BBC reported earlier last month that lock downs in the Chinese city of Zhengzhou would result in delays to shipment of Apple products

That raises an interesting question of at this point in the COVID evolution (basically three years) are lockdown’s the right strategy.

Below is the monthly totals for US COVID cases and fatalities. Monthly cases peaked in January 2022 at 20.4m. Monthly fatalities peaked in Jan 2021 at 100,000 deaths.

Now consider the experience in China. Lockdown’s early in the COVID tenure were effective at controlling the pandemic. Now we see almost all COVID cases were experienced in 2022. But note – in a country with more than 4x the population of the US, peak cases were almost 2 million (that’s one tenth of the US peak).

Also note – monthly fatalities in November 2022 for China were 1,800 – whereas the total for the US was almost 10,000.

Reuters notes that some Chinese cities have begun to ease COVID curbs.

Global approach to COVID continues to deliver surprises and insights.

This one is puzzling. After following most of the world in seeing reductions post Omicron, the fatality rate in Portugal is increasing. The currently level is 2.8 fatalities per million of population per day. The CDC has a warning on Portugal here

According to Reuters – Portugal has administered almost 24 million doses of vaccine – enough to vaccinate 116% of the population. This begins to make me think – when do we need the next set of boosters? Perhaps Portugal is NOT boosted enough. At this point most of the people I know in the US are vaxxed and boosted.

Average daily data below:

Monthly data below:

May data (to the 27th) shows May is the 3rd highest rate of new cases since inception. Its also the 3rd highest level of monthly deaths in the last 15 months (that is since February 2021).

Let’s start with the US wrap up for COVID in January 2022 – in the context of prior month trends. Over 20 million covid cases reported – that’s the highest ever case number; higher even than India during the Delta surge. January recorded 59,000 deaths. Only 3 months have recorded more deaths in this pandemic. Total US deaths are now approaching 900,000.

Still think OMICRON is less troublesome….. when a very big number (like 20 million) gets multiplied by a small number (Omicron fatality rate)… its still a big number. Current average daily fatalities are about 2,400 total for the US. Only in January/ February 2021 have we exceeded those rates.

Average daily trend (this chart is a little busy… I need to edit my macros as I didn’t plan to be sustaining a 2 year time series!). Data points are plotted at month end (and max) points. Clearly cases have peaked!

State data as of 2-2-22

I had to recalibrate my US heat maps because Omicron numbers are so large – but lets cut to the chase and look at the average daily fatality rate across the states. Red is more than 10 fatalities per million per day…very high

As for one example – my home state of Tennessee has an average of 10.7 fatalities per million per day. That translates to single digit availability of hospital and ICU beds:

I’d expect a similar picture across many of the states in red.

While several states have certainly peaked (see NY below); case levels are still very high across the country (2nd chart below)

For those that prefer tables to pictures – here’s the data:

Mississippi is having a very significant surge in fatalities:

Global Context

Here’s India – just to put the US 20 million cases in Jan into context. India recorded 6.5 million cases:

France is currently one of the leading countries in the world for new cases. Over 9 million cases recorded in January – in a country with about 1/5th the population of the US.

Denmark (small population) is leading the world in per capita cases. It recorded almost 1 million cases – and the second highest month for fatalities in its history. Fully 15% of its population tested positive in January. How long until herd immunity?

Israel – almost the exact same numbers play out here. 17% of the population tested positive for COVID in January. It was the 7th highest month for covid deaths.

Africa is recording very little cases – and the epicenter of Omicron (South Africa) has clearly moved past its peak. A look at the global map shows very little activity. I’m not sure if I can put the same level of confidence in this data as we do for US and Europe. Notice how France, Denmark and Israel stand out:

Australia has fully joined the Omicron surge with average daily per capita cases in excess of 2,800. Its kind of shocking to see how an island nation with tough lock downs can have been so successful for some many months – only to see Omicron surge this way. January was the highest ever month for COVID fatalities.

Take a look at the charts below – which highlight since inception the top 3 months for absolute number of covid cases in each of the countries shown. Notably an off the charts rise in cases in some countries – due to Omicron. Likely also due to a much better testing regime. But the data clearly show that we are in an unprecedented surge – and also note – we are not yet at the end of the month (so December data is incomplete).

Here we go:

Current data in the US isn’t hitting one of the top 3 months of all time yet.

But the European data shows what the US can expect. The number of cases identified in France in December to date is 3x that of November – and higher than any other month in its history!

For Germany the last 2 months have been the highest – by a long margin. Also note the substantially increasing fatalities curve. Fatalities in December are 17 times higher than the low point post vaccination (August 2021).

Let’s take a quick look at the league tables. 6 European countries all have new cases per million per day over 1000

Spain shows a very high month in December – over 5x that of November

Denmark has the same pattern – along with a significant spike in fatalities

Ireland has the huge spike in cases, and a gradually and persistent rise in fatalities

UK appears to have a huge spike in cases but fatalities are relatively the same for the past 4 months. Notice how the UK fatality rate came down very quickly in early 2021 – following a very rapid vaccine rollout (opting to defer issuing the 2nd shot until many people had received the first shot).

But now the importance of getting boosted is getting reflected in the UK data. November fatalities in the UK are 15 times higher than the lowest level of fatalities post vaccination rollout.

While it may be too early to conclude – fatalities in this wave are a lot lower than the previous peaks in Dec 2020 / Jan 2021 – mostly resulting from the availability of vaccinations. But having said that a number of countries are experiencing fatality rates more than 10x the post vaccination lows. That’s going to put stress on the hospital systems of those countries.

How do we model this data for the US?

If the fatality curve of the European countries like Germany and the UK predicts the future for the US – then 10x the post vaccination low in deaths (July 2021) would be about 90,000 deaths per month. That is clearly going to be a stressful level for the hospital system.

