Has the second wave begun?

Not everywhere, obviously. The most basic fact about COVID-19 in the United States in April was how stark regional disparities can be. New York City became the global epicenter of the disease while much of the U.S. remained largely untouched; right now NYC is seeing daily deaths shrink to nearly zero while cases are ticking up elsewhere. There won’t be a *national* second wave — I hope — for the simple reason that different regions are at different stages of containment, recovery, and reopening.


But statewide or regional second waves? That’s possible.

Per WaPo, they may be underway:

Since the start of June, 14 states and Puerto Rico have recorded their highest-ever seven-day average of new coronavirus cases since the pandemic began, according to data tracked by The Washington Post: Alaska, Arizona, Arkansas, California, Florida, Kentucky, New Mexico, North Carolina, Mississippi, Oregon, South Carolina, Tennessee, Texas and Utah…

Adding to the disparity in health-care support, residents in states such as Mississippi, Florida and South Carolina are living under only minor-to-moderate restrictions — even as their average daily infection rate is rising.

The problem with using case counts to try to measure a new outbreak is that they don’t take into account the effect that increased testing might have on those counts. If confirmed cases are up five percent in a given state but that state is suddenly testing 25 percent more patients than it used to, the apparent “rise” in cases may be a simple matter of better detection. It’s not that there are more infections out there, we’re just seeing more of the ones that already exist. We look to the positivity rate (the number of confirmed infections divided by the number of tests), not the raw case count, for a truer gauge of whether the disease is spreading.

That logic doesn’t apply to deaths and hospitalizations, though. There’s no “detection” problem there; if those numbers are up, it’s a strong sign that the total number of infections really has risen. CNBC notes today that hospitalizations are indeed on the rise in Texas. And the positivity rate? That’s up too.


There are currently 1,935 Covid-19 patients in hospitals across the state, topping the previous hospitalization record of 1,888 patients on May 5, according to new data from the Texas Department of State Health Services…

The coronavirus has infected more than 75,400 people in Texas, according to data from Johns Hopkins University. The positivity rate for Covid-19 tests in Texas reached a low of 4.27% toward the end of May but has since jumped to 7.55%, according to the state’s health department.

“Texas was among the first states to relax its statewide stay-at-home order, allowing it to expire April 30 and some businesses to resume operations May 1,” the report adds. The good news, though, is that there’s still plenty of ICU capacity in Texas hospitals at the moment, with 1,600 beds available. An increase in infections is an inevitable and foreseeable consequence of reopening; the key is holding those infections down at a level where hospital services aren’t overwhelmed. Texas is managing that. For the moment.

Arizona isn’t so lucky. Cases are rising there too, enough so that some hospitals are already under strain. And as in Texas, it’s the positivity rate that’s increasing, not just the case count. There’s every reason to believe that the COVID-19 epidemic there is getting substantially worse:

New, confirmed cases in Arizona totaled 4,500 from May 24 to May 30, according to the Arizona Department of Health Services, as of Saturday morning. That’s nearly a 50% increase from the week before…

Across all Arizona hospitals, 34% of ventilators were in use on [Thursday], according to the Arizona Department of Health Services. In late March, by comparison, 20% to 23% of ventilators were in use…

The health department’s data show cases increasing at a faster rate than diagnostic testing. The week ending on May 30 saw tests increase by about 14% statewide, compared to the 50% increase in cases. The same week saw tests increase by about 34% in Pima County, compared to the 85% increase in cases.


The report adds that “Banner Health is reporting its ICUs are at full capacity in Maricopa County and rapidly approaching full capacity in Tucson.” Over the weekend the Arizona Department of Health Services sent a letter to all state hospitals urging them to activate emergency plans, like preparing surge beds and postponing elective surgeries, so that ERs are ready for rising demand.

Here’s what the positivity rates look like in Arizona and Texas. Overall, across the entire U.S., the rate is waaaaaaay down off its peak and holding steady below five percent for the moment, which is great. But in AZ, it looks like this:

And like this in Texas:

It’s up in states like Georgia and South Carolina too since late May. There may be a “protest effect” in that, with the virus spreading at demonstrations and then showing up in the positivity rate as protesters get tested. But the protests are too recent to be driving the rise in hospitalizations, I think. That’s mainly a function of reopening and/or people choosing to start ignoring lockdown orders. (Texas began lifting restrictions at the very end of April and Arizona’s stay-at-home order expired in mid-May.)

There’s every reason to think the protests will exacerbate this ominous trend with even greater hospitalizations and deaths in a week or two, though.

Relatedly, one more data point from Nate Silver, who noticed a dramatic shift in polling in Pennsylvania last week on the subject of lockdowns:


Silver wonders if the hypocrisy of public health experts, who turned on a dime from opposing mass gatherings to supporting them for the cause of social justice, has caught up to them by weakening overall support for social distancing, at least among non-Democrats. If the local health department is fine with protesters flouting the rules for political reasons, why shouldn’t business owners and consumers get to flout them for economic reasons?

In lieu of an exit question, keep your eye on this trend in California. The positivity rate there is flat, which is reassuring, but there are other signs of a crisis developing. Infections apparently originating in Mexico have begun to overwhelm hospitals in the southeastern corner of the state, requiring some patients to be transferred hundreds of miles to the north, where there’s capacity, for treatment. Stay tuned.


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