Tales & Trails of a Traveling Wiseguy

I haven't written a Tier Tuesday blog in several weeks. I've been meaning to use the weekly slot to talk about not Coronavirus but another potential pandemic on the horizon. While the Coronavirus pandemic isn't really over so much as it's turning into the Coronavirus endemic it seems that player 2, or pandemic 2, is already entering the game. Monkeypox.



Monkeypox is spreading at a dangerous time. Covid-19 deniers have hamstrung the ability of public health organizations in the government to measure and communicate the degree of the problem. On top of that, Covid fatigue means that far too many people just don't care. They're burnt out. The fact the Monkeypox isn't infecting people left, right, and center— and thank all you hold holy for that, BTW— means they feel it's safe to ignore. But will it become widespread in the future? We could be in another January 2020 right now, when it was unclear whether the not-yet-named Covid-19 would fizzle out as yet another not-really-coming-to-the-US disease or... what it actually turned into.

Arguably it's not even January 2020 anymore for Monkeypox. It could be February or even March already. A report from the CDC yesterday (source: news article published by University of Minnesota, 8 Aug) says that there are already 7,500 cases in the US. This is no longer a hypothetical debate about whether Monkeypox will spread in the US in appreciable numbers; it's already here.

It's important to understand that while some aspects of these two diseases are similar, namely the way they're arguably not being taken seriously enough despite evidence available at the respective moments, they are very different in how they spread. Coronavirus is an airborne virus. You get infected by breathing the same air as someone who's contagious, especially if they're coughing or sneezing a lot because of the virus. Monkeypox, meanwhile, is not airborne. It's spread via prolonged, skin to skin contact.

Another way in which Monkeypox is different from Coronavirus is that we've got a vaccine for it already. That would be great... if there were enough. There's not. In at-risk communities where people are educated about the disease and are seeking protection, there's not enough to go around.

Will our weakened public health institutions be able to rise to this new challenge before it's too late?

This week I was planning to use my Tier Tuesday writing slot to discuss an article I saw yesterday, "If you still have not had COVID after the latest surge, what are the odds you never will?" (SF Chronicle, updated 21 June 2022). It notes a CDC figure that 60% of Americans have had Covid already and poses the question to a handful of doctors and public health experts— basically, Is it inevitable that the other 40% of us will get Covid? The experts explain that while we can and should try to keep from getting infected, the numbers— and the lack of public will— make it more a matter of when, not if, anyone will get Covid.

Well, what an irony. As I was drafting a lengthier blog about the question of inevitability, we joined the when-not-if category. Hawk took an at-home test for Covid last night and tested positive.

Hawk took the test last night because she'd been experiencing cold-like symptoms for a couple days: sinus congestion, a dry cough, minor back pain. OTC medicines and simple home remedies like hot showers (to clear nasal congestion) provided only partial relief. Aware that cold-like symptoms can no longer be written off as "It's just a cold",  she took a Covid test. We've done this drill several times in the past 6 months or so that home tests have been widely available. This time hers came up positive.

I took an at-home test this morning. I delayed mine 12 hours from hers to see if I developed significant symptoms. This weekend I did have some chest congestion, difficulty breathing, and aches— but they could easily have been due to the dry air and exercise at high altitudes. Those symptoms are typical for me in those conditions. Of course, just like "I'm sure it's just a cold" doesn't fly anymore, "I'm sure it's just allergies/dry air/altitude" doesn't fly either. So I took the test. My test result was negative. I'll remain vigilant for other symptoms and test myself at least once more even if no symptoms appear.

Update: What's next? 5 Things.

Update 2: When & Where Did Infection Occur?

Tier Tuesday was two days ago, so today is... non-Tier Thursday? There's a second thing I want to note about Coronavirus statistics this week that I didn't include in Tuesday's post focused on passing the 1,000,000 death mark. It's that even as we're passing that grim milestone in the US, our new case rates are on the climb again.