Is that too unrealistic to contemplate? Well – lets look at NY.

December cases are already a record high – and almost 3x higher than in November. And current monthly fatalities are rising – and are 9x higher than the post vaccination low of 171.

While NY has a jump start on many states re Omicron – the wave is clearly spreading – from Maine to Colorado and Washington:

Buckle up – this is going to be challenging couple of months ahead.

US cases are undeniably on the rise again – no doubt due to the colder weather and holiday driven socializing.

The US is currently recording approximately 120,000 new cases and 1,255 fatalities per day – and I don’t see that coming down significantly over this holiday period.

It basically the same story in the UK (albeit with lower levels of fatalities)

Germany is also on a major upswing – driven by its closer proximity to the Eastern Europe spread we noted in earlier blogs

By contrast Southern Hemisphere countries are mostly doing well

What’s driving the US?

Its likely mainly Delta – and not Omicron yet. Here’s the highest areas of new cases per capita. Florida – I’ll be there for Xmas! Notice both Maine and NY have very high levels of cases.

Fatalities are mostly in line with this trend. Oregon has likely peaked (on Delta) given the rate of new cases.

Lets deep dive into Michigan – which shows a very high case rate and double digit fatality rate. Basically gradual and persistent rises since August.

New York is having a faster increase in cases and fatalities – rightly prompting the governor to take action.

Florida is doing the reverse. Their most recent peak was in mid-September – which we’d assume would be a wake up call for many to get vaccinated.

Kentucky unfortunately had record setting tornados to contend with on top of a troubling set of COVID results. Currently about the same level of per capital fatalities as Michigan.

A surprising picture emerges from the data today: Notice how most of the Southern states have low levels of new covid cases.

And compare this with the same view from end August 2021.

The deep red of the south we see at end August has been completely eliminated today. Take a look at the dramatic reduction for Florida. From almost 1000 new cases per million per day at the end of August to just 64 new cases per million per day today.

Fatalities

Fatalities today have started to shift away from Southern States. Missouri, Kentucky and Montanta are experiencing the highest per capita levels of fatalities.

Here’s the same picture from end August:

Again notice the concentration in the Southern States. Florida substantially improved.

Overall US Trend

The impact of cases away from the south did result in some reduction of cases and fatalities through late October. However there has been a noticeable uptick since December of both cases and fatalities.

Results by State – League Tables

Michigan, Minnesotta and New Hampshire are recordng very high levels of new cases.

Missouri:

The data for Missouri looks like a sharp spike typically due to a correction in the data (in this an upward revision in the fatality numbers)

Kentucky has a serious high fatality rate – and I would be concerned about hospital capacity if I lived there. This is a terrible position to be in during the holiday period.

Tennessee seems to have pulled the case numbers down significantly – but overall fatalities are still high at 3.7 per million per day.

Michigan is in a state of concern with a persistent upward trend in both cases and fatalities

Pennsylvania shows a similar, concerning, trend

What can you say about North Dakota…. very small population so hard to compare directly with other states – but a very different position since August this year. Basically within a 2 month period – what looked like a controlled position – has changed into high levels of cases and fatalities.

Conclusion

With many northern states showing a severe uptick in cases and fatalities on the early start to the holiday season this does not present a positive picture for the next 2 months.

The rapid uptick in many states – from being well controlled in early August to the current levels shows not only how quickly COVID can return to high levels – but must surely be correlated with return to school.

As corporations plan for return to office – they will need to think carefully about their potential impact on the COVID – which can of course be mitigated by vaccination policies.

This COVID thing is almost hitting 2 years – and it aint over yet

Peloton stock took a massive hit this week, continuing a downward trend over the last 3 months. People want to get back to regular gyms it seems. Notice the current level of $55 versus 52 week high of $171.

Why the good news on covid?

Answer – the next COVID pill – for treating patients shortly after detecting COVID symptoms is looking very promising. See below from today’s Morning Brew:

Pfizer released clinical trial data for its Covid-19 pill, and it was a report card any helicopter parent would be proud of: The treatment reduced hospitalizations and deaths in the most vulnerable patients by 89%, a result so good Pfizer halted clinical trials early.

Antiviral pills like Pfizer’s and Merck’s (which was just granted authorization in the UK) are crucial tools in the fight to turn Covid-19 from a pandemic to an endemic virus. When taken at home within days of discovering Covid symptoms, these pills are much more accessible than current treatments, which require a visit to a medical office.

Why it matters: We know you’ve been hearing this for a while, but this time it really is true…the end is in sight. With booster shots flowing and effective pills on their way to authorization, by January 4—the vaccination mandate deadline for large US employers—“this pandemic may well be over” in the US, former FDA Commissioner Scott Gottlieb said yesterday.—NF

US trends:

All data in this analysis is to end October 2021. Per capita we can see cases have fallen significant – but not fatalities

The US still had a very large number of deaths in October – 45,000. Only 5 other months since the inception of the crisis have recorded higher death counts. More to come on that below.

Eastern Europe is still very badly hit

A view in table form – shows the top countries for new cases:

And a similar story for level of current fatalities

Many of these counties have small populations – Latvia for example is 2 million; Lithuania 3m; Georgia 5m. Lets take a look at Russia – population 146m

Russia just recorded its highest level of monthly COVID deaths since the crisis began – 31,000 deaths:

The same story plays out in the Ukraine

United Kingdom

The UK has a sharply rising case rate; but has managed to keep a lid on fatalities. Cases in October were almost exactly those in January 2021 – but look how much lower fatalities are. Jan 2021 noted 33,000 deaths; but in October – just 4,000.

While the UK performance is good – I’ll be the first to state that there is no cause for complacency. The growth of cases in the UK; and across Eastern Europe creates the opportunity for additional COVID variants to take hold.

