deaths

As first COVID-19 vaccine starts to be shipped to the United Kingdom, Canada, Bahrain and the United States, the number of new cases reaches another record over the last fourteen days

While both Russia and China have had vaccines that they have been using within country and shipping to some other countries, the first vaccine to have gone through all testing phases and be approved by certain western countries is the BioNTech/Pfizer vaccine (Pfizer vaccine). The first shots of the Pfizer vaccine were administered in the United Kingdom last week and are being distributed to the other countries which have approved the vaccine for emergency use. In the United States, shipments are going from Pfizer’s Michigan factory today to locations around the country with first vaccinations possible for selected groups as early as tomorrow. A second vaccine from Moderna is likely to be approved in the coming week or so. Others are expected to be submitted for emergency authorization in a few weeks time. So the good news is that vaccines that are safe and efficacious have been developed in record time. The challenges now will be the ramp up of global production, distribution from plant to distribution points and further distribution to hospitals, pharmacies, doctors offices capable of handling the vaccines (particularly for the Pfizer vaccine which has to be maintained at extraordinarily low temperatures requiring special cold storage facilities to handle), adequate medical personnel and equipment to vaccinate populations, organizing populations to receive the vaccine in an order decided by government and a willingness on the part of the population to be vaccinated. In the United States, vaccines will be distributed to the states and local areas but further distribution and state efforts at fulfilling the remaining steps are handicapped by limited funds and the failure to date of the U.S. Congress and Trump Administration to agree on a supplement stimulus package that will, inter alia, ensure adequate funding for the states to ensure proper distribution and means for vaccinating their populations. There is also a need for a major communication campaign as presently only 47% of people in the U.S. indicate they will get vaccinated; 26% indicate they will not get vaccinated and 27% are unsure. The EU is hoping to get the Pfizer vaccine approved by the end of the year although is under pressure to move that time line up. Politico, December 13, 2020, Pressure mounts on EU regulator to approve coronavirus vaccine — and fast, European regulators hope that taking more time will convince the skeptics to get vaccinated, https://www.politico.eu/article/pressure-mounts-on-eu-regulator-to-approve-coronavirus-vaccine-quickly/.

Juxtaposed to the good news of vaccine approval is the continued rise in the number of new cases of COVID-19 around the world, high death rates in the U.S. and much of Europe with very challenging times facing governments until vaccine distribution and vaccinations are widespread.

This post will focus on the United States. The United States has 4.3% of the world’s population but has had one of the worst performances of any country on earth in terms of bringing the virus under control. With 16,067,031 total COVID-19 cases reported in the United States as of December 13, the United States accounts for 22.64% of the total cases in the world (70,957,979). However, during the last fourteen days, the United States 2,820,380 new cases accounted for an astounding 32.74% of global cases (8,613,822). European Centre for Disease Prevention and Control, COVID-19 situation update worldwide, as of 13 December 2020. During the last two weeks, the U.S. averaged more than 200,000 new cases each day — another first. Indeed, no other country has reported 100,000 new cases in a single day throughout the 2020 period. By contrast, the United States has reported 100,000 or more new cases on forty days, including the last 39 days in a row. The United States has now reported 200,000 or more new cases for 10 days including 9 of the last 11 days. Global cases have started to increase again, up 5.79% over the prior two week period (November 16-29). The United States saw an increase of 20.44% or an increase 478,620 over the prior two week. Indeed, the rest of the world declined slightly as the U.S. accounted for more than 100% of the global increase in the last two week. And projections are that the number of new cases will continue to rise in the United States in the coming weeks. For example, the Center for Disease Control and Prevention in the United States monitors forecasts made by various entities and reports periodically the projected number of new cases and deaths. The latest update from December 9 shows a composite projection of an increase of some 14-15% in the coming weeks. See, CDC, COVID-19 Forecasts: Cases, updated Dec. 9, 2020, https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/forecasts-cases.html. Thus, the United States will likely have the dubious distinction of recording more than 3,000,000 new cases in the next two week period.

