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.

Success in the South – but Northern US getting hit hard. It ain’t over yet.

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

Does Peloton’s stock performance mark the end of COVID? Maybe there’s a market in Eastern Europe.

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

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

Northern States with rising cases

Spot the difference – a very similar pattern emerges in the northern states. Notice the sharply rising fatality rate (red line) in most cases. Idaho is currently on 12.4 COVID deaths per million per day.

Fortunately a declinining trend in some southern states – especially the blue line (cases)

The net result is that the US has definitely bent the curve for new cases; but fatalities are not falling much. Average deaths are 1600 per day.

Total deaths for October looks set to have a similar level of deaths as September

Russia gets serious on covid – lockdowns and low vaccination rates

Russia is now at a very high level of fatalities from COVID. Over 7 fatalities per million per day. Approximately 34,000 new cases are recorded per day.

The attached WSj article informs that vaccination rates are in the low 50%. Lock downs are in effect.

Russia Orders People Not to Go to Work as Covid-19 Deaths Mount

As reported recently Eastern Europe has very high levels of new cases. Romania, Bulgaria, Latvia all continue to record extremely high levels of cases and fatalities.

US Cases may be coming down – but fatalities are still very high

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

Eastern Europe and the UK – feeling the Delta pinch

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.

From a peak of 33,000 deaths in January – UK now on pace for about one tenth of that in October.

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.

The Northern Surge

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

The perils of misinformation: Alaska is the latest to feel the effects

All this pandemic needs to thrive is misinformation. You know – the kind where a fact is presented in isolation of other relevant data. Take for example the following statements

  1. There have been 700,000 side effects of the covid vaccine in the US
  2. Asymptomatic people don’t spread the virus

Lets put the first point in contact. 389 million doses of vaccine have been administered in the US alone. Over 6 billion across the world. When stats are quoted in isolation of appropriate context – its misleading. The rate of side effects is well less than 1% – and we also need to know how temporary or permanent the side effects are.

Point 2 – while I’m not a doctor – my understanding is that we are CONTAGIOUS BEFORE WE START TO FEEL IT – therefore in the initial contagious period – most people are unaware and asymptomatic.

There’s no persuading anyone at this time

Another good friend of mine summed it up the COVID situation. There’s no persuading anyone at this time. When the TN governor declares ‘parents know best’ and issues the executive order letting parents over-ride school mask mandates – did that governor look at his own vaccination data? Many rural counties had vaccination rates less than 30%. See analysis here.

Lets look at the impact of biased information on individuals

In this first example – a Kentucky bride to be – aged 29 who was concerned about vaccine effects on fertility – had her bachelorette in the COVID epicenter state of Tennessee – in Nashville – and died shortly afterwards. This happened in August.

Kentucky bride-to-be who hesitated to get vaccinated dies of Covid – NBC News

In the second example – and anti vaccine promoter, who denied the pandemic also died… of COVID

Anti-vaccine activist who said “there’s no epidemic” dies of COVID – Newsweek

Shocked to the point of numbness

In August I went to my local barbershop – and complained that 2 people in the store were not wearing masks. I pointed out some facts – that August had over 700 deaths in TN – which is 6x higher than in June – and ICU capacity was in single digits.

In September I returned to the same barbershop aware that close to 1600 people had died of COVID in TN in the month and decided it would be a waste of breath to say anything. Although perphaps I hadn’t wasted my breath as the one stylist who wasn’t wearing a mask in August was wearing it in September.

TN is still struggling with COVID. While cases are down, fatalities are 8.8 per million per day – which is very high; ICU capacity is just 8% (156 beds for 7 million people).

Alaska is the latest case of the mass effects of disinformation

Check out this article from the NY Times. Alaska’s hospital capacity has been exceeded. Doctors are having to choose who gets treatment and who doesn’t. And unlike other US states – moving patients to a neighbour state isn’t easy.

3. In Alaska’s Covid crisis, doctors must decide who lives and who dies.

Read the article and you’ll see the thread of disinformation. How people are heckling doctors when the doctors give out sound medical advice (not unlike the viral TN school board meeting where some parents demanded kids not wear masks).

Just like TN’s spike in deaths; now Alaska is facing the same. More people died in Alaska than at ANY month in the pandemic. Think about that for a moment: we are 18 months into a pandemic, we have vaccines that prevent fatalities for many, many people and Alaska records its highest ever month of COVID deaths.

TN Deaths by Month

An individuals right not to get vaccinated, or take preventative measures – applied at scale in a pandemic – has consequences. This prevents people who need treatment (like heart attacks) from getting it. Is it really your choice to NOT WEAR A MASK when there isn’t hospital capacity to treat those who need it?

At least some platforms are taking a stand. This week Youtube decided to crackdown on misinformation. About time too!

To close this I’ll say. Its not over yet. Get your information from reliable sources and question those who quote statistics in isolation.

In Alaska’s Covid Crisis, Doctors Must Decide Who Lives and Who Dies – The New York Times

Another example of misinformation leading to chronic medical capacity issues including rationing of care.

Amid the nation’s worst Covid-19 outbreak, patients are trapped in remote communities and doctors are prioritizing treatment based on who is most likely to survive.
— Read on www.nytimes.com/2021/10/03/us/coronavirus-crisis-alaska.html