The UK must now think very seriously about the rollout of vaccine boosters.

Success stories of the month:

Israel managed to bring down cases and fatalities – and had aggressively rolled out vaccine boosters. Deaths in October were less than half those of September.

Costa Rica also did a nice job!

Our neighbour to the north, Canada, is doing a wonderful job. How?

This is in stark contrast to our Northern most states. Alaska had its highest level of COVID deaths ever this month; Maine had its third highest.

The best of the US:

The 3 best states (or equivalent) in the US – are Washington DC; Massachusetts; Connecticut. Basically the bunch below – are doing a very good job keeping cases and fatalities down.

It won’t be the first time for the stock market to declare victory on COVID too soon – and as we have seen – there’s still much work to be done across the US; Eastern Europe; and the UK.

At this point – with new antivirals coming to the market however we finally seem to have the tool kit to address the worst effects of COVID

But we can all do a little more to stop the spread in the meantime

A quick look at this chart reveals that current US average deaths from COVID are over 1600 per day. That’s very high – and in fact numbers not seen since February of this year.

Here’s a similar chart but with real numbers (not per capita). You’ll see back in July – average deaths were about 250 per day.

What’s very odd is that across the rest of the world, most of the epicenter is in Eastern Europe. I can’t think why the US is in the same company as Eastern Europe.

As reported previously, UK is on an upswing of cases (far more than the US) – but due to higher vaccination rates has a much lower level of fatalities per capita.

Hot spots in the USA

Here are the hot spots in the US – expressed as current fatalities per million per day. Pretty much all states are experiencing very high fatality rates. Clearly the numbers spike up in small populations:

The US map doesn’t show a pretty picture (a few good spots in the North East; CA etc)

Texas and Oklahoma have average deaths per day exceeding 150.

Oklahoma is likely a blip – meaning a glitch in collecting data which has suddenly been corrected. It also has a small population of just 4 million. We shall see if the blip theory is correct within a week or so.

As high as Texas is currently, its numbers are trending downwards

Georgia is a pretty large state of 10 million people – its fatality levels are nearing those of January 2021 – but cases have come down quickly.

Tennessee also showing improvement – but still very high

A quick look at the global numbers shows the UK and Eastern Europe feeling the surge of Delta cases.

Latvia is the highest – with over 800 cases per million per day

Not surprisingly this is translating into high current fatality levels in those countries. Romania and Bulgaria are leading the world with over 10 fatalities per day per million.

Romania

Romania is on pace for its deadliest month of covid cases. Already over 4,000 people have died this month. Looks like most of this surge took place from mid-September. The lagged fatality rate (average fatalities now divided by cases 1 month prior) here is 12% – which means that cases are very likely significantly under-reported.

Bulgaria

Bulgaria’s case growth started late August and in still gaining momentum

So far at least – fatalities seem unlikely to exceed past peaks of December 2020 and April 2021 – but its very easy to see from the fatality curve that this is very definitely a 3rd wave for Bulgaria. The lagged fatality rate for Bulgaira is 5.6%. Still very high and again likely means cases are under reported.

UK

The UK isn’t bringing case numbers down quickly enough – although the most recently fatality data (with 1 month lag from cases) is at 0.34%. (we’ll call this the ‘Lagged Fatality Rate’). Translation – fatalities are relatively well controlled.

US

The US is bringing cases down – albeit slowly. Fatalities are much higher than the UK – probably driven still by the high incidence of unvaccinated people. The lagged fatality rate in the US is 1% – about 3 times higher than the UK.

Currrently it looks like US fatality numbers should be less in October than in September – but still around 40,000.

This picture shows it all. The surge of cases that gripped the sourth recently is on a northern expansion. Once again, North Dakota is recording high levels of COVID – but this time – Montana also. I recently reported on Alaska.

Fortunately the top 14 states (from Alaska to Michigan) have a population of just 51 million people or about 16% of the US population.

That means that the improved data in the southern states is able to pull down the US average stats – which continue to improve – but are still not where they need to be.

But across the country, fatality rates are much too high:

The US had over 50,000 deaths in September 2021 – only 3 other months have exceeded that figure. Recall the situation in April 2020 – at the begining of the covid pandemic when the US recorded 56,000 deaths. We were almost at the exact same number of deaths last month!

League tables:

In this scale, anything greater than 2 is bad. Texas in position 10 – is very bad – given its large population – but the numbers for the top 10 states are very bad. Likely driven by cases exceeding hospital capacity.

The table below is in actual numbers (not per capita). 250 people are currently dying per day in Texas; 51 in my home state of TN.

Arkansas population 3 million

Alaska is still struggling – but with a very small population of 700,000 – about the same as the county I live in (Davidson County)

Here you see the Montana charts (population 1 million)

North Dakota – population 760,000

Tennessee (population 7 million) – Example of a southern state getting better. But still a long way to go.

Texas (population 28 million) is also getting better for new cases; but fatalities are far too high

New York has contained Delta – but still a little higher than desirable.

Hawaii is in marked contrast to Alaska:

Connecticut seems to be getting it about right – but the data is lumpy – so watch this space. Not sure what drive the sudden spike at the end of September – likely some kind of adjustment in the numbers.

California is doing well – especially for a state of 40 million people

Things may be looking up for now. Seems that the US current levels of new cases at 358 per million per day are about 63% of the recent peak of 569 per million per day earlier this month.

Its too early to call success on fatalities however. Below is the same chart – but with whole numbers – rather than per million figures. Close to an average of 2,000 deaths per day – having been as low as 195 on 8th July.

Case numbers are falling significantly in Florida, Georgia, Texas – take a look at the right hand side of this table showing the change in the average daily number of cases week over week.

Tennessee looks to have broken the curve… from country number 1 in late August. However over 600 cases per million per day is no cause for celebration. Fatalities are way too high.

