TN icu capacity at 8%

As expected the Omicron wave is starting to make its presence felt in hospital capacity. Many of my readers will note that I periodically look at hospital capacity stats. TN does a nice job in making this data available. The data shows very limited capacity available to deal with additional cases. Be careful out there.

Now is a good time to be more conservative to allow hospitals an opportunity to treat patients and free up capacity.

Good Bye 2021

After a tough start to the year, 2021 held the promise of vaccine rollout and reduced cases and fatalities. That worked really well as vulnerable people got vaccinated and eventually vaccines became available for all. By the end of the year vaccines were available for children and over 8bn – yes EIGHT BILLION doses of vaccine were administered world wide.

Unfortunately the delta variant caused a major flair up in India in April / May – which then eventually became the cause for most cases and deaths in the US in Q3 2021.

Now we’re dealing with Omicron surge – identified in South Africa in Nov / December – and very rapidly becoming the source for new cases here in the US.

As we end the year – the pressure on the hospital system over the next 2 to 3 months will be intense – but (i’m no expert here) – I’m hoping this burns itself out after that. That said 2021 was our most deadly year of the pandemic – over 460,000 deaths (compared to 350,000 in 2020). Total US lives lost due to COVID are over 800,000. On official stats – that’s the most in the world – but I suspect that some other countries have less reliable statistics.

Here are some key charts:

Firstly the average daily trend – with month end values plotted. This clearly shows we are at the begining of an exponential curve. Thankfully the fatality rare is not as high as the prior peak – but an average of 4.8 daily fatalities per million of population per day is significant. [Isolated data point here: Tennessee covid hospital capacity is around 10% today]

Viewing the same data monthly – we clearly see December 2021 is the 3rd highest month for cases of all time – 4.5 million cases recorded; 37,000 deaths:

The chart also shows the initial success of vaccine rollout (through June 2021) – and then the upswing in the more virulent Delta variant. December of course marks the begining of the Omicron wave.

New York

Lets review NY as one example. Here the unprecedented impact of the Omicron wave is very evident. NY did better in 2021 than in 2020. It recorded 21,000 deaths this year – compared to 37,000 in the prior year.

Average daily statistics:

Monthly trends:

Fatalities in December of 1,944 are significantly up on the prior month of 1,054 – that up over 80%.

Vermont – the best state in the US:

Vermont is the best state so far for per capita fatalities – just 750 per million – but has a sharply rising case and fatality curve. Also note the entire population of Vermont is just 630,000 people.

Mississippi – highest per capita fatalities

The state with the highest overall number of fatalities per capita is Mississippi with 3,500 fatalities per million. Here’s how that state was impacted by COVID. Just over 10,000 fatalities on a population of 3 million.

Average daily cases are starting to increase significantly due to Omicron. See right hand side of the below chart.

California

California deserves a lot of credit. Its the most populated state in the country with over 39 million people. Total per capita fatalities are 1,940 per million – which is 50% less than NY, NJ, Arizona etc per capita. This is how it handled the COVID cases:

Texas

Texas is the second most populus state – with over 29 million residents. Its total fatalities per capita are 2,687 – or basically 39% higher than CA. Basically Texas got hit much more severely with the Delta wave. September 2021 came very close to the record number of deaths in January 2021.

Everyone else

Here are a few league tables for all the States + DC:

All fatalities – per capita since inception:

Current new case rates per capita

Current fatalities:

Over 580 counties in America have elevated covid case rates (defined as over 200 cases per million per day) – and of these 224 have an average of more than 3 fatalities per million per day. Here’s a look at some of the highest with large populations:

You’ll notice that Michigan features prominently on the list. Here’s how that data plays out across the state. You can see that December was the highest month on record for COVID fatalities. This resulted in 2021 recording more deaths than in 2020 (15,000 versus 13,000).

2022

As noted in the intro, 2022 will get off to a very rough start – but I am hopeful that this wave will be the final one. It feels like the final wildfire on already partially scorched earth. So much as I hope the news was better today – I feel optimistic that from Q2 onwards we start to see the final return to normalcy.

TN hits 9% hospital capacity

Tennessee hits 9% hospital capacity (source TN website):

While not yet at the prior levels of cases from last year – cases are significantly higher than the prior 3 months. Note from the orange bars we can see TN got hit pretty hard with the Delta wave:

Also note the spike in fatalities in Dec of 3000+ is a result of a correction in the data – likely a result of under reporting of deaths during the delta wave. Actual December deaths are much lower. Best to think about that 3,000 number as spread across the prior 3 months or so. In which case this is still a concering level…. and further corroborates the current hospital capacity data.

