Post Christmas COVID – Rosy or DARK?

There was a comment by a former head of the FDA (who also sits on the Pfizer board) about how as the current surge peaks, we may get 3-4 weeks of declines but then the new variant will take over and things will jump back up. At least until we vaccinate enough people. It is certainly possible that this could happen. It is also true that he does have an interest in making sure Pfizer (who makes one of the vaccines) does well. And, I’m certainly on the cynical side but it is why I find it very hard to take things at face value because bias and conflicts of interest exist everywhere. Science is not as “pure” as you might think.

As to the new variant, it is true that England, Ireland and South Africa all had a couple of days with big spikes in positive cases. But it is also true that the numbers for the last few days have been more normal and the short term trend for all three places suggests that we aren’t seeing a continued rise in cases. Could that reverse? Of course. There is still far too much that we don’t know. I just prefer to remain cautious and wait and see rather than starting to panic over a potential new surge that may or may not happen.

So I will try to talk only about where we are. The data you’ll see is back to my four week summaries of percentage of positive results but I’ll also add notes about cases and deaths. As a reminder, the data is when something was reported, not when it happened because we don’t have that level of detail in all places.

The numbers for the last two weeks of the year were lowered because of reporting delays. A lot of that was made up in the first full week of the new year when backlogs were cleared. But there are still places where we can’t yet see through the disruptions and I’ll try to point those out.

We’ll start with a couple of graphs I haven’t shown in a bit. The first is the number of people currently hospitalized who have tested positive for COVID. The rate of increase has been slowing for awhile as the surge peaked in the northern states and we are now seeing it start to come down. While there are still states where cases are increasing, the downturn suggests we’ve seen the peak in most places. But these numbers can fluctuate so another week of the downtrend would be a better signal.

The other graph is number of people in an ICU with a positive COVID result. These should represent the more serious cases and we don’t see the numbers falling off as fast as just general hospitalizations. Unfortunately, some percentage of these people will not survive so this may be more of a proxy for deaths which is the last thing to peak in a surge.

As always, we start in the Northeast:

• Connecticut – While the highest weekly total for new cases was during the week of December 7th, there has been no consistent pattern since then. The highest week for newly reported deaths was the week of December 28th but it hasn’t dropped off much since then. Looks more like a place at or near a top.
• Massachusetts – The highest totals for cases and deaths was last week. With only one week of declines, we can’t confidently say where the pattern is going to go although it is worth noting that the percentage of positives for last week was 5.9% which is much lower than the previous two weeks. Tentatively put them at or near a top as well.
• Maine – Cases and deaths both jumped last week and the general pattern has been a rise. Things are still going up here.
• New Hampshire – The high for cases was the week of December 7th but the pattern since hasn’t been steadily decreasing. Both deaths and percentage of positive results dropped last week from highs the previous week. Also looks more like they are at or near the top.
• New York – The high for positives was two weeks ago while the high for deaths was last week. (I should say I’m not looking all the way back to the spring so when I say “high” I’m referring to a recent high). Percentage of positives did drop as well but I’m not confident enough to say they’ve hit a top so things are still increasing here.
• New Jersey – Set a new high for cases last week even though deaths and percentage of positives dropped. Like New York, not enough data to say they’ve hit a top so we’ll just say things are still increasing here.
• Pennsylvania – The weekly high for new cases was the week of December 7th. There was a dip over the holidays and then an increase but this last week saw cases drop to the lowest number since before Thanksgiving. Deaths hit a new high last week but percent of positives has dropped. It does look like they are past the peak of new cases and slowly on the way down.
• Rhode Island – Another state that saw a rebound the first week of the year but the high for new cases was during the week of November 30th. Deaths hit a high the week of December 14th and have been dropping since then. For the last week, percentage of positive results was 5.3% which is the lowest since the week of November 2nd. Another state that looks to be past the peak and on the way down.
• Vermont – Big jump in new cases two weeks ago. Last week’s numbers were down but still higher than any week in December. Did see a drop in deaths but not percentage of positive results. Similar to New York and New Jersey but just with far fewer cases so we can’t confidently say they are at the top yet.

As an overall summary, there is only one state (Maine) where things are clearly still going up and a couple more where we have a one week trend of good news that we need to see replicated. As a region, it looks to be at or near a peak. Now let’s move on.