Applying that to the rest of the US, generally more than 300 new cases per million per day is still very bad:

Here’s the same data visually. Tennessee still wants to feature in the league tables

Most states are struggling with very high fatality rates right now. As an example TN has just 6% ICU capacity – just 127 available beds for a population of 7 million:

TN has recorded over 1,500 deaths from COVID this month alone, the 4th highest in this states pandemic history:

September to date is the 3rd deadliest month in our COVID record:

Close to 50,000 deaths. US deaths from this pandemic at over 680,000 have now eclipsed that of the 1918 flu pandemic (known as Spanish Flu) – albeit the 1918 population was obviously a lot smaller.

Some good news for Peru

Peru leads the world in reported deaths per capita. As you can see from the table below – almost 2x the number of the second country in the table. Thats a total of almost 200,000 deaths on a population of 32 million people

Improving trend

Current fatalities are now just 1.2 per million per day. The best result in many months.

A similar story for Brazil

Improvement – but 3 fatalities per million per day is still too high

The Driver: Vaccinations

The chart below shows steady progress in a rollout of vaccinations commencing around May 2021. Levels are still relatively low: as of Sept 4th 26% of the population are fully vaccinated. Seems like the case curve started to fall sustainably in June – which fits the profile of the vaccination curve with 1 month lag – as we would expect.

Is herd immunity a driver? Unlikely. Almost 2m people have been diagnosed and presumed recovered from COVID – which is 6% of the population. Assume that’s 2 to 5x underreported – that still shows this population is no way near the level of exposure to generate herd immunity.

Well done Peru in clearly targetting potential vulnerable populations with your vaccine rollout.

Gotta hand it to the Governor – he knows how to get things done. From executive order #84 allowing parents to circumvent mask rules of schools to # 1 in the country for new cases per capita took just 16 days. Seriously – where is the accountability. Make your voice heard.

Tennessee is now the #1 state for new cases of COVID – expressed per capita. I could not be more disappointed. Just for comparison – that’s 5x higher than Vermont.

With growth like that, its no wonder that fatalities are sharply rising

153,000 new covid cases in August; 740 deaths

4x as many people died in August as July.

I called it at the time. Governor Lee you have a blatant disregard for the pandemic risks and the data. We are in unchartered territory for a pandemic precisely because you – and leaders like you – evidently have no clue what you are doing.

Do you think this pandemic respects your political philosphy? Think again. Your job is to protect people in a pandemic, lead by example, and manage hospital capacity. Epic FAIL; FAIl; FAIL

Its not too late to be the leader that people need to address this pandemic

Still think this is over? Think again. Davidson County TN just crossed 1,000 deaths from COVID; from a population of 695,000 people. That means that 0.14% of people have died from COVID.

Souce for this is the NY Times Data – which shows recent data. Below is a pretty cool graphic – which basically shows that cases now in August 2021 are approaching the peak levels of December 2020.

Hospitalizations are on the rise:

Deaths are sharply rising

Deaths in August are 4x those of July and 20x those of June

Per the CDC we are at very high risk levels:

Davidson County is at an extremely high risk level for unvaccinated people because there was an average of 59 daily cases per 100,000 people reported in the past two weeks and the test positivity was over 10 percent. 

For more of the excellent NY Times reporting on COVID click here.

For the Davidson County Dashboard click here. This shows 981 deaths, but the data is on a 5 day lag and updated only 2x per week. This site also shows test positivity rate of 14%.

Its time to stop acting like its over – and get back to the basics

Thankfully some businesses are taking some proactive steps… here’s an example from a business in Nashville

Hi Parents,
Unfortunately we have found ourselves in a position to re-evaluate our Covid policy once again.

After much thought, parent feedback and research into how the delta variant is affecting children we think the safest action is to reinstate our mask policy for the time being.

We will be requiring our staff to be vaccinated as well as wearing masks in order to limit any kind of spread. We ask our parents to also wear masks if inside.

The safety of our kids is important and we want to make sure we are taking every step to provide a safe environment for them.

A local martial arts business

Average Deaths per Day

Current average daily deaths

Fatalities since inception on a per capita basis. Peru is #1 – we’ll take a look at that later.

Current case levels: Israel is currently 2x that of the US – we’ll look into that below.

Indonesia shows improvement

A few weeks ago – Indonesia was recording the current highest levels of daily deaths in the world; now it is showing significant improvement. Average deaths are still about 1280 per day – currently the highest of any country – but down from 1800 per day in late July.

The rise of Delta was swift in Indonesia. Deaths increased from an average of 5000 to 6000 per month to 35,000 in July. So far in August 34,000 deaths have been recorded – and this will likely be the deadliest month on record for the country.

US Deaths are Rising again

Very high level of fatalities per million; and over 17,000 deaths in August (compared to 8,000 in July)

Israel – sharply up

Its been widely reported that Israel is rolling out booster shots to its 9m people. With the curve like that below – that’s very easy to understand. Good luck with getting that booster out quickly. Time is of the essence.

Fatalities so far in August are 10x higher than in July – and only 8 deaths in the month of June.

UK, Italy, France – cases are up – but fatalities still largely under control

Philippines – sharply rising fatalities

Brazil showing sustained improvement – but fatalities still far too high

No denying the improvement here.

Peru shows continued improvement

Peru is the world #1 for per capita fatalities since inception. On a population of just 32m, it has recorded almost 200,000 covid deaths. Thats 0.6% of their entire population – just on COVID. Based on the current numbers, is this country demonstrating an example of herd immunity?

As some of you may know, in the early days of COVID monitoring, I posted on the worst counties in America. This measures how widespread COVID is impacting counties across America. i.e. not just looking at one or two large cities – but considering if the impact is more widely felt.

