This Surge is Spreading ...

We have updated our covid tracking plotting app to allow daily/smoothed/per capita plots.

Here is the 7-day moving average for new cases counts per million residents/day for all of the states that are part of this June surge, with NY included for comparison so we can see how this surge compares with the well-known initial surge driven by NYC

For reference, here is the USA numbers compared with some of the major European countries that have had outbreaks. The curl upwards in June is driven by this pack of states.

Some comments:

• These states the ones that are sharply increasing in June. There are a few others following just behind (TN, MO, UT, OR, CA) and at danger of joining the party

• There is no explaining away this surge as an artifact of testing. It is undeniably real and still increasing and spreading to new states.

• Some places are approaching the per capita daily case levels of New York during its initial surge, and others have a steep slope so could reach that level if it continues.
  

• Much of this surge is comprised of younger infected (e.g. in Florida, >1/2 of the cases in this surge are less than 35 years old). These might not have as high a risk of severe complications and death as the older demographic, but this virus is nasty enough that it will kill or permanently damage a sizable minority of these currently young and healthy people, plus this type of spread will not stay with the young but will spread to the other members of society, many of whom are at higher risk for severe complications and deaths.
  

• This type of growth, if allowed to continue unconstrained, will start to overwhelm the health care systems. The current surge indicates exponential growth many of these places, with cases/day doubling every 2 weeks or so. Hospitalizations lag behind cases by a couple of weeks, so this means the covid-related hospitalizations may also double in that time frame, and indeed in Houston and Arizona we have seen fast doubling of covid-related hospitalizations. Arizona and Texas are already at the brink, and Florida may also be close behind. Texas has the largest medical center in the world, and is into surge capacity, and this expanded capacity could become filled in just a few weeks if the surge continues. The problem with plans that don't constrain spread enough thinking that there is plenty of health care capacity is that it underestimates how fast cases grow under exponential growth, and thus underestimates how quickly a big healthcare system can go from available capacity to overflowing.

• I believe this surge was completely preventable. If a higher proportion of society would follow the basic guidelines of avoiding crowded indoor settings where social distancing isn't possible, and wearing masks when indoors around people, this surge almost certainly wouldn't have happened. Better messaging and planning from governments could have contributed to this. Mask wearing is starting to catch on more broadly, which should help start to flatten out this growth.
  

• Cases are roughly 2 weeks lagged behind behavioral changes, so even with mask wearing directives and other precautionary steps, it is likely the behavior from the past few weeks will continue to cause increases before these benefits kick in. I am hoping that people are already showing more vigilance so we will see the numbers flatten as soon as this week, and if not then the recent mask directives should provide this flattening in the coming weeks as long as it is followed by most people.
  

• With this type of volume of cases and the open travel going on in the USA, it is unavoidable that this surge will spread to other parts of the country, and places in the midwest and middle Atlantic are already showing upticks that may be seeded by this surge. For example, Allegheny county in PA is seeing an outbreak that has been seeded by a group of residents coming back from vacation in the Atlantic southeast.
  

• This surge threatens our fall plans and what I hoped would bring more of a return to normalcy. I know how desperately we need to get children back in school, especially children from underprivileged settings whose homes are not as safe, supportive, and nourishing, not to mention the childcare crisis we will face if schools are not open. We want sports to start up -- pro baseball, pro basketball and NFL and college football hope to start up. If this surge continues, all of these plans are at risk. There may still be time for this to flatten and turn around, but there is no margin for error -- it has to happen right away. If this surge goes on much longer, then the fall plans are at risk of going out the window.
  

This is a huge setback, but hopefully we are learning from this -- we have to realize that this virus is going to be with us for a long time and spreads wicked-fast, so it is CRUCIAL for us as a society to work together to take the basic steps that can keep it at bay. We need to practice a sustainable strategy for living with it. I believe that if society can cooperate to do the key things, especially taking care to avoid crowded indoor settings, and when around people indoors practice social distancing as much as possible and wear a mask, then we can manage the virus without shutting things down.

If we would have done those things better, this surge would never have happened. Now that it is underway and has this momentum, it might not be enough to do these small things to get it under control again -- we'll have to see. More extreme measures may be taken. But once the surge is under control, if we can all agree to do these small things, we can effectively manage it. We really don't have a choice -- we HAVE to figure this out.