COVID Cases Rise: What Does it Mean?

Last week (the week of June 13) there was another big drop in U.S. COVID cases, the ninth straight week of falling numbers, but this past week the trend suddenly reversed and cases started rising again. You may not have heard this news yet; I noticed because I watch the trends daily and saw an increase four consecutive days after a very long string of declining days. It means either the curve is flattening or we are at the start at of another flare-up in cases. The rise is significant in a few states, although still declining or flat in most. So, do we need to be alarmed?

We knew eventually the decline had to end; otherwise, we would see cases continue to trend towards zero and that has not happened anywhere in the world the last two years. We may be at the bottom right now or we may eventually go lower still. Remember, we saw a rise in U.S. cases earlier this year between March 16 and April 14 (from 55,000 per day to 73,000 per day), only to see them fall precipitously again the next nine weeks. When you are in the midst of an upward swing, you don’t know if it is the start of something big or if it is a blip that will soon be forgotten.

As of Friday, June 25, COVID cases stand at around 12,500 per day and deaths from COVID around 300 per day, both numbers much lower than we’ve seen in the last 15 months.

What to Expect Next:

As I have often preached, the statistics can also help us determine where we are headed by seeing how we got where we are now. We can examine the states doing the best and determine what factor is responsible for their qualitative edge. We do this by looking for a correlation between a mitigating factor and the current per capita death and cases rates.

To study this I looked at two mitigating factors to determine the impact each is having. Clearly, the vaccination rate is a factor which must be considered. The second factor I considered is the case per capita rate for the duration of the pandemic; higher case rates are synonymous with higher natural immunity levels, so I use per capita case rates as a proxy for natural immunity levels. So, the question is: are the states with higher vaccination rates (artificial immunity) and higher natural immunity rates doing better than those with lower rates?

For vaccination rates, I divided the states into five groups based on when states hit 50% partially vaccinated. Ten states hit this milestone in April; these states currently have 61.4% or more of their citizens vaccinated. The second group hit the mark between May 5 and May 15. The third group hit the mark between May 25 and June 23. The fourth group I project will hit 50% in July and the last group are the ones lagging behind. Overall, the U.S. has partially vaccinated 54% and fully vaccinated 46% as of Saturday, June 26 and a little more than half the states have hit 50% or more partially vaccinated (source: More Than 2.89 Billion Shots Given: Covid-19 Vaccine Tracker (bloomberg.com))

What I found is that the case rate is lowest for the first and second groups. The rates are similar for the last three groups; the last three groups could probably be combined into one group as there the correlation does not hold among these groups. The case rate for the last three groups is about 2.5 times higher than for the first group and the death rate is about 30-40% higher. These numbers indicate that higher vaccination rates are reducing cases and deaths, especially when the rates get into the mid-fifties. States like Florida and Michigan that just hit the 50% mark in the last two weeks, may expect to see further declines soon if the pattern holds.

States	WHEN HIT 50% (current rate)	Population	Deaths/ Day	Deaths/1M	Cases/day	Cases/1M
NH, ME, CT, MA, VT NM, RI, HI, NJ, PA	4/14 to 5/1 (61.4 to 73.4%)	40,041,943	29	0.72	725	18.11
CA, MD, DC, NY, WA, VA, MN, DE, IL, OR, CO,	5/5 to 5/15 (57.4 to 61%)	111,129,135	95	0.85	3005	27.04
WI, FL, IA, MI, NE, SD	6/6 to 6/25 (50.2 to 53.3%)	43,261,165	46	1.06	1939	44.82
AZ, KY, KS, NV, UT, AK, OH, TX, MT	(47.4% to 49.1%)	63,431,122	62	0.98	3152	49.69
NC, OK, MO, IN, SC, ND, WV, GA, AR, TN, AL, ID, WY, LA, MS	(35.9 to 45%)	70,735,978	65	0.92	3123	44.38

source: United States COVID: 34,490,134 Cases and 619,343 Deaths – Worldometer (worldometers.info)

These results indicate that vaccines are doing what they are supposed to do and that continued vaccinations should eventually lead to better results and are likely thwart this latest increase.