Criteria for the list is those counties with more than 100,000 population – and with new cases greater than 200 per million per day. In September 2020 we had managed to get the list down to 75; by Nov 2020 it was around 400; now in August 2021 we are back to 465.

Digest that for a moment. 465 large counties across America have elevated rates of covid transmission. Texas for example has 39 counties meeting the criteria above; Florida 36; California 34. (Tennessee has 13)

Now – some may argue that many are vaccinated; we are in a new wave where more infections doesn’t necessarily mean as many fatalities in the past. Well lets look at those counties with the highest current fatality rates:

Counties with highest current fatality rates:

Here’s a geographic map by state:

Mississippi and Louisiana are literally off the charts. Current per capital fatality rates in those states are almost 10x that of many other states.

Here’s the data in table form.

Louisiana – how not to handle COVID – worse than ever

The level of cases in Louisina is at unprecedented levels. Only in the very first wave (April 2020) did the fatality rate peak (13.9 deaths per million per day) – but current levels are very close to exceeding that level (12.2).

Here’s an easier to see monthly trend:

Monthly deaths peaked in April 2020 – at 1,665 – and came close to that level again in January 2021 (1,371). So far in August we are at ~900 – and likely to exceed 1200 by the end of the month.

If there was any reason not to have faith that we as a society will do whatever is necessary to protect our own self interest then Louisiana is the case in point.

As an example, East Baton Rouge has had 65 deaths so far this month in a population of 440,000. For more on Baton Rouge click here. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_ae0ba3d6-0204-11ec-a518-57118752dde3.html

Little wonder the overall US fatality rate is rising

So far this month almost 13,000 people have died from COVID; that’s sharply up from 8,400 recorded last month. Average deaths are now 800 per day.

Its no wonder that the US is preparing to encourage booster shots. The current accelerating rate of infections and increased transmissibility of Delta – mean that case numbers are almost certain to increase significantly in the short term. Faced with news that the vaccine potency reduces over time; stepping forward with a wave of boosters – especially for the vulnerable populations is especially important.

If the US follows the same path as last year (through the traditional holiday period); its very likely COVID will still be around in Jan 2022.

Given the experience of Louisiana – is it even wise to hope for the best….far better to plan for the worse – and to assume we’re living with this thing next year. Under that assumption – its critical to approve the release of vaccine for our children.

If Governors of Texas and Tennessee can issue decrees banning the use of face masks in schools; on the grounds that parents have their own kids best interests at heart; then provide us parents with the tools to protect our children. At this point, many states (those in RED on the charts above) have proven they have lacked the ability to manage this crisis.

Sharply rising case count here in Davidson County, TN:

Daily cases now are 5x the level of early July.

Which is a similar case for TN.

And – clearly the US as a whole:

US is now almost 10x higher than the levels in early July.

Proactive businesses are masking up

I’m encouraged by those businesses that are voluntarily masking up. Davidson County has been slow to update guidance to businesses.

Hospital Capacity

A lot of what we expect from government officials speaks to capacity management. When hospitals are close to capacity – we expect more proactive measures to ensure health services operate as expected. That does not seem to be the case. See attached:

https://www.tennessean.com/story/news/health/2021/08/13/nashville-hospitals-covid-19-no-beds/8124120002/

Don’t Deny the Data

Delta is a new strain – so treat it with the appropriate caution – especially for those of us with children who are too young to be vaccinated.

The current return to school situation easily looks like a repeat of 2020 – and we can all recall the spike in cases & fatalities over Thanksgiving to New Year. While many of the vulnerable have received vaccines , as current hospital capacity concerns show, there’s plenty of opportunity for this variant to disrupt.

Its almost back to the 2020 year end peak for these states. Louisiana, Florida, and Mississippi; South Carolina and Oregon have all set record numbers for new COVID cases this month!

All numbers expressed per capita for comparison purposes.

Louisiana has eclipsed this year’s peak in average daily cases. Not surprisingly fatalities are sharply rising

Florida has a 4x larger population than Louisiana – which likely means pressure on hospital capacity once again. Over 20,000 new cases per day are being recorded – a new COVID peak for the state; and unfortunately an average of 141 deaths per day.

Arkansas – almost same level of per capita fatalities as Florida.

Missouri – appears to be slowing the rate of new cases; but fatalities still at a very high level

By comparison – some states that seem to be holding it together

Tennessee – cause for concern:

Adding this state, as its my home state:

Davidson county also sharply rising

Return to school starts soon.

Indonesia (population 265m) is currently leading average daily deaths from COVID – at approximately 1700 deaths per day. As can be seen from the charts, both cases and fatalies have sharply risen in July.

Here are the top countries in table format:

Here’s look at the global hot spots for new cases – Spain is also very high

All of these countries have very high per capita death rates

Virus mutations

One of the facts that I’m reminded of is that viruses mutate especially well in crowded conditions. It seems no suprise therefore that the Delta variant first emerged in India. There are recent reports that the COVID deaths in India are under-reported – with various analysis measuring excess deaths reporting potentially 4m deaths from COVID. If those numbers are true – its easy to see how the virus was able to transform into its current, more transmissible, form.

Now, some concerns are focused on whether new variants may emerge in Indonesia. See the story below:

https://www.abc.net.au/news/2021-08-08/could-indonesias-outbreak-give-rise-to-a-new-variant-covid19/100343554

COVID has been the complacency virus. Each time we relax our measures, it springs up. The US is now firmly in an additional wave. Fortunately most of our very vulnerable segments of society have had adequate opportunity for vaccination; however children under 12 are still not eligble. Its truly hard to read about populations within the US with very low vaccination rates. That just increases the risk that a more lethal variant could do significantly more damage to those people currently unvaccinated in the future.

The global picture is proving that new variants are being created and can be more virulent. A complacent approach to preventation is going to increase our short and medium term pain. We need to step up the vaccination drive.