Oh, I've written about rising new-case rates for several weeks now. The rises on a week to week basis seem small: 24%, 26%, 21.5%, etc. Those are incremental changes, right? Wrong. Because when you stack them up on top of each other they become big changes. Just three weeks of 25% increases doubles the number. Five weeks triples it. Indeed, we're seeing case rates today that are double to triple what they were not too long ago.

Per figures at The New York Times Coronavirus in the U.S. the 7-day average new case rate in the US was 84,329. A month earlier, on April 11, it was 32,220. The latest rate is 2.6x just a month ago.

It's Tier Tuesday so time for my weekly check-in on Coronavirus statistics. This week's check of the data at The New York Times Covid in the U.S. (retrieved 3 May 2022) shows the 7-day average number as of Monday was 60,953, vs. the previous Monday's average of 49,175. That's a 24% increase in average daily reported cases.

This week's increase is a continuation of the trend of increases over the past few weeks. This week's increase of 24% is similar to last week's growth of 26% over the previous week. Similarly, 2 weeks ago there was a 21.5% increase over 3 weeks ago.

In some of my past Tier Tuesday posts I've compared the latest case rates to the rates we saw prior to the Omicron surge and in last summer's lull prior to the Delta surge. Such comparisons need to come with a major caveat. Case rates today look artificially low compared to past figures because nowadays many cases are not reported to the government health authorities. The rise in availability of at-home tests this year, coupled with people experiencing milder symptoms from the Omicron strain prevalent since December, means that fewer and fewer people who need tests go to clinics for them. Clinics are where reporting to county, then state, then national health agencies, occurs. At-home tests occur off the radar screen. Thus, while this week's average daily new case count of 60,953 seems "only" 5x higher than last summer's June lows of less than 12,000— of course, even 5x is bad— the reality is that today's figure could be double that (ie, 10x) or more due to unreported positive results.

The data that are more comparable now vs. 5+ months ago are hospitalizations and deaths. In recent weeks hospitalizations have been ticking up in tandem with reported new cases. That's not surprising. The death rate continues declining from the winter's astonishing peak. That's also not surprising, as deaths are a trailing indicator. Case rates have been increasing for only the past 3-4 weeks. Deaths will probably start to increase soon. Compared to last year, the recent hospitalization rate is only slightly higher than last June's summer lull. Ditto the death rate. These make sense as while there are significantly more cases now, the dominant Omicron strain produces less severe illness.

It's Tier Tuesday so time to for a weekly check of Coronavirus statistics. I skipped last week because I was on vacation in Hawaii— and already backlogged with travel blogging that's still about 5 days behind. Let's catch up on Tier Tuesday now.

The news this week is that Covid-19 case rates are trending up again. That's frankly not surprising to me as they were flattening out 2 weeks ago and 4 weeks ago. When a rate is flattening out often the next logical change is that it reaches and inflection point and starts to reverse. Two weeks ago, Apr 4, the 7-day average new case rate stood at 27,454. Last week (Apr 11) it was 32,220. This week (Apr 18) it's 39,152. Statistics are from The New York Times Coronavirus in the U.S., retrieved 19 Apr 2022.

These are weekly increases of 17.5% and 21.5%. So not only are cases increasing now, they're accelerating.

It's Tier Tuesday, as California's health department used to call it when it updated risk charts weekly on Tuesday. I like the cadence of checking stats once a week. It keeps me abreast of what's going on without it becoming an "Every day is Coronavirus news day" doomscrolling situation. Sharp-eyed readers will note I didn't post on Coronavirus last week. Rest assured that I did read and digest the news; I just didn't have time to write about it.

