new cases this week. In particular, we were looking at increasing numbers in both Delaware and Virginia while the other three states saw slowly falling numbers.
In Delaware we have the numbers down a bit, but the longer term trend remains generally up. I will be watching this closely this week. Virginia, however, is an easier, but maybe better explanation? During the course of this past week, Virginia stated that it’s processing death certificates from the post-holiday surge in deaths.
This means the state under-reported deaths earlier this year and so that the curve should have actually been significantly higher. But the positive news in that is that the deaths we are seeing now happened in the past so that deaths today are far lower than are being reported.
And with vaccinations we continue to have good news. The lines below are clearly off the baseline now as the three states we track move towards 10% fully vaccinated.
It’s not all perfect, as the rate in Pennsylvania appears to have slowed slightly. This after vaccine administrators mistakenly used second doses for first doses. Now the state has to play catch-up.
But in Virginia and Illinois, we continue to see increasing rates. You can see this as the curve is beginning to gradually slope more and more upward instead of the shallow angle we saw for the last few weeks.
Like with new cases, which, while positive, still have a ways to go before we get to summer-like levels that would allow us to head out and socialise, vaccinations have a long way to go.
And importantly, just because someone is vaccinated doesn’t mean society should reopen just for those lucky to get their doses early. We need to wait—or should wait—for higher levels of vaccination before reopening.