COVID-19 day 315: 📈 On three separate days, more than 1 million Americans flew during Thanksgiving week : 29 November 2020

Hospitalizations cross 93K; masks work (Kansas data); patients with severe pneumonia who received convalescent plasma showed no improvement relative to patients with placebo

Sunday was day 315 since the first case of coronavirus disease was announced in the United States. Despite health warnings and pleas for Americans to stay home and celebrate Thanksgiving in single households, Wednesday was the busiest travel day of the year. TSA reported that 1,070,967 passengers cleared airport security. Last year, TSA screened 2,602,631 on Thanksgiving eve.

It was the fourth time since 16 March 2020 that TSA has reported more than 1 million passengers and the third time in one week. In addition, TSA screened almost a million passengers on Saturday, a little more than one-third as many as in 2019, and 820,399 on Friday.

More than 93,000 Americans were hospitalized with COVID-19 on Saturday (Sunday report), the most since the outbreak began. Hospitalizations are at
record levels in several states including Indiana, Pennsylvania, Oregon and Washington.

Sections (no jump links, sorry!)
1, One big thing; 2, Recommendations; 3, Politics, economics & COVID; 4, Key metrics;
5, Resources

⓵ One big thing - post-Thanksgiving quarantine

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told ABC’s “This Week” anyone who has traveled “outside of the family setting in which they really don't know the level of exposure” should, if possible, “quarantine yourself for a period of time or even get tested to make sure that you are not bringing infection back.”

The US Centers for Disease Control and Prevention recommends that a person quarantine after being in close contact, or “6 feet of someone who has COVID-19 for a total of 15 minutes or more.” The CDC also recommends Americans take precautions such as mask wearing inside the home, hand washing, and social distancing “regardless of where you traveled or what you did during your trip” to protect others from getting the virus. The agency also advises Americans to follow guidelines in states that require travelers to quarantine or get tested.

US Surgeon General Jerome Adams, on FOX News: "For those who did travel and those who did attend large gatherings, we want you to know it's not too late to take measures to slow the spread of this virus.” You do that by quarantining, not entering isolation.

Dr. Deborah Birx said that anyone who traveled should avoid contact with family members over 65 or those with underlying illnesses:

[Travelers] have to assume that you were exposed and you became infected and you really need to get tested in the next week.

“[M]any people who celebrated with family, with friends over Thanksgiving will find themselves in the hospital, in ICUs over Christmas and New Years,” Dr. Celine Gounder, a member of President-elect Joe Biden's COVID-19 advisory board told CBS.

Remember: a negative test today means you were not infected about five days ago, not that you are clear today.

Canada celebrated its Thanksgiving six weeks ago, and the number of daily cases there more than doubled. Our surge-upon-the-current-surge is expected to be worse given that we have doubled our daily case seven-day average since 01 November.

Arizona “risks a catastrophe on the scale of the worst natural disaster the state has ever experienced,” due to hospital overcrowding. There were no ICU beds available to accept cases from a rural hospital. In Wisconsin, leaders of a rural health system have “began drawing up protocols for the once unthinkable practice of deciding which patients should get care.”

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⓶ Recommendations

🤓 Recommended reading

We’re tired of seeing patients who got the virus after their kid’s “limited” birthday party or because they went out to a restaurant dinner with “close friends” or flew to a celebration in a state “that didn’t have much COVID.” … COVID doesn’t care how you vote, where you live or if you die. The fire burns all around us and we are dry grass, from sea to shining sea.

Reminder: a single wedding of 55 people in Maine infected 27 guests. Those people infected at least 176 people over the next 38 days. Seven of those 176 people, who did not attend the wedding, died.

Op-Ed: On the COVID frontlines, we’re tired of hearing lame excuses for risky behavior. LA Times, 23 November 2020.

▪️ America today: a surging stock market and record lines at food banks. The number of people who filed for “first time” unemployment benefits “hit 778,000 last week, more than three times the rate a year ago.” 