On deaths from COVID-19, the United States has recorded 297,837 from COVID-19 or 18.35% of the world total (1,605,595). Over the last fourteen days, the United States has recorded 31,774 deaths (2,269.57/day) or 20.90% of the world total (152,064). Deaths in Europe have been very high in recent weeks following the extraordinary surge in the last two months in new cases although cases in Europe have been dropping over the last several weeks which should mean declining death totals in Europe in the coming weeks. Deaths in the United States are projected to continue rising and are already around one death every thirty seconds (indeed as deaths exceed 3,000/day some days, it is one death every 25-29 second. CDC’s recent update of various forecasts show likely increases in deaths in the U.S. in the coming weeks, some projections showing more than 3,000/day. See CDC, COVID-19 Forecasts: Deaths, updated December 9, 2020, https://www.cdc.gov/coronavirus/2019-ncov/covid-data/forecasting-us.html.

U.S. hospitalizations due to COVID-19 have now topped 100,000 and many states are near or exceeding capacity for ICU beds. On December 12, 2020, The COVID Tracking Project tallied 108,487 U.S. hospitalizations due to COVID. The image below is copied from the COVID Tracking Project webpage and shows current hospitalizations more than 60% higher than prior peaks from April and June/July. https://public.tableau.com/profile/covid.tracking.project#!/vizhome/CTPWebsiteGallery/7_USCHospitalized.

With the continued surge in new cases and increasing hospitalizations, many states are facing severe challenges. California has reimposed lock down requirements on most parts of the state. Reno, Nevada has had a huge spike in cases, requiring the city to convert a parking lot to a COVID-19 facility. Press articles show the problem is occurring in many places. See, e.g., Houston Chronicle, December 10, 2020, TMC hospitals, hit by COVID surge, exceed base ICU capacity for first time since summer, https://www.houstonchronicle.com/news/houston-texas/health/article/COVID-ICU-capacity-patients-Texas-Med-Center-news-15791754.php; Raleigh News & Observer, December 8, 2020, NC hospitals will run out of beds if current COVID trends continue, researchers say, https://www.newsobserver.com/news/local/article247691885.html.

With vaccines now starting to ship, the U.S. is predicting that some 60% of Americans will be vaccinated by the summer (described as any American who wishes to be vaccinated). Dr. Fauci has indicated that vaccinations of 70% or more will be required for herd immunity, but life may start to return to a more normal state by late summer if the government, businesses and the population work together to maximize vaccinations and continue to follow other precautions until then (mask wearing, social distancing, handwashing, small group gatherings, etc.). It will also require the Congress and the Trump Administration to get the supplement stimulus package passed and enacted into law to ensure adequate funding for the states to ensure full and timely implementation of the vaccination effort.

But despite the good news on vaccines, the challenges facing the U.S. certainly for the first two quarters of 2021 and perhaps longer, will continue to be extraordinary considering current conditions and projections through January. For the United States, it is certain to be a very dark and challenging winter and at least early Spring. The incoming Biden Administration understands the importance of a full court press to get the pandemic under control. Let’s hope that the problems prove manageable and that the carnage the American people have suffered can be drastically reduced and quickly stopped.

As United States continues to set new records in COVID-19 cases, deaths and hospitalizations, United States accounts for more than 30% of new cases in last 14 days

The United States has 4.3% of the world’s population but has had one of the worst performances of any country on earth in terms of bringing the virus under control. With 14,371,633 total COVID-19 cases reported in the United States as of December 5, the United States accounts for 21.85% of the total cases in the world (65,777,945). However, during the last fourteen days, the United States 2,457,689 new cases accounted for an astounding 30.47% of global cases (8,066,518). European Centre for Disease Prevention and Control, COVID-19 situation update worldwide, as of 5 December 2020. While global cases are now slowly declining, cases in the United States are continuing to increase. And projections are that the number of new cases will continue to rise in the United States in the coming weeks. See, e.g., CNN, December 5, 2020, As hospitals start to max out, medical workers beg officials for new Covid-19 mandates, https://us.cnn.com/2020/12/05/health/us-hospitals-covid-pandemic/index.html.