• Delaware – Has had between 4427 and 5789 weekly new cases since the week of November 30th. The two weeks at the end of the year were low and then things went up the first week of the year and dropped a bit last week. We did see percentage of positive results drop last week as well. Really looks like a place at a peak right now because things aren’t really increasing or decreasing.
• DC – Very similar to Delaware with cases in a narrow range since the week of November 30th. The number of new deaths hit a high last week while the percentage of positive results dropped. Like Delaware, it looks to be at the peak with things not really increasing or decreasing. This is the thing about peaks because sometimes you get a places that plateaus at a range for several weeks. That seems to be the case here and in Delaware.
• Maryland – Actually hit a new high in cases the week of January 4th but that was coming off two low weeks over Christmas. Really, they’ve been in the same relative range since the week of November 30th (a pattern emerges?) The high for deaths was the week of December 14th but it hasn’t really fallen off much since then. Another state that seems to be at peak and in a plateau.
• North Carolina – After a low week during Christmas, cases started to rise again but the high was set during the week of January 4th and new cases dropped last week. That was the same story for deaths and we saw a big drop in percentage of positive results last week as well. Another state where we don’t yet have clarity because one week of good news isn’t enough to say they are at a peak.
• Virginia – New cases have gone up the last five weeks and hit a new high last week. They also hit new highs in deaths and percentage of positive results. The only state in this region where the patterns clearly are still increasing.

General summary is that we have one state where things are still going up but most of the region is at a peak but the peak has been pretty long. Moving on to the Midwest where the news is better.

• Illinois – Did see a rebound in cases during the first week after the holidays but the numbers were about half of the high set during the week of November 9th. Deaths peaked during the week of November 30th and we saw a big drop last week along with a corresponding drop in percentage of positive results. Clearly over the peak and dropping back to “normal” levels.
• Indiana – New cases peaked during the week of November 30th and deaths hit a high during the week of December 28th and both have dropped since. Saw a big drop in percentage of positive result last week and new cases were at their lowest levels since early November. Also over the peak and on the way down.
• Michigan – New cases for last week were the lowest since the week of October 19th and percentage of positive results has been below 7% for two weeks in a row. The high for deaths was the week of December 14th. Also past peak and on the way down.
• Ohio – New cases peaked during the week of December 7th and have slowly started to drop. New deaths did hit a high last week but have really been in a range for a couple of weeks. A little behind the other states in this region but also looks to be past peak.
• Wisconsin – Cases and percentage of positive results are back to mid October levels and deaths hit a high the week of November 30th. Also past peak.

All states in the Midwest appear to be over the peak and slowly working their way back to whatever normal looks like. We continue to the next group which is a group of three states that had been relatively untouched for most of last year.

• Kentucky – The high for new cases was during the week of January 4th but we didn’t see a big drop last week and percentage of positive results has been on the rise. Death numbers hit a new high last week as well. They had really been in a range since the week of November 16th and I don’t know if this is a break out or just the top. The pattern isn’t consistently up so we need a few more weeks to see what happens.
• Tennessee – The high for new cases was the week of December 14th and last week’s number was the lowest in seven weeks. The high for deaths was the week of January 4th and we saw a relatively big drop last week along with a drop in percentage of positives. Won’t say they are past peak but they do look to be at or near a top.
• West Virginia – New cases hit a high the week of December 28th and the figure for last week was the lowest in seven weeks. The high for deaths was the week of January 4th but last week’s numbers were close. But there was a big drop in percentage of positive results. Again, looks to be at or near the top.

Kentucky is the one state of the three where you could argue things are still going up. The other two look to be at or near a top. Let’s move down south.

• Alabama – The high for new cases was the week of January 4th and last week’s numbers were the lowest in six weeks. The number of deaths last week was the highest but we saw percentage of positives go down. Another state where we need to see the pattern for a couple more weeks to know for sure.
• Florida – The state everyone loves to hate for some reason. New cases did hit a new high the week of January 4th and dropped a bit last week. The number of deaths hit a high last week although percentage of positives did drop. Pretty much like Alabama as it isn’t clear where the pattern is going.
• Georgia – Let me just repeat the Florida comment. High for cases was two weeks ago and it dropped a bit last week along with percentage of positive results. Deaths hit a new high last week so they could still be increasing which can happen even as cases start to drop.
• Mississippi – Again, it is interesting to me how states in similar regions follow similar patterns. The highs for cases and deaths here are exactly the same as the other states.
• South Carolina – A small break in the pattern as the high for new cases was actually last week although it was a very small increase from two weeks ago. Like every state in this region, the number of new deaths last week was the highest. And, like the rest, we saw a drop in percentage of positive results.

It is too early to draw conclusions about the Southeast. The good news is that with one exception, we did see a drop in cases last week so the pattern of increases was broken. This will take a couple of weeks to sort out. Now we go way up north where the situation is much better.

• Iowa – Cases have bounced a bit over the last couple of weeks but are still less than half of the high observed during the week of November 9th and deaths have been dropping since the week of December 7th. Past peak and on the way back down.
• Minnesota – New cases last week were the lowest since the week of October 5th and the high for deaths was the week of December 7th. Also on the way down.
• Nebraska – Same story as Minnesota for cases but the high for deaths was the week of November 30th. Past the peak
• North Dakota – New cases for last week were the lowest since the week of August 10th. Deaths and percentage of positives are way down.
• South Dakota – New cases for last week were the lowest since the week of September 14th and deaths and percent positives are also down.

Pretty clear that we can say the surge is over in the upper Midwest and the holidays didn’t ignite any sort of new surge. Let’s stay in the middle of the country but move south.