Those two lines tell the story of the “K-shaped” recovery in America. The top line of the “K” is up and to the right, for the investor class. The bottom line is down and to the right, for the working class, the working poor and the unemployed.

This Thanksgiving, millions of Americans are going hungry in the midst of Covid. MSNBC, 26 November 2020.

The Asia–Pacific region models to the rest of the world that a zero-COVID strategy works and should be prioritised as a highly effective strategic response.

We should learn from the Asia–Pacific responses to COVID-19. The Lancet, 27 November 2020.

🔬 Research and medical news

▪️ Until now, there has been anecdotal support for convalescent plasma as a COVID-19 treatment but little from randomized trials. In this study, 228 patients received convalescent plasma, and 105, a placebo.

No significant differences were observed in clinical status or overall mortality between patients treated with convalescent plasma and those who received placebo… Our data are consistent with the recently published results of a randomized, controlled trial in patients with moderate Covid-19 that showed no difference in severe disease or death at day 30…

A Randomized Trial of Convalescent Plasma in Covid-19 Severe Pneumonia. New England Journal of Medicine, 24 November 2020.

▪️ Masks work.

The governor of Kansas issued an executive order requiring wearing masks in public spaces, effective July 3, 2020, which was subject to county authority to opt out. After July 3, COVID-19 incidence decreased in 24 counties with mask mandates but continued to increase in 81 counties without mask mandates.

Trends in County-Level COVID-19 Incidence in Counties With and Without a Mask Mandate — Kansas, June 1–August 23, 2020. CDC MMWR, 27 November 2020.

▪️ According to KHN research, “about 3 in 4 counties in Kansas and Missouri don’t have a single intensive care unit bed.”

A recent patient count at St. Luke’s Health System in Kansas City showed a quarter of COVID patients had come from outside the metro area. Two-thirds of the patients coming from rural areas need intensive care and stay in the hospital for an average of two weeks.

Rural Areas Send Their Sickest Patients to Cities, Straining Hospitals. KHN, 24 November 2020.

▪️ Neither breast nor prostate cancer were associated with increased COVID-10 case–fatality rate, per a Lancet research report in October.

Patients with haematological malignancies were at a greater risk of having a more severe COVID-19 clinical phenotype, to require more intensive supportive interventions, and to suffer an increased risk of death compared with patients with non-haematological malignancies…

Patients with breast cancers or malignancies of the female genital tract appeared to be at a much lower risk of contracting or dying from COVID-19. However, multivariable analysis showed that this protection was due to patients being women, rather than an inherently lower risk associated with these tumour types.

COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. The Lancet, 01 October 2020.

🎦 Recommended viewing

⓷ Politics, economics and COVID-19

🦠 Merriam-Webster announced its 2020 word of the year: “pandemic.”

📣 In a 5-4 vote just before midnight Wednesday, the U.S. Supreme Court sided with plaintiffs arguing that religious gatherings should be accommodated despite a surging pandemic. The plaintiffs: the Roman Catholic Diocese of Brooklyn as well as a Jewish organization, Agudath Israel of America, in concert with with two synagouges, Agudath Israel of Kew Garden Hills and Agudath Israel of Madison.

This contrasted with earlier decisions in California (May) and Nevada (July), where the court agreed that governors have authority to restrict attendance at religious services. In the earlier rulings, Ruth Bader Ginsburg was with the majority. In this case, Amy Coney Barrett sided with the court’s conservative members.

✅ On Thursday, Pope Francis wrote a rebuttal (of sorts) in the NY Times:

Yet some groups protested, refusing to keep their distance, marching against travel restrictions — as if measures that governments must impose for the good of their people constitute some kind of political assault on autonomy or personal freedom! Looking to the common good is much more than the sum of what is good for individuals. It means having a regard for all citizens and seeking to respond effectively to the needs of the least fortunate…

❌ Also on Thursday, Brazilian President Jair Bolsonaro said that he would not take a COVID-19 vaccine. With 6,314,740 cases (Sunday), Brazil follows the US (13,383,320) and India (9,431,691) in leading the world in total cases. Brazil is second in deaths (172,833) to the US (266,873, all Johns Hopkins data).

