Coronavirus

We had warned two months ago that the CDC had erred in dropping the tracking of COVID-19 breakthrough cases and not doing more to track serious breakthrough cases with more detail.  This has led to tremendous confusion and bickering among the White House, the CDC, and the FDA regarding the need and timeline for rolling out vaccine boosters.  Somehow the FDA decided to ignore a lot of good data from the UK, Israel, Iceland, and Singapore regarding the seriousness of breakthroughs.  Now the CDC is leaning toward quicker and broader booster rollout.  Why? One reason is that yesterday, the CDC reported a big jump in breakout hospitalizations and deaths due primarily to the addition of one more state in their weekly report .   Based on the trend over the last 10 weeks, everyone had expected 3,400 cumulative breakthrough deaths to be reported yesterday (red curve in graph above and table below).   That they got 4,493 was probably a huge shock.   It meant that the total breakthrough deaths o

Russians headed to polling stations across the country this past weekend to vote in a totally new lower house of parliament.   Despite very little notice in the West COVID-19 is a driving factor in the elections and for a good reason.   The Delta variant is hitting Russia very hard.   For much of 2020, Russia claimed they had a good handle on the global pandemic and while they saw surges in cases, they reported better than average case fatality rates (CFR) of 1.6% for most of the year.   Further they claimed to have developed a vaccine, Sputnik V , that provided good protection against SARS-CoV-2 infections.   Mass distribution began in Dec 2020 near the same time as in the US.   Things worked out pretty well in early 2021 as cases and deaths dropped, but as the Delta variant began to spread in May 2021 a third and most deadly wave hit Russia.   What went wrong?   Assuming that the COVID data from Russia is of average quality (big assumption), it seems that the Sputnik V vaccine is v

Why has Governor DeSantis spent so much time since early August pitching $2,100 Monoclonal Antibodies (MAB) as his solution for the pandemic when there are cheaper and more effective solutions such as $20 vaccines and $0.20 masks that have been used by a thousand times more people safely to reduce SARS-Cov-2 infections and deaths?   MAB does have a very useful purpose: they serve to help high-risk patients who have been infected as a second line of defense; they are expensive and should not be given as frontline defense until cheaper and more durable versions are made.    The original reason seemed to be that Governor DeSantis wanted to do his biggest donor a favor .   But now that the country has run out of Regeneron MAB and everything is backordered, and states are on allocation, he continues to complain and push a false and dangerous narrative.   Does he really think that he is fighting for the average Floridian by doing this?   Today he boasted that since he has been promoting MA

For the first 15mo of the global pandemic, many analysts had held up Taiwan as an exemplar for how to handle a pandemic.   They had experienced only a few hundred well-monitored cases and only 7 deaths from COVID-19 for 15 months.   During this same period, Singapore also did very well.   They weren’t able to avoid infections with a high number of guest workers in a fast-growing City-State but they kept their case fatality rate low (CFR = 0.06%) due to a young population and a good healthcare system.   Japan, being a larger country with many International ties experienced all the travails of the global pandemic in 4 waves matching more or less those of the USA and the rest of the world.   They had a CFR that was near 2% - quite good for a population with high median age.   The fates of the 3 have diverged dramatically with the arrival of the Delta variant this Spring.   Taiwan’s island nation status allowed them to isolate themselves from the storm raging outside in 2020.  Then they

The COVID-19 pandemic had been relatively mild for children in 2020.   In the early days, schools were shut and kids were sent home to learn remotely.   Later when people found out kids were not as susceptible to serious illness from SARS-CoV-2, schools reopened and in-person learning was slowly restored with strong mitigation measures instituted.   Pediatric hospitalizations (red curve in the figure below) increased last Fall but not too badly –running near 1.2% of adult hospitalization at the peak around the New Year.   L ate Spring 2021 with Delta edging onto the scene it became obvious that kids were more susceptible to this more contagious and possibly more virulent variant .   Epidemiologists warned that school reopening without strong mitigation measures could lead to disaster and yet ironically more governors and parents went the opposite direction and eased mitigations.   The end result is that pediatric hospitals were swamped and more kids suffered needlessly with MIS-C and o

Many studies have now shown that the Delta variant is about 2.3x more contagious than the original SARS-Cov-2.  Some people suspect that it could also be more deadly but there is no clear evidence for this.  Much anecdotal evidence points to there being more young adults and kids being seriously ill and hospitalized during the latest Delta wave.  But are there more people hospitalized and dying from Delta than before?  Are cases resulting in more hospitalizations?  For the period before 6/1/21, 8.1% of all COVID-19 cases in Florida (FL) required hospitalization (CHR = Hospitalizations/Cases).  For the last 100 days when Delta began to dominate, 9.3% of all cases resulted in hospitalizations.  You may have noticed in the graph below that this trend that had brought the hospitalization rate briefly over 10% (note that the hospitalization rates are scaled at 1/10th the scale of cases) has reversed over the last 3 weeks.  The reason for this is that since schools reopened more pediatri

COVID-19 data tracking and reporting has been problematic from day 1 .   Outdated systems and procedures made it difficult to understand the severity of the pandemic in its early days and handicapped the US efforts to control it.   President Trump in a fit of pique and for political reasons decided to bypass the Center for Disease Control (CDC) for COVID-19 reporting and shift it to another department in Health and Human services (HHS) on July 15 th , 2000.   This has turned out poorly because while the CDC had problems, the HHS had no experience with tracking and reporting infectious diseases.   While this helped Trump in the short term politically because the HHS was more willing to alter the data to fit the President’s message it hurt the US pandemic response long term.   The President should have spent money on improving the existing CDC system instead of building another parallel system to monitor COVID-19.   Have things improved in 2021?  The recent miscues in reporting cases

Our blog post about the major change in Florida’s COVID-19 reporting to the CDC has developed into a national story with partisan biases.  A couple of days ago the Miami-Herald “broke” a news story that claimed Florida changed its COVID-19 data recently – something that I had worked with a Sun-Sentinel reporter to break 18 days prior.  Now the story has been picked up by MSNBC , the Wall Street Journal , and other national news services.  However, none of these stories have addressed the full impact of Florida changing COVID-19 cases and deaths from date of reporting to actual date of occurrence.    1.      While technically correct the new FL method is only used by a few other states to report their deaths to the CDC.  Contrary to the WSJ article’s claim, TX is not using the FL method - or if TX is using the new method they only have a 1-2 day lag in recording deaths. The figures below show how CDC currently stores and displays FL and TX death counts.  As you can see FL death c

In the early days of the COVID-19 mRNA vaccine rollout in the USA this year, vaccines were in short supply and people had no choice as to which vaccine to try.   Both two-dose vaccines from Pfizer and Moderna seems to have similar 95% efficacy against serious disease.   Recent studies are revealing significant differences between the Pfizer and Moderna vaccines.   Moderna has nearly 3X the amount of active ingredients in Pfizer: 100 m g vs 30 m g.  Moderna created 2.6X more antibodies in patients than Pfizer – with both being negatively correlated with patient age and both declining exponentially over time.  The higher amount of initial antibodies allow Moderna to be more effective and durable against the Delta variant than Pfizer: the risk of a breakthrough case was 2X lower.  While Pfizer is recommending a booster 6 months after the second shot, Moderna is recommending a booster before this winter.   Moderna’s proposed booster has only 50 m g of active ingredients , but it is sti