US risks coronavirus rebound with 2,000 deaths daily as no state meets safety criteria for reopening: Experts
Several US states are in the process of lifting lockdown measures, but none meet the safety criteria that warrant reopening, according to an expert from the Johns Hopkins Center for Health Security. In the absence of measures such as adequate testing, contact tracing and sufficient supply of personal protective equipment, among others, the country risks a rebound and 2,000 preventable deaths every day, warned Dr Caitlin Rivers, senior scholar at the Johns Hopkins Center for Health Security, during a House Appropriations Committee hearing on the coronavirus pandemic response.
“It is clear that more difficult times lay ahead. The US still faces 25,000-30,000 new cases and approximately 2,000 deaths every day, a range that held steady for the entire April. Many states are in the process of reopening or are considering doing so, despite inadequate capacities to do diagnostic testing, contact tracing and insufficient supplies of personal protective equipment. Other states not yet reopening are looking ahead to those decisions, as we all are, to try to understand how and when that transition to reopening should unfold,” said Dr Rivers, also an assistant professor in the Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health.
“We are in a critical moment in this fight. We risk complacency in accepting the preventable deaths of 2,000 Americans each day. We risk complacency in accepting that our healthcare workers do not have what they need to do their jobs safely. And we risk complacency in recognizing that without continued vigilance in slowing transmission, we will again create the conditions that led to us being the worst-affected country in the world,” she told the Committee.
Over 1,256,970 coronavirus cases have been reported from across the US as of May 8, and 75,670 have died in the Covid-19 pandemic, according to the Johns Hopkins tracker.
The first critical capacity that states need is diagnostic testing, that is, enough capacity to test everyone with Covid-19-like symptoms and have results with 24 hours. “We should start by understanding, from start to finish, what resources and components are involved in the testing pipeline. Swabs, reagents, test kits, PPE, have all intermittently been implicated in shortages. Next, national leaders should map out, in great detail, the current and expected capacities for each of these elements. What national capacities can we expect at the end of May, and June, and August? Where are the bottlenecks? What untapped resources could we draw from? How will we get from where we are to where we want to be?” the expert questioned.
Dr Rivers said if this work has been done, she has not seen it. “And I fear that neither have the governors and other state and local leaders who are having to make decisions about how and when to reopen,” said the infectious disease epidemiologist.
The second capacity, closely related to diagnostic testing, is contact tracing. The third and final pillar is healthcare capacity, explained the researcher. Dr Rivers said both large and small cities face the risk of healthcare systems becoming overwhelmed through the transition. To guard against that, the federal government should support states in deciding how and when to reopen and should work with states to carefully monitor for signs that transmission is accelerating. If the number of newly diagnosed cases begins to rebound, or if the number of hospitalizations and deaths increases, additional measures may be needed to regain control, said Dr Rivers. The federal government should also plan to provide rapid surge capacity for healthcare systems that become strained, she added.
“These three capacities are what will enable the US to transition safely from staying home to slow the spread into a gradual reopening. We should be working now to ensure we have the tools to do that successfully,” said Dr Rivers.
The scientist said the Congress should consider establishing a national center that would perform epidemic forecasting and analytics, patterned after the National Weather Service. Such a center could be relied upon to produce disease forecasts and analytics to support high-consequence policy decisions made by federal and state officials who are working to protect the public. “There is some misconception that because Covid-19 is unprecedented, it is not worth designing new systems around. But in fact, outbreaks that threaten our national interests are unsettlingly common,” said Dr Rivers. She said the US must set an ambitious goal of rapidly developing medical countermeasures for novel or unknown threats in months, not years, “as the next fast-moving, novel infectious disease pandemic could be right around the corner.”
Projections suggest potential late May Covid-19 rebound
A separate analysis by Columbia University Mailman School of Public Health scientists estimates that, nationally, new Covid-19 cases and deaths will rebound in late May, as states ease stay-at-home orders and social contacts increase. The researchers anticipate a rebound in Covid-19 cases approximately two to four weeks after states begin to reopen.
By June 1, one projection scenario gives average estimates of 43,353 cases per day and 1,841 deaths per day in the US. A second scenario with a greater progressive loosening of restrictions projects median estimates of 63,330 cases per day and 2,443 deaths per day by June 1.
“25 states have or plan to partially re-open their economies in the coming week. The impact of this increased activity on contact patterns, the transmission of SARS-CoV-2 (the virus that causes Covid-19) and Covid-19 incidence remains highly uncertain, as levels of compliance with social distancing, return to work, and consumer willingness to frequent businesses are unknown,” say researchers in their findings.
“The lag between infection acquisition and case confirmation, coupled with insufficient broader testing and contact tracing, will mask any rebound and exponential growth of the Covid-19 until it is well underway,” they warn.
According to the report, the 25 states that have eased stay-at-home orders or plan to ease stay-at-home orders, as of May 2 are Alabama, Alaska, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Maine, Minnesota, Mississippi, Missouri, Montana, Nebraska, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia and Wyoming.
In all but two of the 25 states that already have or plan to partially re-open their economies in the coming week, the scientists predict substantial increases in coronavirus cases based on two scenarios. This includes a one-time 10% increase to the contact rate during the week that the state is scheduled to reopen and a weekly 10% increase in contact rates, which represent a progressive loosening of restrictions and increased public confidence and frequenting of businesses. “Daily confirmed cases will likely rise more sharply in the second scenario, notably in Texas where they could pass 500 by early June. If stay-at-home orders in these states had been maintained, cases would likely have declined,” says the report.
New neighborhood-level projections in New York City point to an easing of Covid-19 infections, hospitalizations, and deaths over the next six weeks, including in North Central Queens which has seen the highest numbers in recent weeks. On a per capita level, northern Staten Island and Far Rockaway, Queens, are expected to be most affected in the coming weeks, shows the analysis. The latest projections also find that in recent weeks the rate of transmission has sped up in some neighborhoods, likely due to relaxed social distancing. These areas include parts of Staten Island, the Bronx and Queens. “Citywide projections assuming a 50% increase in the contact rate due to relaxed social distancing show the number of infections in the coming eight weeks could be twice as high as would be seen if the city maintains the current rate of contact,” says Dr Wan Yang, lead on New York City projections and assistant professor of epidemiology, in the analysis.
The researchers caution that as infections rise where stay-at-home orders are lifted, hospital critical care capacity in those states will be stressed in ways already seen in hard-hit areas like New York City.