I do want to caution, however, there are risks to the vaccines as I discussed in detail last week: COVID: Fauci is the Science, Check Your Mask at the Door, and Be Informed on Vaccines – Seek the Truth (seek-the-truth.com). Those least vulnerable to COVID should carefully weigh the risks before being vaccinated. On the other hand, more than 90% of U.S. senior citizens have been vaccinated, so the people most at risk appear to be making sensible choices with regard to their own situations.

Also, the lower vaccination rates among states is not necessarily problematic; it depends on who is vaccinated. Boosting the numbers by vaccinating large numbers of youths may reduce case rates but may not have an impact on death rates. We’ve seen this in the UK the last two months. Cases in the UK have increased six-fold since May 8, a period of seven weeks, but deaths have barely increased during that time period. Last summer, the U.K. saw a similar increase in cases beginning in late August. Seven weeks into that wave, there had been an eight-fold increase in cases and a six-fold increase in deaths. What a difference a year and a few hundred million vaccines make.

The U.S. experienced a wave last summer as well, starting around the same time as this year. It is Deja Vu all over again. Last summer’s wave from bottom to peak lasted only seven weeks and then numbers fell again for a couple months. How long will this current run-up continue and how severe will it be? Unless variants are a whole new ball game and we are starting from scratch, something many medical professionals have said is not the case, this one should be less impactful (more on variants below).

Unlike last summer, we have a very large percentage of folks with natural or artificial (vaccine) immunity, so we should not panic. Last summer, COVID became the second leading cause of death in the U.S.. Currently, it is the seventh leading cause of death. The numbers may rise again for a time, but the pattern has always been that the numbers rise but fall again after a period of time.

The second factor I looked at was the cases per capita rate for the duration of the pandemic. A few states in the top ten: North Dakota, South Dakota, Utah, Iowa, Arizona, Tennessee, Wisconsin, Nebraska, and South Carolina are not among the highest vaccinated group. Have these states fared better because they have more folks with natural immunity? Is this factor as significant as vaccine immunity?

To answer this question, I ranked all fifty states plus DC and divided them into groups of ten based on their rank (1-10, 11-20, 21-30, 31-40, and 41-51). I found no discernible correlation whatsoever. The states in the top ten along with the states in the bottom ten had the lowest death rates with the middle three groups being highest. The states in the bottom two groups had the lowest case rates, the opposite of what I expected to find. If natural immunity were a distinguishing factor, we would expect the top ten to be doing the best and the other groups progressively worse; we wouldn’t see the bottom ten with a lower death rate than the groups ahead of them.

States	Population	Deaths/Day	Deaths/1M	Cases/day	Cases/1M	Group Rank
ND, RI, SD, UT, IA, AZ, TN, WI, SC, NE	36,080,557	22	0.61	1287	35.67	1-10
OK, NJ, AR, DE, AL, NY, IN, FL, IL, GA	92,686,675	90	0.97	3719	40.12	11-20
KS, MS, NV, MN, ID, WY, MT, KY, TX, LA,	56,156,201	53	0.94	2717	48.38	21-30
MA, MI, MO, CT, NM, CA, NC, CO, PA, OH	108,929,036	109	1	3216	29.52	31-40
AK, WV, VA, MD, NH, DC, WA, ME, OR, VT, HI	34,387,054	23	0.67	1005	29.53	41-51

Natural immunity is without a doubt a significant factor in limiting further spread of the virus, but it is not currently a distinguishing factor when comparing the states, meaning that natural immunity offers baseline protection for folks in all states, but that baseline is not significantly more for any group of states. Right now, it is the vaccination rate that is a better predictor of how states will fare with the current increase in cases. It is likely why Massachusetts, a state of nearly seven million, has seen cases fall to about 10 per million while Missouri, a state of similar size, has a case rate 12 times higher (123 per million). Both states have had roughly similar numbers of people infected with COVID the last two years, but Massachusetts has a much higher vaccination rate than Missouri (70% partially vaccinated for Massachusetts versus 44% for Missouri). Should cases in Massachusetts begin rising again in the next few weeks, I will have to reevaluate this conclusion, but for now this seems a reasonable conclusion.