Be careful – especially this new years eve

Europe sets new records

WHO global data shows the following data for new cases – basically virtually matching the peak from April / May (driven out of India and South East Asia). Notice how the green portion of the chart is growing significantly – which is Europe.

Here’s a closer look at the Europe case trend. As you can see – very clearly a record.

Cases at record levels: WHO data

Here’s a closer look at Europe deaths. These are not at the same levels as this time last year (pre vaccination) – but certainly very high. About 60% of prior peaks. Something to be very concerned about.

Fatalities not at the levels of prevaccination – but very high

My prior posts have provided the detail on some of the these countries – but here’s a brief recap of some:

  • UK has record high cases but fatalities relatively well controlled in percentage terms
  • France and Italy have high number of cases and steadily rising fatality curves
  • Spain appears to be doing the best at controlling fatalities
  • Germany appears to have bent the curve but fatality levels are still high; in fact the highest in the vaccination era.

Looking at the monthly charts it’s easy to see the Omicron spread is unprecedented in its rapid pace of spread. Solid bars show number of cases with top 3 values highlighted.

Germany will likely hit a record number of cases in December 2021

We are expecting this wave to burn itself out quickly… but this still makes for a bumpy road with pressure on hospital systems. In my next blog – we’ll aready see that in the US hospital capacity is coming under pressure and we are not yet as far along the Omicron curve as Europe.

Fasten your seat belt – Very high case counts in Europe may set the precendence for the US.

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:

Where Omicron was first detected – South Africa

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.

Over 50 million covid cases in the US

Startling fact: the US has recorded over 50 million cases of COVID since inception. Our total (as of Dec 24th) is around 51 million – and with an average of just over 150,000 new cases per day. Without a doubt, Omicron is now fueling a fresh set of growth – as we can see from the hotspots in the chart below.

An in aggregate the impact on the US is significant:

So far this month, over 3 million new covid cases, and 29,000 deaths have been recorded. Expect close to 40,000 deaths by the end of the month. At this point I can’t help reflect how we were at ‘only’ 9000 deaths in the month of July. The world has moved on; Delta took hold; and now Omicron is spreading rapidly.

Here are the current fatality hot spots – all expressed in per capita numbers:

Note: Tennessee is likely due to a data anomaly – or a catch up recording of deaths that were previously not reported. The New York Times data shows a large spike in deaths on Dec 23rd.

NY cases have risen sharply. Fatalities appear to be stable – but we do not have a full month of data for December yet. Expect fatalities in Dec to be at least 50% higher than the prior 3 month average:

Michigan looks precarious:

Seems to have gotten the Delta wave under control – reflected in the lower case levels recently.

But zoom out to the monthly trend – and this looks like a health care system under pressure. This could well be one of the deadliest months for Michigan.

Global view:

Globally the story is somewhat similar. While the UK, France and Italy have a much higher rate of COVID spread; fatalities are far below the US levels. Likely due to a higher levels of vaccinations.

Here’s a quick look at the league tables for current cases and fatalities before we explore some charts

Germany did have a significant ramp up in cases and fatalities, but enacted restrictions on those who were unvaccinated and fatalities now seem to be levelling off.

South Africa; the country that detected Omicron has relatively few deaths from COVID

Eastern Europe is still suffering heavily from Delta – and likely Omicron as well

There are very high current fatality rates in these countries:

Russia has high fatalities but low case numbers; likely reflecting insufficient testing

The sun contibues to shine in South America:

The Southern hemisphere (excluding South Africa) is doing very well. Maybe we should have taken that trip to Costa Rica after all!

There’s no doubt about Brazil’s progress month over month:

Or that of Peru:

Oh well Costa Rica – maybe we’ll visit next year:

Europe tops the league tables for COVID cases

Europe is having a major upswing in COVID cases and deaths. As you can see from the tables above. Here’s how some of the top country charts are looking:

Only Germany, Netherlands and Belgium seem to have bent the curve – but, as we head into holiday season, its too early to tell. Poland has an extremely high level of average daily fatalities per capita. Germany is #15 in highest levels of average daily fatalities

US Cases Sharply Rising Again Dec 12 2021

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.

COVID Global Outlook: Germany puts the brakes on – and for good reason. Eastern Europe still dealing with Delta.