The latest WHO weekly report (though November 29) shows global cases starting to come down or plateauing with the major exception being the Americas where cases continue to increase. See WHO, COVID-19 Weekly Epidemiological Update (data up to November 29, 2020)

20201201_Weekly_Epi_Update_16

On deaths from COVID-19, the United States has recorded 278,994 from COVID-19 or 18.35% of the world total (1,520,082). Over the last fourteen days, the United States has recorded 24,583 deaths or 16.79% of the world total (146,387). Deaths in Europe have been very high in recent weeks following the extraordinary surge in the last two months in new cases although cases in Europe have been dropping over the last several weeks which should mean declining death totals in Europe in the coming weeks. Deaths in the United States are projected to continue rising and are already around one death every thirty seconds. See, e.g., CNN, November 28, 2020, US is ’rounding the corner into a calamity,’ expert says, with Covid-19 deaths projected to double soon, https://www.cnn.com/2020/11/28/health/us-coronavirus-saturday/index.html. The U.S. Center for Disease Prevention and Control (CDC) periodically provides forecasts of deaths from COVID-19 based on various forecasting models. The most recent projections were updated December 3. The four charts below are from the CDC posting. CDC, December 3, 2020, COVID-19 Projections: Death, https://www.cdc.gov/coronavirus/2019-ncov/covid-data/forecasting-us.html.

U.S. hospitalizations due to COVID-19 have now topped 100,000 and many states are near or exceeding capacity for ICU beds. On December 4, 2020, The COVID Tracking Project tallied 101,276 U.S. hospitalizations due to COVID. The image below is copied from the COVID Tracking Project webpage and shows current hospitalizations more than 50% higher than prior peaks from April and June/July. https://public.tableau.com/profile/covid.tracking.project#!/vizhome/CTPWebsiteGallery/7_USCHospitalized.

Medical personnel are stretched to the breaking point and recent news stories review the challenges at hospitals with medical staff required to reuse N-95 masks (typically reuse is of masks treated in some way) because of shortages of personal protective equipment. See, e.g., NBC Today, December 5, 2020, NBC News investigation: Nurses say reusing N95 masks feels ‘unsafe’, https://www.today.com/video/nbc-news-investigation-nurses-say-reusing-n95-masks-feels-unsafe-97174085710; NPR, December 3, 2020, ‘We’re All Tired Of This’: Health Care Workers In Seattle Prepare For Another Surge, https://www.npr.org/2020/12/03/940114449/were-all-tired-of-this-health-care-workers-in-seattle-prepare-for-another-surge. Some media reports are indicating that the fallout from COVID-19 on the U.S. medical profession may damage U.S. healthcare for decades with doctors, nurses and other medical professionals opting to withdraw from the field after the exhausting and never ending challenges with COVID-19.

The last week in the United States, COVID-19 became the largest cause of death surpassing heart disease, strokes, etc. See, e.g., CBS News, December 5, 2020, COVID-19 was the leading cause of death in the U.S. this week, report says, https://www.cbsnews.com/news/covid-19-leading-cause-of-death-united-states-this-week/.

There is, of course, the good news of the likely approval for emergency use of several vaccines in the coming weeks in the United States. And there is a projected active rollout of vaccines from later in December through the summer. But there is a long road to actually getting the vast majority of the American population vaccinated, assuming that a change in Administrations will be able to change the views of a skeptical public that the vaccines will be safe. For example, even after the very positive press about the Pfizer and Moderna vaccines, only 52% of Americans have indicated a willingness to be vaccinated for COVID-19 (although that is some improvement from earlier views). See Gallup, November 17, 2020, More Americans Now Willing to Get COVID-19 Vaccine,https://news.gallup.com/poll/325208/americans-willing-covid-vaccine.aspx.

Certainly for the first two quarters of 2020 and perhaps longer, the U.S. will be struggling to bring the case count down, take the burden off of the health care system, and reduce the number of deaths as we try to bring life back to some semblance of normal. For the United States, it is certain to be a very dark and challenging winter and at least early Spring. While the current Administration could have significantly changed the challenges for the public and our health care system by having a consistent and uniform message to have the public wear masks and do the other steps needed to reduce the spread of the virus, the Trump Administration has opted not to do that. The Biden Administration is 46 days from taking office. We are likely to suffer more than 100,000 additional deaths by then. A tragic outcome for a pandemic that should have been far more manageable.