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July 1st Impressions: is the southern and western COVID-19 surge spreading?

Updated: Jul 7, 2020

The PolicyLab group has put out a new blog post discussing projections for July in the 519 counties included in the model. I encourage you to check out the website and look at the graphs and projections for various counties. This week has the most dire forecasts seen to date, with Florida surging out of control all over the state along with parts of Texas and Arizona, and many places experiencing clear upticks that is in danger of getting out of control. The key lesson is that everywhere in the country, we need to be practicing basic vigilance to minimize time indoors in crowds and wear masks when indoors. The mask directives a month ago in North Carolina and Virginia have reversed upticks started there, and hopefully the recent muncipality-directed mask directives in Texas, Florida and Arizona along with higher levels of public vigilance can help reverse the surges and get the virus more under control.

Here are my impressions stepping around different regions of the country looking at the recent case and testing positivity numbers as well as the PolicyLab model projections. First I will start with my summarizing points, and then more detailed observations:

Summary points:

· The undeniable surge in AZ, TX, FL, and SC continues, and should probably also be considered to include NV.

· It threatens to spread to other southern states showing upticks, including Georgia, Alabama, Mississsippi, Louisiana, Arkansas, Tennessee, and North Carolina, as well as tornado alley state including Oklahoma, Kansas, and Missouri.

· The I95 corridor is also a threat with increasing travel to bring some of the extra disease northeast to middle Atlantic states that are stable for now but are teetering around R~1 that could very quickly become an uptick.

· The surge also threatens to spread throughout the west, with Nevada, Utah, Idaho and Oregon prone, and Washington also vulnerable.

· At the state level, California has had a stubbornly stable viral rates with daily cases increasing proportional to testing, but recently showing an uptick in testing positivity rate suggesting the virus may be advancing, along with numerous hot spots with growing upticks. Given the enormous population of this state, it is essential to prevent this uptick from becoming an out of control surge.

Southern and Western Surge:

The current southern/western surge has progressed at an alarming rate – AZ, TX, FL, and CA account for >1/2 of new daily cases in USA.

· In Arizona, Maricopa county’s surge has stressed the medical facilities, and if it does not flatten quickly we could see the need for rationing of care reminiscent of Lombardi, IT and Queens, NYC earlier in the pandemic. Pima, Pinal, and Yuma counties in Arizona are also experiencing upticks in danger of further surge. Note that Arizona has activated their “Crisis Standards of Care” the other day that outlines their prioritization process for triaging and rationing care.

· The surge is hot in all parts of Florida, with alarming transition into exponential growth in many places including Tampa, Orlando and Miami areas but surges all of the state. During this pandemic, when a state shows evidence of an uptick or surge it is usually primarily driven by one part of the state, but here we see nearly all counties in Florida surging strongly, east and west, north and south, coastal and interior. This has the makings of a super spread feeder for the rest of the country.

· The surge in TX continues with alarming exponential growth evident in Dallas, Houston, and San Antonio and many surrounding suburbs, and surges also evident in the Austin area, and upticks in El Paso and Lubbock, as well. Texas is another potential seed for super-spread to other states.

· CA has large increases in counts per day, but does not yet have evidence of a broad surge as encountered in TX and FL, and the testing positivity rate has not significantly increased like those states. But a number of areas in CA are showing clear upticks that could be in danger of becoming surges if they continue, including Sacramento, the bay area, and southern CA including the coast and inland desert regions, plus inland Fresno. Testing positivity has held firm around 4% since early May, but in late June has crept up near 6% indicating potentially increasing spread.

Potential Expansion of Surge through the South:

· The surge in SC is nearly as alarming as AZ, TX, and FL, but perhaps less noticed because of smaller population. In particular, coastal counties including Horry, Charleston, and Beaufort are surging, perhaps propelled by tourism, as well as the broader Columbia area, and Greenville area is also showing an uptick as well. Increase in test positivity rate from 3% at end of May to 15% recently shows the alarm.

· Georgia has remained relatively stable since opening, but is showing sharp increases some places, with the Atlanta area showing surges in Cobb and Gwinnett counties and concerning upticks in DeKalb, Fulton, Douglas, and Cherokee counties. Also, some coastal areas of Georgia are showing surges, including the Savannah area in Chatham county and Richmond county containing Augusta. Other areas of concern include Whitfield county in the north, Lowndes county containing Valdosta in the south, central Bibb county containing Macon, and western county Moscogee containing Columbus. Especially with its proximity to South Carolina and Florida and increasing travel, Georgia may be at risk for starting to grow out of control. The test positivity rate, hovering around 5-7% in early June, has increased to 11-13% in late June.

· Mississippi is experiencing a surge in the greater Jackson area, including Hinds, Madison and Rankin county plus DeSoto county in the north and central Grenada county are showing upticks.

The test positivity rate data is noisy, but has shown increases from steady 5% rate in late May and early June to 10-15% rate in the past week or two.