See the following news headline from this week:

Germany announced severe restrictions on unvaccinated people, banning them from nonessential stores, recreational venues, and more.

Merkel announced the measures after a meeting with federal and state leaders, as the nation again topped 70,000 newly confirmed cases in a 24-hour period. She said the steps were necessary to address concerns that hospitals could become overloaded with patients suffering from COVID-19 infections, which are much more likely to be serious in people who have not been vaccinated.

Note that throught this crisis, managing to hospital capacity has always been a challenge. With the new variant potentially having greater transmissibility this puts any population of people who are unvaccinated at greater risk. That in turn has a potential impact on hospital capacity.

Here’s the German COVID curve (per capita) over the past 4 months. No doubt about it – this looks closely like an exponential curve to me.

Fatalities in November were higher than any month since May 2021. Basically the highest in 6 months and more than double the prior month

South Africa:

So far at least South Africa results are relatively low per capita … but hard to say whether there is complete and accurate data here:

However – looking at the World Health Organization data – the largest growth in cases week over week is mainly in African countries or those with strong affiliations. Clearly there are some small populations in many of these countries – so small changes in data can have a big percentage impact – but it pays to keep an eye on the longer term trends.

In the case of French Polynesia (population 280,000) the WHO database recorded 683 new cases on Nov 30th – wherease typically 1 or 2. Looks like they are catching up on a backlog of testing or administration.

Current global fatality rates

Delta is still driving the majority of cases and fatalities with Eastern Europe most affected. Hungary continues in #1 spot recording its 4th highest monthly total of deaths in November since COVID began.

Monthly totals for COVID (December 2021 is thru Dec 3rd). November 2021 is the 4th highest on record.

Bulgaria appears to be coming out of the current crisis albeit with currently very high fatality rates

Outlook:

Global cases are again on an upswing. Notice the rising number of cases in the chart below. At about 4m new cases per week – that’s more than 40% greater than week begining October 11th

Omicron Concerns; even while Delta is still stongly impacting the world

The financial market indices signalled concerns about COVID – the Omicron variant from South Africa on Friday. The Dow was down 2.53%; FTSE100 down 3.64%; NASDAQ down 2.23%; S&P500 down 2.27%

Here’s the core problem: The US (and the world) still isn’t done with Delta. Take a look at monthly cases and deaths. So far in November – approximately 30,000 deaths – on 2.2 million new cases. Average daily deaths are 3x higher than 1st August – about 1,500 per day. We are certainly not yet back to normal – even though we are increasingly acting as normal.

WHO reports close to 260 million cases of covid since inception and almost 5.2 million deaths. The global picture shows no significant sustained reduction of cases or fatalities. (Although note a lage drop off in cases and fatalities as vaccine began rollouts from April 2021 to June 2021). Still much work to be done.

South Africa

Hard to tell how accurate the data is; or how effective the testing is, but here’s the the data (source WHO). 62 cases per million per day. But using recent data – the fatality rate is 7% of those infected (prior month lag) – which points to likely a very significant level of cases that are undetected (lack of sufficient testing).

But the week over week comparisons show a more alarming story in Africa – sharply rising cases and fatalities:

And we also see fatalities on the rise, week over week as follows:

In all of the WHO global data – Africa has a very low percentage of cases. In my view that is most likely a sign of insufficient levels of testing. In the data below – Africa is about 1% of all cases. Seems unlikely given that Africa is about 16% of world population.

European countries with sharply rising cases:

All expressed per capita – as cases & fatalities per million of population per day. Notice the higher cases are translating into significantly increased fatalities.

The Netherlands spike is best viewed in comparison to longer time range data:

Here’s the longer term Germany chart. Easy to see why German authorities are getting concerned. The fatality curve from August to Date looks almost exponential.

Russia & Eastern Europe

Russia and Eastern Europe are still leading the league tables for highest per capita level of fatalities. These are very high levels of average daily fatalities per million of population. By contrast the US is @ 4.5 fatalities per million per day; UK is 1.9

Russia is still experiencing very high fatality levels – even though cases have started to reduce:

Ukraine has an even higher fatality rate:

Hungary has an even higher current level of fatalities

Bulgaria has the highest levels of per capital fatalities, but down over the course of November:

South America Success:

Hard to know the reasons for success – but South America in general is having very low rates of COVID. Is it the shift to the summer season? Brazil, Peru and Argentina continue to trend down:

Conclusion:

The VIRUS is again showing its ability to mutate – even while Delta is still impacting the world.