Over 500 cases per million per day in Louisiana

Louisiana hasn’t missed out on any spike in COVID.

In absolute numbers Florida is recording the most new covid cases:

Nevada at 2.8 fatalities per million per day – leading the country

The net effect of this is pulling up the US average for cases. US average for fatalities remains good:

Here’s the fatality daily average per capita for the US

The UK may be leading the path the US follows

Louisiana is looking a lot like the UK – which recently announced Freedom Day – albeit with large growth in Delta. Fatalities still very low and lets hope they stay that way. One way or another the UK is putting vaccine efficacy to test.

The markets like the low fatality rate

Quote: “This is becoming a pandemic of the unvaccinated.”

The Delta variant is spreading quickly among unvaccinated people in the US. Cases are up 70%, hospitalizations have increased 36%, and deaths are up 26% from the prior week, Walensky said. 97% of people hospitalized due to Covid-19 are unvaccinated.

CDC Director Rochelle Walensky

Cases and fatalities are on the rise in Louisiana; Arkansas; Nevada; Missouri; Alabama; Kentucky

The rate of new cases in Arkansas is more than 3x the national average – and more than 10x greater than the states with the lowest rate

76 large counties (over 100,000 people) have high rates of new COVID cases

– here’s the list: Notice the majority Southern concentration – which aligns with low vaccination rates. Greene, Missouri is the highest.

What a difference 1 month makes – the case growth in Greene County, Missouri

As of July 17th 2021

Countries with very high levels (above objectively acceptable levels)

Its really hard to look at data that shows that once again the COVID virus is finding ways to continue to spread. I already reported on Arkansas and Missouri not being with the program last week – and this week we can add Florida, Nevada and Utah to the list.

We can start to see the impact of these states on the right hand side of the graph below

Lets take a look at that part of the curve in whole numbers:

From a low of 10,000 cases per day in early July – cases have now rapidly accelerated to more than double that – erasing the progress made in the month of June.

Fortunately the fatalities numbers continue to fall in the US… but note there were still 10,000 deaths from COVID in the month of June.

What’s happening the in the rest of the world: UK

This shows the same period as the US zoom in. Here we see an exponential rise in the number of cases. From a low of 1500 cases per day in mid may – the UK now has an average 33,000 cases per day.

Spain shows a similar spike

Global League Table shows some significantly high levels of COVID

Brazil

Brazil has recorded 534,000 deaths versus the US 602,000. At the current daily rate of 1295 per day (versus US of 256) – this means Brazil could overtake the US for most number of deaths from COVID by end September. June deaths in Brazil were still the 4th highest on record for that country.

The Brazil Daily trend shows no sustained downward progress in average fatalities… albeit slow – and still to high:

Contrast that with the US monthly data:

Staying in South America;

Columbia recorded its highest monthly total of deaths from COVID in June. Current fatalities are 11.3 per million day.

The Spanish Curve also shows more plot twists that a hollywood blockbuster

India: Significant progress – from 9.3 million cases in May to 2.3 million cases in June

CUBA is also facing a record high number of cases and fatalities:

No surprise therefore to watch the news reports this week of the civil unrest in that country

Conclusion

It’s not over yet. Just as F9 was the first blockbuster of the proclaimed ‘post covid’ era in the US, we know we can expect an F10 and the virus isn’t taking any time off.

A quick look at the global covid status hows that India has successfully brought its COVID numbers down; but South America remains the worst hit continent – using official WHO numbers. Mongolia is also trending higher – with currently 300 cases per million per day (but based off a low overall population of approximately 4m).

US News

Across the US – the vaccination impact is showing clearly. All states are at very low levels for new covid cases.

Fatalities have still not fully come down in Michigan; West Virginia or Georgia– but should do so very soon based on the current case data

Perhaps the best way to show the solid improvement across the whole US – is a stat I was tracking since early COVID which is the ‘worst counties’ in America list. Today there are only 4 counties on the list. In late December 2020 there were 572

The critiera is population greater than 100,000 and new cases per million greater than 200. Here are the 4 counties.

With numbers this low across the US, travel season is back! Get out there and visit a National Park…. we did just recently and they have never appeared to be more popular

In today’s blog we take a quick look at the global picture for COVID. Once again South America has the highest rate per capita of new cases. One key point to note; many of the countries worst hit now are the poorest in the world. As you read this – spare a thought for those countries – and lets all try to do something to encourage international aid to support them.

Lets look at this in table form. Some of the countries on the list have very small populations (Maldives; Bahrain; Costa Rica) – but we can see here Uruguay; Argentina very high on the list

Argentina

Argentina never really bent the curve – as is shown in the chart below. Fatalities per million per day are at an alarming level – on an increasing case load:

To make the point more emphatically – here’s the 1 year trend

Uruguay

Uruguay’s a different story. Seemingly relatively untouched by COVID in 2020 – the current 2021 wave is far more persistent and troubling. Of note however, the population is 4 million. This should be a small enough population to quickly vaccinate, if international assistance can be provided (that’s half the population of Israel).

Brazil

Brazil – is on the same upward trend as Argentina – as we see below – althought interesingly the fatality curve is reducing significantly. That said – in real numbers (not per capita) Brazil is averaging almost 2,000 deaths per day.

India

In line with my intro to this article – did you know India (population 1.4bn) has per capita income of $2,000 per person (as compared to US = $60k). Its impressive that India seems to have bent the curve with that financial constraint.

Although cases for the month of May (to 5-21-21) are 7.3 million and fatalities are 83,000. That’s still an average of over 4,000 deaths per day.

Nepal

I learned something new today(!). Nepal is a country of 28 million people. Perhaps by watching so many Expedition Everest shows I’d assumed a much smaller population.

Nepal’s proximity to India is causing an explosion of cases there. Did you know GDP per capital is just $900 per year. Lets all spare a thought for Nepal – and pray that the country gets the aid it needs to protect its people.