Nine states have seen a rise in cases rise significantly the last two weeks. None of these are in the top two tiers for vaccinations and only South Dakota is in the middle tier (50.2%). The rest are in the bottom two tiers.

State	% increase since 6/14
Missouri	50.4
Nevada	47.4
Arkansas	38.6
Oklahoma	27.5
South Dakota	27.3
Arizona	26.3
Utah	17.6
Louisana	8.4
Texas	6.1

So, what do we conclude from all this?

• The highest vaccinated states are doing the best right now. This is the conventional wisdom and in this instance the experts appear to be correct. We can further test this theory by waiting a few more weeks to see if the states in the top two tiers avoid a rise in cases and if the other states improve as their vaccination rates rise. This will be a significant test of vaccine efficacy. Can the vaccines get us to herd immunity or not? Vermont, with almost 75% partially vaccinated and Massachusetts and Hawaii with almost 70% may be nearing herd immunity. Mississippi, Louisiana, Wyoming, Idaho, and Alabama, all under 40% partially vaccinated may not achieve herd immunity and are likely more susceptible to future flare-ups.
• Unless the current vaccines offer no protection to variants, this increase in cases is likely to be short-lived and not that steep. We will without doubt see it turn around again before the end of summer; how much the rise will be is not clear yet.
• We will likely be living with some low-level of COVID for the foreseeable future. COVID has been mitigated and is less of a threat now than it was last year, but we can’t seem to eradicate it completely given the interconnected world we live in today.
• We need to learn the lessons from the last year and not reflexively return to mask mandates, lockdowns, and demagogic political rhetoric. COVID is more likely to be a risk on par with the flu going forward and we should take similar precautions and not blow its impact out of proportion.

Variants

What about variants though? Is the latest variant the big bad wolf we’ve been hoping against hope will stay away? We have been hearing for probably close to six months now about the risks from variants and the increase in cases in several countries appears to be linked to variants. I mentioned in a prior post that the increase in the UK has been linked to the new delta variant. Should we be concerned? Are we back to square one now because of these new variants? If you listen exclusively to Dr. Fauci you might think so, but I gleaned the following from our pediatrician in his most recent newsletter. His report is hopeful regarding the current vaccines and the delta variant:

Variants – SARS2 Version B 1.617.2 delta is emerging as a new trouble maker. First seen in India in December of last year, it is rapidly spreading in the United Kingdom and the western states of the United States. Early data for the delta variant is showing increased transmissibility (maybe 40% higher than the original strain) and maybe slightly more morbidity in the unvaccinated which is yet under study. The mRNA vaccines appear to be working quite well with the Pfizer-BioNTech vaccine showing 88% efficacy against symptomatic disease from the delta variant after 2 doses. (UK.Gov)

So far the trouble is only increased transmission against the unvaccinated and the poor responders to the vaccine. However, the vaccine still appears to be incredibly useful against hospitalization and death. I have not seen any data that children are at any significant increased risk. There are still no SARS2 variants of high concern leading to reductions in vaccine function or significantly increased mortality.

It seems we variants are here to stay and we better accept that and make needed adjustments to them. I just hope we put the risks into the proper perspectives, not pull the trigger too quickly (but not too slowly either) and not do more harm than good when responding. If the last year has taught us anything, it should teach us to take more deliberative and measured responses to new threats.

Other News

The World Health Organization (WHO) this week recommended minors should not receive the COVID vaccine. I have been saying for a while that the cost-benefit analysis doesn’t make as much sense for kids as it does for older or less healthy individuals.

The WHO Says Children Should Not Receive COVID-19 Vaccines — Precision Vaccinations

The WHO has unfortunately been unduly influenced by politics with regard to COVID, but I think this is a genuine reflection of concern for long-term effects that new vaccine technology may have on kids, most of which are not clearly known at this point.

