What did Dr. Fauci mean when he suggested there could be “100,000 COVID-19 infections per day in the United States”?

Today, before Congress, Dr. Anthony Fauci stated his extreme concerns about the current uptick in the number of COVID-19 infections and the potential for this number to grow. He used the projection of “100,000 infections a day” as a number that could be achieved if Americans continue to ignore public health guidelines related to wearing masks and social distancing. I think he was purposely putting the country on notice, and he did a good job.

Dr. Fauci was obviously trying to admonish the population and get better compliance with routine social distancing guidelines, an important and crucial way to control local outbreaks of disease. This is because of the recent rise in COVID-19 infections in the US. But what is happening now is of greater complexity as there are outbreaks in only a few areas of the country that have contributed most of the increase in infections. In addition, only a few states have had significant increases in the number of confirmed cases of COVID-19.

From the above chart, COVID-19 tests are confirming a high number of cases per 100,000 residents in Alabama, South Carolina, Arizona, Mississippi, and California. Most of the other states are stable. Despite this, the Rt. live numbers continue to show about 2/3 of states to have an R0 of greater than one, suggesting increased spread of the virus. However, these numbers have not changed for the past few weeks.

Also, the number of deaths has not increased but stabilized at about 600 per day. Again, this paradox suggests that the infection dynamics are very different than in April.

While these numbers are nothing to cheer about (!), these data suggest that there are clusters of infection in several states that must be controlled. In the other states, however, overall increases in infection numbers are due to some increase in infections, but also to increased testing. This is the pattern that keeps recurring with SARS-CoV-2 clusters of infections that geographically localize, predominantly in major urban areas. There is no seasonality and no “waves” to these infections.

It is obvious to focus on a few important things, especially if you live in one of the states showing high numbers of COVID-19 infections. Forget about washing everything you touch with Lysol or bleach. Wear a mask in public, social distance, and wash your hands. Those are the only things that really matter.

Tomorrow I will further discuss new approaches for COVID-19 testing.