What’s going well

Quite a lot – check out some charts of the best performing countries; including the US and UK – where largescale vaccine rollout is unquestioningly delivering these benefits

UK monthly deaths peaked at 33,000 in January – and thus far in May are 200. That’s another amazing record of success.

Above is a quick dashboard I’ve been tracking. The Covid numbers in Davidson county have been steadily dropping – in line with vaccine rollout.

The 2nd chart are 7 day average stats per million. We can see a short spike in fatalities – but at this point the numbers are low – so 1 or 2 deaths can drive up the curve – so expect some volatility in the fatality line of the curve.

A similarly good story is in TN

From the picture below we can see a large concentration of cases across many countries in Europe.

France, Turkey, Poland and Sweden all have over 500 cases per million per day.

At the other end of the spectrum Poland and UK have the lowest levels of new COVID cases

Within South America, Argentina and Brazil both have around 300 cases per million per day

France:

Ignoring April monthly data (this is as of April 9th)- we can see that cases in March were almost as bad as those in November. Fortunately we can also see that monthly deaths are slowly declining…but since deaths lag cases, lower deaths in March (~9,000) may be the result of lower cases in January and February.

UK – vaccine experience shows success

The number of UK covid deaths has sharply fallen – from 33,000 in January to 4,000 in March. That’s astounding!

US – starting to plateau – not yet at target

US has made great progress since January 1st. But notice that the cases, and fatality rate have levelled off at still too high a level. We are still looking at an average of 63,000 cases per day and 1000 deaths.

Where is the growth in the US?

Pretty much the same as last week. Michigan continues to lead the recent explosion in new cases

Michigan: almost at the level of Thanksgiving

Michigan recorded 100,000 new covid cases in March – almost 3x the level of February. Deaths were still substantially lower at around 600 for March, compared with 3,400 for December. Perhaps vaccinations are protecting the most vulnerable. The state has administered 5.2m doses of vaccine in a population of about 10m people.

Brazil has worst month of the crisis so far

With the concerns growing about new variants, Brazil recorded its worst month of the crisis. Over 2m cases were recorded in March and over 60,000 deaths. That’s more than double the prior month level of deaths.

The fatality rate has sharply increased – from about 2 fatalities per million per day in early November 2020 to 13 fatalities per million per day currently. Deaths are averaging 2,700 per day. Currently the highest level of any country.

At these trends, Brazil could well exceed the US level of fatalities per capita soon. If those trends are sustained over the next 4 months; Brazil could record the highest number of COVID deaths (US currently has 550,000 deaths versus Brazil of 340,000).

Effectively distributing the vaccine quickly to Brazil citizens is critical. Currently about 9% of the population have received 1 or more doses (just 3% are fully vaccinated). For the US we have 34% of the population with at least one dose and 20% fully vaccinated.

Check out the experience of France as reflected in the chart below. Cases now are approximately 3x higher than the level in January.

If we look at the league table for global new cases, many European countries occupy the top spots in the league tables. A common factor in these countries; low rates of vaccination. Hungary has about 6% of its population fully vaccinated against covid. France has about 3.8% of its population fully vaccinated.

UK

The UK has taken a different approach to vaccination. Over 29 million people have received at least one shot. 87% of those 50 years old and over have received at least one shot. As we can see below, this approach is paying off.

These two charts really illustrate the importance and impact of vaccination. France had its year end spike peak sooner than the UK – but the UK has delivered sustained reduction in cases and deaths. Notice the current per capita fatality rate in the UK is 1/5th that of France.

US

The US appears much better than Europe but not quite as successful as the UK. Current fatality rate is about 3x higher than the UK – but, most importantly has fallen very significantly since the begining of the year. 14% of the US has been fully vaccinated.

Brazil

Brazil has reached new highs for covid infections and fatalities. Fatalities are sharply rising. This is a population of over 200 million people. As of early March only 2% of the population had been vaccinated.

Putting this in raw numbers, Brazil has an average of 77,000 new cases per day, and 2300 deaths per day.

Israel

While Israel has a population of only 9m people, this has become a good case study for vaccine rollout. The country began rollout of vaccines on December 19th 2020. To date, over 50% of the population has been fully vaccinated, and for those aged 70-79, 91% have been fully vaccinated. This proactive approach shows in a much lower rate of COVID.

This chart also shows the clear linkage between cases and fatalities. The month of March has the lowest number of total cases since September (with the exception of November).

Conclusion

The race is on to vaccinate. The data could not be clearer. Higher vaccination rates (particularly of vulnerable segments of society) are having a material impact on rates of new infections and deaths.

This week the Texas Governor announced the lifting of all COVID restrictions from Wednesday March 10th. We have repeatedly seen that ‘early liftings’ by states that have later seen an upsurge in cases. However, this is the first lifting of this scale where we have broad availability of multiple vaccines.

So lets start by examinging the pro’s of the governors case. The governor states that cases are rapidly falling; fatalities are falling and most importantly, the vaccine has been rolled out to well over 4 million Texans.

• 4.2 million people have received at least one dose (14% of the population)
• of these 2.3m have received 2 doses (full vaccinated) – equivalent to 8% of the total population
• An average of about 800,000 vaccination doses administered each week
• New cases are 255 per million per day, down from about 800 in Jan 2021
• Fatalities are 8 per million per day – down from about 11 at the most recent peak in Jan 2021
• Hospital capacity is at likely around 70% (my calculations)
• About 2.4m have tested positive and recovered from COVID

Event though the reductions have been dramatic – current levels are still high

February was still the 4th highest month for cases, and the 2nd highest month for deaths

Current cases levels are higher than August 2020

Many counties still have elevated fatality rates

Consider this list of large counties, all with new cases per million over 200 and population more than 100,000. The average daily fatality rate in most of these counties is still far too high.

