National Trends
First let’s start with a look at national trends. Up first is the community transmission level map from CDC. This one uses recent case rate and test positivity to estimate the likelihood one would be exposed to COVID-19 in a given county. Last week 77% of US counties were considered to have high or substantial transmission of COVID-19. This week, the count is 84%.
This is how things look as of now, but it can be helpful to see things over time. The graphs below come from the HHS Community Profile Report for 01Jun2022. Interestingly it is showing a cresting peak for the Northeast, the first part of the country where the current wave began. It’s hard to see, but the Midwest is also plateauing.
Of course, it’s a lot harder to count cases these days with limits on federal reimbursement for the uninsured to access testing, the favorability of at home antigen tests that go unreported, and people who have moved on from the pandemic regardless of their symptoms. So we also need to consider what’s happening with hospital admissions for COVID-19 as well. That’s what the next graph shows. Again, we see a cresting peak for the Northeast that is only slightly higher than their Delta peak. The Midwest also shows a plateau, slightly obscured by the national line in black.
We can drill deeper to look at COVID-19 admissions by FEMA hospital region (of which there are 10) as compared to the four regions presented above. The FEMA map that shows the regions can be found here.
Keep in mind that the gray bar on the right of each graph is the window of uncertainty - a time when we don’t have a clear picture of what’s going on because of delays in reporting. The most reliable information is prior to that gray bar. We can see a clear peak that is now descending for regions 1-2 (the Northeast). Region 5 is where that plateau is coming from for the Midwest - it is states like Minnesota, Wisconsin, Michigan, Illinois, Indiana and Ohio. There may also be the beginning of a plateau for region 7 - Nebraska, Iowa, Missouri and Kansas. Everywhere else is still rising.
Wastewater surveillance data also indicates that the surge may be cresting in different areas. The data for Boston are shown below. The green line is for the sewershed on the north side of town. It crested and has rebounded slightly in the last week. The orange line shows the sewershed for the southside of town, which continues to descend. You can review the data for each sewershed to see what I mean here.
The state of Missouri has one of the most robust networks of surveillance sites. But their updates to the public can be sporadic. Their website updates weekly and for a while it was on Fridays. But that hasn’t been consistent. To be fair, I think this webiste is managed by 1-2 people (I’ve met them). I think it’s a big task for 1-2 people and I’m just grateful to have data at all. In any case, as of 27May when it was updated last, it appears that the Missouri testing sites have plateaued. Population centers like St. Louis, Kansas City, Columbia and Springfield are all stable.
As often happens with COVID-19 data, we can’t see that a wave has begun or peaked until some time has passed and we can see the trend emerge. Certainly, the disease isn’t in decline throughout the country. Rather, it is still growing at a fast pace in areas like the Mountain West and Southwest. But it is encouraging to perhaps see this wave crest in the Northeast, where it first began. Keep in mind that there are virtually no strategies in place on a community level to halt the transmission of disease right now. So for this wave to plateau or start to descend at this relatively low level compared to Omicron is a first. We haven’t yet had a nationwide wave of COVID-19 hospitalizations that was less awful than the one that preceded it. Could we finally be turning the corner on this pandemic?
I don’t want to kill that optimism…because I feel it too. I’ve often said that this pandemic isn’t really waning until we start to see a season (either summer or winter) without a huge spike in cases and hospitalizations. These data seem to suggest that the Northeast is in that sort of position. But I want to add in some caveats - we need more time to see if some of the caveats matter. First, the Northeast has the highest COVID-19 vaccination rate in the country. So what’s happening there might not predict what we can expect in other regions of the country. Second, seeing a reduction in hospitalizations is a really good thing. But even mild cases of COVID-19 that don’t warrant hospitalization can lead to Long COVID which can include semi-permanent or permanent disability. So as much as we want to cheer for fewer hospitalizations (and likely fewer deaths), there’s another really important outcome for COVID-19 that can have big impacts on quality of life and societal function. We won’t be out of the woods until we address that issue. Third, the risk for the immunocompromised is still significant. There are also some data out of Georgia that we might want to keep in mind. The graph below shows the weekly case totals (from PCR tests) for each age group for the past 8 weeks. The data are sourced from the Georgia Department of Public Health weekly status reports. The increase seems to be slowing down for all age groups, but some of this may be an artifact of the Memorial Day holiday in the most recent week. But something interesting to me is that cases declined for all K-12 aged kids in the most recent week. A lot of schools wrapped up the school year in the last two weeks. And college aged adults saw a really small increase after several weeks of big increases. It could be a plateau, it could be Memorial Day delays. It could also have to do with colleges dismissing for the summer and students scattering away from that communal living environment.
