The insight provided by five states

Yesterday, ABC news ran a story comparing Florida, Connecticut, Texas, and Ohio in their handling of COVID. While the story was balanced in how it described the state’s handling of the infection, it implied that the social distancing requirements directly led to current virus numbers. While this clearly played a part in where each state finds itself, I think there are also other dynamics at play. This is important to understand, as it helps to guide future plans for states. I looked at five states, four with increased infections.

Connecticut, for example, which had massive outbreaks early on, continues to show declines in COVID cases and deaths (the following data comes from Johns Hopkins COVID resource). This is typical for essentially all of the states that had early outbreaks and then shut down.

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In contrast, Florida, South Carolina, and Texas, states that did not have early outbreaks, now have increasing infection numbers.

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The increase in infections in these states has occurred despite a stable number of deaths from the virus. This dynamic is very different from states with early outbreaks and has been attributed to a number of things, such as decreasing age of infected individuals in Florida. However, I think much of this is due to increased testing, especially of younger individuals who were ignored early on when testing was so scarce it was mainly being done on susceptible, older individuals who were at higher medical risk. This is not to say that measures shouldn’t be taken to reduce these numbers (more on that in a minute), but without increasing deaths, and if hospitals can manage the sick, this creates a different scenario from NYC in April!

Finally, a few states do have more concerning numbers. Arizona is particularly important given a recent rise in deaths.

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The number of new cases is actually lower than in Florida or Texas, but deaths are now equal or higher than those states and increasing. This suggests either a change in the dynamic of infection in AZ, or a difference in counting deaths. But it raises more concern about hospital and support resources. So the biggest worry right now is not Florida but Arizona.

(I did not look at California, since the large and diverse state is difficult to evaluate as a whole.)

Moving forward, what does this mean? I am not sure that anything other than a full lockdown will reduce infections. Contact tracing is impossible when 85% of infected people are asymptomatic, and won’t prevent infection spread in large clusters. Given this, I expect eventual increases in infections in all the states that had earlier, large outbreaks and are just ending social restrictions. Importantly, these outbreaks appear to continue to be in cities, sparing many rural areas across states. Therefore, urban areas remain an important focus for social measures.

Certainly, the most important single method of controlling infections is mask use in public, which should be mandated. This should allow many normal activities, if masks are worn correctly. One thing that interferes with effective mask use and social distancing is alcohol, which makes everyone less cautious. This is likely responsible for outbreaks related to bars and needs to be addressed. But I doubt if the public will agree to a total lockdown again.

A pivotal need is to find a set of medical measures that reduces both deaths and clinically severe COVID-19 infections. Remdesivir will help and is coming on line. We still need data about dexamethasone, but it could be a game changer. This is really important as preventive measures like vaccines are still a long way off.

I have said this before, but if we have effective medical treatments for COVID-19, everything else becomes easier. It is really the only way forward.