Is the Governor just thinking about capacity?

From the begining of COVID, there has been the debate about whether it is the role of leaders to simply manage hospital capacity – with the objective that all those who need medical attention can get it. If that’s the case, then the current data supports that there is some excess capacity in the hospitals.

With a population of 28 million people, and 4 million having received 1 or more dose of vaccine – has the state adequately targetted its high risk population? Quite possibly.

Vaccination stats

Link here for the official page:

Before we get into the State data – lets compare with the rest of the nation. Texas is one of the lagging states for vaccine adminstration. It has administered 32,000 doses per 100,000 population, but others – such as New Mexico have administered 43,000 doses (that’s 34% more than Texas).

People aged 85 or over make up about 1.5% of the population – so approximately 400,000 people. Clearly we would acknowledge this group is high risk. From this data we can see over 400,000 in the 80+ demographic have been vaccinated.

We can conclude that a sizeable portion of the elderly population have been vaccinated

Distibution of vaccine by race/ ethnicity

We know the virus disproportionately impacted minority populations in Texas. How do the numbers look for vaccination rates by race / ethnicity? In this case, a back of the envelope calculation shows the following.

• From a 2005 survey, Hispanics make up 34% of the population. That would represent approximately 10 million Texans. From the vaccine data we see approximately 800,000 people vaccinated – close to 8%
• White non hispanic therefore makes up about 14 million people – and we see that 1.6m have been vaccinated – about 11.4%

A large number of vaccinations, close to 1m (about 3.5% of the population), have been administered to ‘unknown’ race / ethnicity which may likely be those who declined to disclose. On balance it looks like more needs to be done to roll out the vaccine to the Hispanic population

Conclusion

Is the Governor directionally right?

Probably YES. There’s enough good news about the vaccine rollout to be hopeful about the future.

Is the timing right. NO!

• Texas is lagging behind the majority of states for vaccine rollout
• The data does not clearly evidence that vulnerable popuations (especially Hispanic) have had the right level of vaccine penetration;
• Many counties are still experiencing high levels of new cases and deaths

What should the Governor Do? Phase it!

In this case, the solution should be straight forward. PHASE it!

It would show good leadership to let business owners, and people know how and when restrictions could be lifted, IF the pace of progress is sustained.

Leadership matters, and the Governor’s actions simply tempt people into reckless behaviors which make it all the more difficult for the health care system and vaccine roll out to get ahead of the curve.

This is another example of declaring victory too soon. Be patient Mr Governor. Don’t lead when your data doesn’t quite support it. 6,700 Texans died from COVID in February.

Phase it in…. allow 25% restaurant capacity etc in 2 week phases. Within a month the vaccine data should be so much better, and more evidence of lower case generation, and lower fatalities.

Excellent news to report. With the public holidays of Thanksgiving and Christmas behind us, we are really starting to see a substantial, and sustained reduction in COVID cases across America.

Here’s the current rate of new case development:

The US is now #14 of the countries with highest per capita rate of new cases – at 237 new cases per million per day.

Here’s the timeline trend over the past 5 months

Fatalities are still very high in a number of states, as you can see below. Total US deaths are getting close to half a million (489,000).

Results by state

Vaccination News

Since inception and as of Feb 19th :

• 60 million doses have been administered
• 17 million people have received 2 doses
• A further 24 million people have received 1 dose
• In total – 41 million people have received 1 or more shots
• In the last 12 days, 20 million vaccine doses have been administered! Thats 1.6 million per day

Add to these figures, that 28 million COVID cases have been recorded. Using various assumptions we can say about 23 million have recovered – which means that well over 74 million people are either vaccinated or have had some exposure to COVID. That’s 23% of the US population.

Great news, US case levels are now back to pre Thanksgiving levels. That is a welcome reduction – and with no major public holiday events coming up soon, this new trend should continue. Also, this week, it has been reported that number of people hospitalized with COVID has reduced below 100,000 for the first time since Thanksgiving.

Also more people have received at least one dose of vaccine than have tested positive for COVID. The US has vaccinated 36.2m people! This compares to 26m people who have tested positive

Since cases typically jump around holiday events – the next event to prepare for is the school / university spring break period – which is typically 2nd week of March. In the meantime lets hope for another month of continued case reduction.

Where in America?

Compare my chart below with that on previous blog posts. Certainly a more continued, broad based reduction in cases. Arizona is no longer the top spot for new cases (well done Arizona). The top spots now are Texas, and South Carolina.

Arizona still takes the #1 spot for highest level of current fatalities

A quick look at the Dakotas

South Dakota has now reduced the caseload to very acceptable levels. Current fatalities at 4.1. per million per day are not in the acceptable range yet – but are far below the 30 per million per day at the peak

North and South Dakota are in the top 5 of states who have administered the highest percentage of vaccines that have been delivered to them.

Wrong way messaging in Texas

Texas is still on the climb – both for cases and fatalities. Ted Cruise – Senator for Texas needs to step things up there.

Good news, almost all states across the US are reporting reductions in new cases of COVID. The one exception is Alabama, with a 4% rise over the previous week. The impact across the US is that cases have fallen 16% week over week.

Here are the week over week case changes:

Shout out to CA with a 30% reduction is cases. While Wyoming has the best performance – its smaller size relative to CA means that I give most kudos to CA.

But with many states showing very substantial declines – the result is the map of the US looks better each day. Notice how the states in the north are starting to get into a more acceptable range of cases – from Washington to Missouri.

Arizona seems determined to hold onto the #1 spot for cases.

Average daily fatalities.

For the month of January so far, deaths are 86,000, substantially higher than the prior month. Average deaths are 3,100 per day – but at least this looks like this could be the peak (especially if daily cases continue to fall – and vaccines are administered to the most vulnerable).