• Arkansas – Cases and deaths hit highs the week of January 7th. Both were down last week but still in the range they’ve been in since December 7th. Percentage of positive results dropped slightly but remain high. Another state where we need more data.
• Kansas – The last two weeks have seen cases drop. Deaths were up a bit last week but not as high as the week of December 28th. Percentage of positives did see a big drop last week. With the spotty reporting, I can’t say they are past peak but they do seem to be at or near the top.
• Louisiana – Highs for cases and deaths were during the week of January 7th. Cases, deaths and percentage of positive results were all down last week but not big drops. We need more data here as well.
• Missouri – The high for cases was the week of November 16th and the high for deaths was the week of December 14th. Saw a big drop in cases and percentage of positives last week with both being at the lowest levels in 8-9 weeks. There is enough evidence to say they are past peak.
• Oklahoma – Cases have kind been in a range since mid November. They did hit a high during the week of January 7th and were down slightly last week. Deaths hit a new high last week but percentage of positives dropped. So we need more data here as well.
• Texas – Saw a big jump in cases the week of January 7th and not much of a drop last week. Deaths hit a high last week but we did see a drop in percentage of positives.

A mixed bag. The two northern most states are in the best shape while we need more data for the other four. Like the southeast, we can expect deaths to remain high for a few weeks even if cases do continue to drop. Let’s go to the mountains where the situation is better.

• Colorado – New cases last week were the lowest since the week of October 19th and deaths hit a high the week of December 7th. Last week percentage of positives was below 6% for the first time since the week of October 12th. Clearly past peak and on the way down.
• Idaho – Cases and deaths both hit highs the week of December 7th and have been dropping since then. Also past peak on on the way down.
• Montana – The number of cases peaked during the week of November 16th. The two holiday weeks had low numbers and things have increased a bit since then but are still less than half of what they were at the high. Deaths dropped last week as well and percentage of positive results has been below 9% for two weeks in a row which is the lowest since the week of September 21. Again, another state that is past peak and continues to see things drop.
• New Mexico – New cases peaked during the week of November 16th and have dropped since then. Deaths have dropped but are still high and the same is true of percentage of positive results. But sometimes it takes a while for things to really start dropping. They are clearly past the peak though.
• Utah – While the peak for cases was the week of November 16th, the numbers for two weeks ago weren’t that different. And we haven’t seen deaths or percentage of positives drop off that much either. I think it is fair to say they are at the top but still in the plateau and have not started to drop yet.
• Wyoming – Also hit a peak for cases during the week of November 16th. The numbers for last week were the highest since early December but the numbers were way down during the holidays so it may have taken longer to clear the backlog. Still, the case numbers for yesterday are about half of what they were at the peak so it seems fair to say they are past the peak.

A couple of states that are at a top but most are on the way down as we move to the last region where things are interesting.

• Alaska – Cases peaked during the week of November 30th and have been dropping since then. This last week was the lowest since the week of October 12th. Deaths and percentage of positives are also dropping so they are clearly past the peak.
• Arizona – Hit a new high for cases during the week of January 7th. They did drop last week but still remain higher than most of December and deaths hit a new high last week. We have seen percentage of positives come down a bit. With only one week of declining numbers, we don’t have enough information to say where things are going.
• California – Actually hit a peak for cases during the week of December 14th but numbers aren’t dropping that fast since then. Did hit a new high for deaths last week but we saw percentage of positives come down a bit. I kind of feel that are at or near a top which would be good news for the overall numbers.
• Hawaii – Numbers are up a bit with over 1000 new cases four of the last five weeks. Not quite as high as they saw in August but I’d say things are increasing there but it is an uneven rise and not exponential growth.
• Nevada – While last week’s numbers were down a bit, they’ve really been in a range since the week of November 16th. Deaths did hit a new high last week but the percentage of positives dropped quite a bit and is at the lowest level since the week of November 9th. Since things aren’t really increasing, they look to be at a top but it is a fairly long plateau.
• Oregon – Cases hit a new high the week of November 30th and are down a bit from there. Deaths just hit a new high last week and percentage of positives are down a bit the last two weeks but still high relative to before the surge. Like Nevada, I’d say they are at a top but I don’t have enough of a trend to say they are on the way down.
• Washington – Very uneven reporting makes it hard to determine a true trend. Case numbers have been in a range since the week of November 9th. Deaths have been in a range since the week of November 30th. I don’t see evidence of a real increase so they do look to be at a top and just in another long plateau like other places in this region.

So we are roughly two weeks into the new year. We have not seen a new surge in cases since Christmas. We have just a few states where things are still clearly going up. It seems like the majority of them are at or near some kind of top. In that case, we would expect to see cases start to drop on the national level although deaths could remain high for another couple of weeks as they do lag cases. With the hospital data, it does seem like the worst of the surge is over for now. Time will tell about the new strain. I’ll certainly keep watching.