It's just as well I've gone 2 weeks now since writing about Coronavirus stats because the lead headline this week is that they're leveling off. This chart from The New York Times "Covid in the U.S." page shows case rates over the past 90 days:



At the peak of the Omicron surge 2 months cases averaged over 800,000 per day. The average has dropped markedly to just under 30,000 recently. But as you can see from the shape of the chart, the rate of improvement is leveling off. Today's average of 29,288 is only slightly better than March 15th's 32,133, which in turn is only slightly better than March 8th's 39,740. (Visit the NYT link above for an interactive chart where you can pinpoint these daily numbers.)

Flattening Out... 3x Higher

The fact that improvements are tapering off is not the only reason to temper celebrations of the declining Covid case rate. The fact is we're leveling off at a level that's still almost 3x last summer's low.



As I've noted before, the low last summer was just over 11,000 cases per day (average), on June 21. As great as it is that today we're 96% of the way down from the peak 2 months ago, today's rate is still over 3x last summer's low. That was before the Delta surge that preceded the Omicron surge.

3x the Cases, 4x the Deaths

So, the case rate is leveling off at 3x last summer's lull... is that the only dark cloud in the partly-sunny news? No. The death rate remains elevated, too.



The recent average of just over 1,000 deaths per day is still more than 4x the pre-Delta, pre-Omicron low of 228 last summer.

Discussing high and lows relative to strains is pertinent because each one brings new challenges. Delta was more contagious than Alpha and hit people harder. Omicron was much more contagious than even Delta but caused lighter symptoms. You can see that reflected in the charts, BTW.... The case rate surge for Omicron is way higher than Delta's, while the death rate surge is only somewhat higher. Still, it's higher. The "mild" Omicron strain killed more Americans than Delta.

A new surge may kick in soon. Many articles in the past week or two have talked about the BA.2 sub-variant of Omicron. It's thought to be even more contagious than Omicron. And even if BA.2 fizzles it's only a matter of time until the next variant emerges. With 30% of the US population refusing to get vaccinated there are 100,000,000 human petri dishes for the next strain to develop in. And that strain may make Omicron look like the J.V. team.

It's Tier Tuesday so time for a weekly check of Coronavirus statistics. The main metric, average daily cases per 100,000 population, has continued to decline. A week ago it was 81,823. Today it stands at 58,986. This is not only a 28% decline in one week but a 93% decline from the peak of 805,062 on January 15. Figures are per New York Times Coronavirus in the U.S. (retrieved 1 Mar 2022).

Along with the dropping case rates, mask requirements are dropping. The governor's office allowed the statewide mandate to lapse two weeks ago. Two counties, Santa Clara (where I live) and Los Angeles, kept indoor mask policies in place. But one week ago Santa Clara announced it would drop its policy if data supported such a change. The latest data have, so mask laws are largely lifted here, effective Wednesday. Example news coverage: KRON 4 news article, 1 Mar 2022; San Jose Spotlight article, 1 Mar 2022.

Previously I described the new policy as still requiring unvaccinated people to wear masks in indoors public settings. That is inaccurate. The new policy makes masks voluntary— though recommended— for all.

Masks remain required for all in certain settings. Masks must be worn in schools and child care facilities per a state requirement in effect through March 11. The governor has indicated he expects to lift that restriction starting on March 12. A separate rule mandating masks on public transit and in homeless shelters, health care and long-term care facilities, and correctional institutions remains in effect with no sunset date proposed yet.

Good News/Bad News

In the last several of my Tier Tuesday updates I've warned that the news is good news/bad news. That remains true this week. While Tuesday's 7-day average case rate is down sharply from the height of the Omicron surge, it is still higher now than before the Delta and Omicron waves.

The last time California lifted its mask mandates, 15 June 2021, the national average case rate was 12,620. Today my county decided to lift mask requirements with nearly 5x that rate... and most of the rest of the state and most of the rest of the country lifted theirs long before that. Other key metrics— test positivity, hospitalization, and deaths— remain substantially higher, too.

This all adds up to a conclusion that this lifting of the mask mandate is unscientific, that it's a premature, rushed change because the political will to tolerate restrictions in the name of public health no longer exists. We're effectively a nation of children who vote now.