· Alabama has a number of counties showing recent upticks, including Jefferson, Montgomery, Lee and Marshall counties, all having R slightly above 1 that could go either way with Mobile on the coast showing evidence for a sharper surge and a higher R. Many other counties are at R~1 so need to be watched for potential upticks. Test positivity rate has hovered between 7% and 14% throughout June, and given its proximity to surging South Carolina, Florida, and Georgia is in danger of continuing increase.

· In Arkansas, Little Rock in Pulaski county may be experiencing the start of a surge, with R up near 2, and Benton, Crittenden, and Washington counties showing evidence of June upticks that are concerning. The test positivity rate in the state has increased from ~5% in late May up close to 9-10% at the end of June.

· Parts of Louisiana experienced upticks in early May that came back down, but many counties in Louisiana shows recent evidence of upticks and surge potential like the rest of the south, with many places showing R>1, and several showing indications of a possible ongoing surge, most notably Calcasieu, Lafayette, and Orleans counties. Test positivity rate has crept up slightly from 5% to 7% in June, but not as notably as other southern states.

· North Carolina has been teetering along the R~1 ridge, with potential to go either way. They have held up, but many counties are showing evidence of sustained upticks, including Durham, Guildford, Mecklenburg, Carrabus, Cumberland, Davidson, Johnson, and Union, and with Wake county the most concerningly looking like a significant surge. Test positivity rate has hovered around 7% for the entire month of June.

· Tennessee is similar to North Carolina, flirting with R just above 1 and producing some concerning upticks, including Davidson, Hamilton, Knox, Rutherford, Sumner, Williamson, and Wilson counties, and the Memphis area in Shelby county showing the most concerning increase. Test positivity rate has crept up from ~5% at the end of May to ~8% at the end of June.

Tornado Alley:

· In Oklahoma, Tulsa seems to be experiencing an outright surge with increasing R, and Oklahoma City is also experiencing an uptick. The testing positivity rate, which was very low at the end of May at 2%, has increased to 6-7% by the end of June.

· Kansas is also starting to show some areas of concern, with upticks evident in Johnson, Sedgwick, Shawnee and Wyandotte, KS, and the testing positivity rate has increased from 3-4% at the beginning of June to near 9% the end of June.

· Counties around St. Louis and Jackson county in Kansas city also show evidence of upticks, and statewide the testing positivity rate has increased from 3% to 6%

Expanding Western Surge:

· Most notably, Nevada looks destined to become the next state experiencing an undeniable surge. The tourism and indoor activities seemed destined to produce a surge here, and the numbers are backing that up, as Las Vegas in Clark county is clearly surging, with R consistently above 1 since the beginning of June and cases per day increasing 10-fold up to 1000/day. Washoe county is also showing clear upticks. The testing positivity rate has surged from ~2% at the beginning of June up over 15% by the end of the month. It can probably be considered along with AZ, TX, FL and SC as the undeniably surging areas of the USA.

· Boise, Idaho (Ada county) has started to surge in the past two weeks, experiencing 5-10 fold increases in daily counts/day and R well above 1. Also, the testing positivity rate has also spiked from 3% to 12% during that time. The population of Idaho is not large, but should be considered part of the Western surge.

· Utah is also experiencing growing virus, with Salt Lake, Utah, Washington and Davis counties all showing sustained R>1 and clear upticks, as the testing positivity rate has increased from 5% at the end of May to 10-15% at the end of June.

· Oregon also shows some evidence of upticks, in particular Marion, Multnomah and Washington counties, and a testing positivity rate that has increased from 2% at the end of May to 4-5%+ by the end of June.

· Washington has most areas with R~1, with some problem areas, including King county, and Benton, Franklin and Spokane that have small but increasing counts. The test positivity rate has remained stable around 5% in June.

States teetering around R~1:

· The middle Atlantic states have been steadily decreasing for a while, but this decrease has flattened. Many parts of the region have R~1, showing vulnerability that any uptick could produce growing infections again. This includes southeastern PA, New York City, much of New Jersey, Delaware, Maryland, Virginia and much of North Carolina. These appear fine now, but this could change quickly if the increased travel and surge in the south brings additional virus to the area in the midst of its reopening. Baltimore city and County in MD show some upticks.

· Kentucky also seems to have R~1, and with relatively stable test positivity rates of 3-4%.

· Colorado has not experienced any upticks since opening, but similarly is teetering around R~1 in many counties, so should be watched with the surging states to its west and south. Nearby New Mexico also has places with R~1 that should be watched given the other surging states in the southwest.

States with R<1

· New England has continued to decrease, showing R<1 across counties in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island and Connecticut.

· In the Midwest, we also see decreasing counts in most of Iowa, Indiana, Minnesota, Wisconsin, South Dakota, North Dakota, Indiana, Nebraska and Michigan. Most of Ohio looks pretty good, except a few counties including Hamilton and Montgomery showing potential upticks.

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