As the situation in New York has significantly improved as it prepares to enter phase 3 in reopening, the state of affairs in the south and southwest seems like a car going in reverse.
The failure we are witnessing in these regions revolves around the decision not to follow the CDC guidelines for reopening, which are supported by basic tenets of public health.
After reopening in early May, Texas in particular began to see a modest but steady increase in the growth of new cases just 2 weeks after some businesses reopened at 25% of capacity. This happened even as the state did not meet all the benchmarks for reopening set by the White House or even Abbott himself. By mid-May, in fact, Texas set new daily records for both new cases and deaths. Fast forward to the end of June and the sentiment is now more akin to “I told you so”.
The story with Florida, which began reopening May 4th, provides another example of a state with a steady increase in cases amid a report by Florida’s Health Care Administration of shrinking ICU capacity, according to Becker’s Hospital Review.
Now, as 36 states report a rise in new cases, there is growing concern that Florida may be the next epicenter for the virus.
The data reveal quite concerning numbers in Florida: 9,585 new cases yesterday, a new one day record since the pandemic began. What’s most concerning is that these numbers exceed the peak of daily cases New York reported when the pandemic exploded there in early April.
When Florida Governor Ron DeSantis made remarks that his state’s increase in cases last week were the result of a “test dump”, the reality is that public health officials in Florida and many other states now realize that this increase in cases is now among younger persons.
The spike in contribution of infections among younger persons was the major theme of Dr. Fauci’s remarks when the White House Coronavirus Task Force held a press conference on Friday. In essence, the nature of the pandemic and how they are approaching it, has significantly changed since it began over 4 months ago.
Fauici called the change a “paradigm shift” which is now being given by younger persons.
“It’s a paradigm shift because we’re dealing with young people, people who are going to be asymptomatic, and people who are getting infected in a community setting, not an outbreak setting where you know who to identify, isolate, and contact trace.” Fauci said.
The rise in cases among younger age groups has also been apparent in Mississippi where officials there have identified fraternity parties as a catalyst for the increase in the state’s cases. Dr. Thomas Hobbs, Mississippi State Health Officer, announced 381 new cases and 5 deaths at a press conference on Thursday. Dobbs explained that many of patients have been linked to fraternity rush parties, specifically in Oxford, Mississippi. It’s believed that many of the parties violated state guidelines, due to large numbers of persons attending the parties.
And, as the paradigm shift was announced by Dr. Fauci on Friday, the US broke another record as it reported the greatest number of new cases on Friday with over 40,173 new infections. This new data likely led to Governor Greg Abbott ordering Texas bars to close again and restaurants to reduce occupancy to 50%, with the surge in new cases. The news was likely a factor in Florida Governor Ron Desantis banning the sale of alcohol at bars on Friday as well.
These concerning numbers, however, may be just the beginning of a wake-up call as a new CDC antibody survey estimates that the overall number of cases in the US could be 6-24 times higher than initially reported. This survey comes on the heels of another serological survey estimating that nearly 25 million Americans may have been infected, announced by CDC Director Robert Redfield, on Thursday.
Younger Groups and Asymptomatic Spread
With a shift to increased transmission by persons under age 35, it’s vital to acknowledge the role of those congregating at bars fueling the creation of so-called “superspreaders”. It’s at these events where public health officials believe that such individuals are created. Superspreaders have the ability to transmit the virus more effectively and thus the ability to infect greater numbers of people.
Superspreaders are created when large numbers of people gather close together, don’t practice social distancing or wear masks. This allows for the efficient transfer of aerosolized droplets that can remain airborne for 8-14 minutes from simply talking in an enclosed space, and potentially up to 3 hours according to recent studies.
While we don’t yet understand the biology of how superspreaders are created, we do know that such persons generate higher viral loads, shedding more virus than is typical compared to others infected with the virus.
There is also increasing sentiment that the transmission of Covid-19 likely follows the 80/20 Pareto Principle, named after the Italian economist, Vilfredo Pareto). The Pareto Principe says this: 80% of all consequences come from just 20% of the possible causes. For Covid-19, the translation is that 80% of new transmissions are caused by less than 20% of the carriers. This means that the majority of people infect few people or none at all, while a select few are aggressively responsible for spread of the virus. In fact, a recent preprint evaluating transmission in Hong Kong lends support to the 80/20 figure.
Multiple other outbreaks around the world have already been linked to single events in which a superspreader likely infected significant numbers of people. A megachurch in Seoul was linked to the bulk of initial infections in South Korea, a wedding in Jordan with about 350 guests led to 76 confirmed infections, and a choir practice in Washington State resulted in 52 people being infected.
While it’s difficult to diagnose and identify superspreaders, what we can do is limit their impact on the course of the pandemic. We do know that sound public health principles such as contract tracing are still essential for finding potential carriers and isolating them and their contacts. This helps precent superspreaders from emerging, traveling around and spreading the virus to others.
Finally we also must not ignore the importance of mitigating the 3 C’s of transmission: closed spaces with poor air circulation, crowded venues, and close contact with other people. The translation of this is to always look for outdoor seating when possible, seek out indoor spaces with good air-conditioning or ventilation, limit the number of people indoors, maintain 6 feet of physical distance between other persons, and wear a face covering.