It's "Tier Tuesday" as California reporters used to say when California had a Covid risk tier system and updated it every Tuesday. I like the weekly cadence for checking the latest Coronavirus statistics. It keeps me updated at a regular interval without the risk of "doomscrolling" by reading about Coronavirus infections, deaths, etc. too frequently.

The good news today is that new cases are down by 2/3 from their peak a few weeks ago. According to The New York Times' Coronavirus in the US page the 7-day average as of last night, 7 Feb 2022, is 253,782. The peak of 806,795 occurred Jan 14. We're at less than 1/3 of that peak now.

The not-so-good news is that even though we're well below the peak infections of the Omicron/winter holidays surge, we're still well above the infection rates of a few months ago. The new case rate on Nov. 27, when news of the Omicron strain first hit major national media, was 85,432. While the peak of the surge was 9x that, even today we are still 3x that level.

The low point of the past year occurred last summer, Jun. 21, when the 7-day average reached as low 11,179. Today's rate, while dropping, is still more than 22x that low.

Death Marches On

More bad news— yes, the bad news outnumbers the good 3:1— is that the Covid death rate remains very high. Yesterday 2,598 deaths were recorded in the US. We're at the highest death rates seen in more than 12 months. We passed a total of 900,000 deaths from Covid a few days ago. The grim 1 million death mark is likely to fall by the end of March.

For comparison, the 9-11 attacks killed 2,977 people (excluding the terrorist perpetrators). The US turned life upside down for 20 years and counting because of that one day death toll. The same US now shrugs its shoulders when nearly as many people die each day from an almost totally preventable cause.

One week ago the US hit a new record in the ongoing Coronavirus pandemic: over 1 million new cases reported in a single day. I noted at the time that the Jan. 3 tally of 1,018,935 (it's been adjusted upwards a tad since I published my Jan 4. blog) was a bit of a statistical anomaly; it was on a Monday following a holiday weekend. Some states don't report data on Sundays or holidays, so Monday counts almost always show an artificial spike.

Well, today's Monday, and there's another spike. And this one dwarfs last Monday's spike. Today's tally is 1,417,493 per the New York Times' Covid in the U.S. page (retrieved 10 Jan 2022). Here's a graph of recent case numbers:



Along with this extreme new high in daily new case numbers the rolling 7-day average has continued to increase. As of today it stands at 737,415. Suddenly last week's spike isn't so anomalous.

"It's not like March 2020," I've been seeing in numerous headlines about Coronavirus over the past 24 hours. The president even said it in a speech today. The point of the comparison is to reassure the public that 1) the risks of Coronavirus today aren't as bad as they were in March 2020, and that therefore 2) drastic measure such as shutdowns are unwarranted. But here's the thing: by at least one important, evidence based measure the risks are clearly worse.

A key metric I follow, and which I frequently reference in this blog when I write about Coronavirus trends, is the average daily new case rate. This best reflects the answer to the question, "What are my chances of being exposed to Coronavirus?" The more people who have recent cases, the greater the chance you'll be exposed to someone who's contagious. Here's how that looks, now vs. then:



I created the graphic above from The New York Times's "Coronavirus in the U.S." page (retrieved 21 Dec 2021) with callouts to compare now vs. then. At the end of March 2020, the worst part of that month, the daily average was 19,217. Today the daily average is 157,412. That's more than 8 times as many new cases. By this objective measure, "This is not March 2020"; it's WAY WORSE!

Now, not everything is worse today. A big positive is that we've got the vaccine in wide availability. More than 2/3 of everyone in the U.S. has gotten vaccinated. I've gotten vaccinated and gotten a booster, too.

The problem is that the vaccine is not a magic bullet. It gives only about 4x protection vs. the Omicron strain (meaning vaccinated people are 4x less likely than un-vaccinated to test positive for it) according to preliminary data being reported this week. 4x protection but 8x higher exposure.... Those are not favorable numbers!