❌ A Salem, OR, nurse was placed on leave this weekend after she posted TikTok video “where she stated that she did not wear a mask out in public away from work and let her children engage in play dates.” It’s 2020; people still don’t know better?

🆘 California’s local governments are imposing local restrictions.

Los Angeles County will impose a lockdown calling for its 10 million residents to stay home. Santa Clara County, which includes San Jose, is banning all high school, collegiate and professional sports and imposing a quarantine for anyone traveling into the region from more than 150 miles away.

This means that the San Francisco 49ers are without a home field for at least three weeks.

In addition, Los Angeles Mayor Eric Garcetti is requiring anyone entering the city from another state or country to complete an online form at travel.lacity.org. Those arriving at LAX and Van Nuys Airports will see signs to prompt them to complete the required form.

✅ On 19 November, New Hampshire became the most recent state to mandate masks. The mandate applies “to all indoor public spaces and outdoors when social distancing cannot be maintained.” Some states have limited mask mandates. See the Axios map.

⓸ Key metrics

🦠 Friday, Johns Hopkins reported 13,088,821 (205,557 new) cases and 264,858 (1,404 new) deaths, an increase of 1.60% and 0.53%, respectively, since Thursday. A week ago, the daily numbers increased by 1.67 % and 0.74%, respectively.

  • Friday
    - cases 🔺22.2% compared to seven-day average; deaths 🔻5.9%
    - seven-day average: 🔺168,280 cases and🔺1,492 deaths 
    - 2.02% cases leading to death
    - 51.2 cases/100K (CDC)
    - 1,172,280: cases last seven days (CDC)

  • One week ago
    - cases 🔺30.4% compared to seven-day average; deaths 🔻16.6%
    - seven-day average: 🔺167,646 cases and 🔺1,440 deaths 
    - 2.12% cases leading to death
    - 49.7 cases/100K (CDC)
    - 1,173,523 cases last seven days (JH)

Note: the seven-day average is important because dailies vary due to factors other than actual case numbers, particularly over a weekend.

🇺🇸 27 November 

  • CDC: 12,823,092 (324,358 new) cases & 262,673 (3,668 new) deaths (no report Thursday)
    One week ago: 11,650,817 (185,095 new) cases & 251,715 (2,045 new) deaths

  • State data*:  12,709,043 (199,475 new) cases & 254,530 (1,389 new) deaths
    One week ago: 11,755,246 (192,911 new) cases & 245,606 (1,869 new) deaths
    KS reports only M-W-F; CT and RI report only M-F

  • WHO: 12,441,925 (0 new) cases & 257,825 (0 new) deaths (not reported)
    One week ago: 57,564,078 (665,668 new) cases & 1,372,182 (11,801 new) deaths

🌎 27 November

Johns Hopkins interactive dashboard (11.00 pm Pacific)

  • Global: 61,645,530 (671,899 new) cases & 1,442,664 (10,617 new) deaths
    One week ago: 57,564,078 (665,668 new) cases & 1,372,182 (11,801 new) deaths

* Johns Hopkins data, ~11.00 pm Pacific.
State data include DC, Guam, the Northern Mariana Islands, Puerto Rico and the US Virgin Islands

The virus was not created in a lab and the weight of evidence is that it was not released intentionallyAlthough early reports tied the outbreak to a market in Wuhan, China, analyses of genomic data have suggested that the virusdeveloped elsewhere.

⓹ Resources

👓 See COVID-19 resource collection at WiredPen.
📝 Subscribe to Kathy’s COVID-19 Memo :: COVID-19 Memo archives
🦠 COVID-19 @ WiredPen.com
📊 Visualizations: USWorld
🌐 Global news (at WiredPen)

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