As for the larger picture and optimism, I’m continuing to hold my breath until we see what happens to the rest of the country in this wave and to see what this winter looks like. I would like to see a winter wave that is far less severe than 2020 and 2021 before I start talking about “moving on.”
COVID hits home
All the same, one of those cases for Region 7 this week is my husband. Last weekend, we went on a multi-state voyage. We were planning to camp in Omaha, Nebraska with friends and also go to Ames, Iowa to see our son compete in the Odyssey of the Mind World Championships. We dropped our camper off in Omaha (a 3 hour drive), then proceeded to Ames (another 3 hour drive). We had our dog with us so we had to alternate turns going in to see the competition and the chaos of that many teenagers all in one place. We all had masks on and I’m really glad that was the case in hindsight.
As we left our son in Ames (he had a few more days of festivities), my husband mentioned that he felt really achy and congested. I knew he was congested, but so was I - it is cottonwood season around here and that’s something that usually sets off our allergies. I had tested that morning since we were going to a crowded place and also because I woke up with some congestion. I was negative. I assumed the same was true for my husband that morning. But hearing the muscle aches thing was different than my symptoms and not really something we experience with our allergies. So we drove to a Walgreens and got a COVID-19 antigen test kit. The test was screaming positive before the liquid even reached the control line. And then, the thoughts I had included things like how long has he been contagious? We’ve been riding in a truck together for 6 hours so far today. My booster dose was in late November (incidentally so was my husband’s). Our younger son was in the back seat and he had COVID-19 in January. But he hadn’t yet been boosted. We made the decision that it was going to be really difficult to isolate him in our camper and keep me protected. We were going on a much bigger camping trip next week and didn’t want to miss that due to overlapping infections. We also wanted to be near medical care that we were familiar with in the event that his case was more serious. So we all put on KN-95 masks and drove with the windows cracked back to Omaha to collect our camper (3 hour drive) and then back to Kansas City (3 hour drive). Miracle of miracles, I have not tested positive at all despite being less than 3 feet away from him for 12 hours in the car, only half of which was masked. Our younger son is also still negative. But I got him boosted the next day.
My husband went to urgent care when we were back in town for a PCR confirmatory test. We wanted an official record of his test result in case he developed Long COVID. We also wanted to get treatment (i.e. Paxlovid) to shorten the duration of illness and prevent him from spreading it to me. He was denied because he’s healthy. It didn’t matter that I had an underlying condition. My husband didn’t push it. I’m not sure if there is a shortage of Paxlovid and providers are rationing the medication? Was the provider a COVID minimizer? In any case, yesterday was day 7 and he was still showing a strong positive test result. We are hoping that he tests negative by the time we leave for our camping vacation so that we don’t have to drive across the plains with masks on and the windows cracked.
Travel update
The next two editions of the newsletter will have a different feel to them. We are going on a multi-week camping adventure. Camping is something we were into prior to the pandemic, but really leaned into once the pandemic arrived. Last year we went for 3 weeks, exploring northern Colorado and Utah. Dinosaur National Monument was our big destination - totally worth a visit, by the way.
This year, we’re going back to Colorado, but not really spending as much time there as last time. This year our destinations include Garden of the Gods (CO), Jackson Hole, Grand Teton National Park and Yellowstone National Park (WY), Wind Cave National Park, Badlands National Park and Mount Rushmore (SD). Then we’ll make our way back home. We’ve never been to Yellowstone and our kids haven’t seen any of these destinations, except Garden of the Gods. We really want them to see all of these things before climate change, wildfires, or other things change these national treasures.
So in a sense, you’ll be coming on this journey with me. I’ll share more on why camping is sort of “pandemic proof,” pictures of our adventures, etc. There may be some science lessons along the way too. My boys will tell you that there’s no getting out of that. Those PCR tests we all talk about for COVID-19? There’s a connection to Yellowstone National Park. Stay tuned for that.
Thank you for your support of the COVID Digest.
My Ph.D. is in Medical Microbiology and Immunology and I am Chair of the Division of Natural Sciences and Mathematics at the University of Saint Mary. I've worked at places like Creighton University, the Centers for Disease Control & Prevention and Mercer University School of Medicine. All thoughts are my professional opinion, do not represent the views or opinions of my employer and should not be considered medical advice.
Sorry to hear about your husband's diagnosis. I suspect the doctor didn't prescribe Paxlovid because there are some strong side effects and there's new evidence of covid rebound. I think the risk-benefit analysis has changed since it was first made widely available. My 18yo son recently tested positive and I gave my doctor the head's up. She was willing to send a script for me to have on hold in case I got it (I'm also higher risk), but she advised that I only take it if my symptoms were more than mild. She said she'd need me to stop all other meds too. So even with my health risks, she wanted me to consider it carefully.
Love your fact dense weekly updates. Can't wait for yellowstone connection!