Below is more from our pediatrician regarding vaccines and kids. My own research has shown that vaccines are effective, but we should target who is being vaccinated because there are clearly some serious risks.  The vaccine should not be a one-size fits all remedy.  The doctor has this to offer regarding a group which should be targeted:

If your adolescent children are obese, have asthma, cancer, diabetes, neurological disease, blood disorders, immune deficiency or metabolic dysfunction, please have them vaccinated.

German panel recommends COVID19 vaccine only for children with pre existing conditions based on all of the current vaccine data. (Reuters) This is in direct contrast to the United States recommendation to vaccinate all over the age of 12 years. (CDC webpage) The disparity follows from different perspectives on risk for children and the pandemic as whole. The German approach clearly feels that children are low risk in general and not worth taking the risk of a vaccine side effect whereas the CDC feels the opposite. I tend to agree with the German approach as long term safety data is years away.

For an excellent look at this topic, see the article by Dr. Martin Makary in Medpage Today. He states: “Returning to the discussion of the COVID-19 risk to kids (ages 0 to 12 years) right now, it’s worth aggregating the best available data to date. In reviewing the medical literature and news reports, and in talking to pediatricians across the country, I am not aware of a single healthy child in the U.S. who has died of COVID-19 to date. To investigate further, my research team at Johns Hopkins partnered with FAIR health to study pediatric COVID-19 deaths using approximately half of the nation’s health insurance data. We found that 100% of pediatric COVID-19 deaths were in children with a pre-existing condition, solidifying the case to vaccinate any child with a comorbidity. Given that the risk of a healthy child dying is between zero and infinitesimally rare, it’s understandable that many parents are appropriately asking, why vaccinate healthy kids at all? To those parents, I would say the primary reason to give a healthy child the vaccine may not be to save their life, it’s to prevent the multisystem inflammatory syndrome (MIS-C), which can be painful and have long-term health sequelae. According to the CDC, there have been 4,018 cases of MIS-C after COVID-19 with the average age being 9 years old. A total of 36 children died. Cases of MIS-C were heavily skewed toward minority children (62% were Hispanic/Latino or Black), likely due to the disproportionate rates of childhood obesity and chronic conditions in these populations. This finding again supports COVID-19 vaccination in any child with a medical condition, including being overweight.” (Makary M. 2021)

He also offers this advice to let us know we do have some control over our own fate:

Yet again, we see data pointing to our own personal control of our health outcomes. We can as parents make the following decisions to reduce our risk of MIS-C for our childrenNo matter what has happened in the past, clean up your child’s diet by switching to an Anti inflammatory diet, Whole 30 diet or at the least a no processed whole food diet of predominantly fruits and vegetable matter. A highly processed modern diet is the most important antecedent trigger of dysbiosis and intestinal permeability.

Finally, as I mentioned in a prior post, countries relying on the Chinese are not doing as well battling COVID. There is a resurgence of COIVD in countries like Chile, Brazil, and others which have relied on the Chinese vaccines. More than 90 countries have received the Chinese vaccines. Refer to this link for more:

https://www.bignewsnetwork.com/news/270011250/countries-relying-on-chinese-vaccines-reporting-surge

The article cites the following numbers:

While the Pfizer-BioNTech and Moderna vaccines have efficacy rates of more than 90 per cent, China’s Sinopharm vaccine has an efficacy rate of 78.1 per cent and the Sinovac vaccine has an efficacy rate of 51 per cent.

Israel, which has the second-highest vaccination rate in the world with shots from Pfizer after Seychelles, reports 4.95 new COVID-19 cases per million. On the other hand, Seychelles, which relied mostly on Sinopharm, that number is more than 716 cases per million.

I am somewhat dubious that Pfizer and Moderna are able to achieve 90% rates in a real world application of the vaccine, outside of clinical trials, although they have clearly done an effective job and the rate is likely very high if not actually 90%. I am outright dismissive of the rates that the Chinese claim for their vaccines. They appear to be failures and are likely offering very low protection rates, if any at all. This an unwelcome result and a significant setback for many countries around the world. It likely means COVID will be problematic even longer than we had hoped. The U.S. should fill the void and offer its vaccine to other countries in order to get the rest of the world back on track.