Listen: The Sun Belt Spike

It’s March all over again.

What does the surge in coronavirus cases in the South and West mean for the country’s chances of ending the pandemic? Staff writer Alexis Madrigal joins the podcast Social Distance to discuss.

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What follows is an edited and condensed transcript of their conversation.

Katherine Wells: Alexis, you have a really good handle on the latest coronavirus data. What are you seeing?

Alexis Madrigal: There’s a lot happening. Let’s go through the four metrics that we track really closely: the tests, the cases, the current hospitalizations, and the deaths.

With tests, things have been scaling up. We do many times more tests than we did back in the spring, but it’s not localized in quite the same way. In the spring, the Northeast was where the bulk of the outbreak was. Now you need a lot more testing, and I think we’re starting to bump up against the limits of the current generation of testing that we have here in the U.S. We’re hearing about supply-chain shortages, in particular pipette tips.

Wells: There’s a pipette-tip shortage?

Madrigal: Yeah, it’s kind of a necessary part of doing the laboratory work of a diagnostic test. There are a lot of parts to it—swabs can run out; there can just not be enough machines, which you need to do the test. You need the chemicals that go into the test. You need the swabs that go into people’s noses. And apparently, you need the pipette tips to go over your pipette.

This is a real problem. All of the big labs like Quest and LabCorp are putting out advisories that their turnaround times are growing. For people who are going into a hospital, perhaps they can get tests more quickly, at least for now. But for people who are just getting tested at a drive-thru location or elsewhere, turnaround times are four, five, six, seven, eight days, which, of course, is what happened back in March and April. So, we’re kind of back where we were. And the real problem is that if you want to use testing to get people to stay in their homes, if they may have COVID-19, you need fast turnaround times in order to be able to use testing for that kind of mitigation.

James Hamblin: Yeah, because at that point, you’re kind of through the contagious phase.

Madrigal: Yeah. We now have hit this point particularly in the hot spots for the outbreak: Arizona, Florida, Texas, Louisiana, Georgia, South Carolina. Testing gets overrun when there’s a surge like this. People thought they had enough testing capacity and they clearly did not. And infections are growing across basically the entire southern part of the United States and places that really hadn’t been hit very hard in the first round. I think a really good example is Texas. We have hospitalization numbers for them going back to April. They were basically between like 1,000 and 2,000 people hospitalized from the beginning of April all the way to about June 8. They finally broke 2,000 on June 10. They broke 3,000 on June 19. They broke 4,000 on June 23. They broke 5,000 on June 27. And now they're up to over 9,000 less than a month later and it doesn't really seem like there’s a real end point to it right now.

I don’t know what that means for these southern states. When we saw stuff like this happening in the Northeast, the governors—Republican and Democrat alike—they all took pretty similar actions. They locked everything down and took intense measures. That’s just not what happened in Texas and Arizona and Florida and still isn’t happening. We’re really in a different kind of situation right now.

Hamblin: Yeah, I totally agree on the point that when you have this many cases—testing becomes less of an issue because you just need to lock down. That’s the only effective way to stop it when you’re at that level of spread. Do you think that the shortage of testing means that we’re really not seeing the full scope of things in any of the states that are being hit hardest right now?

Madrigal: I think that’s been a meta-point all along. The data that strikes me as the highest quality is the hospitalization data. You look at the cases or tests, and it’s not as clean. One thing that we’ve been digging into over the last few weeks is that cases are going way up, hospitalizations are going way up, but deaths have continued to drift downwards. If you look at Arizona, Florida, and Texas, which have been kind of the leading edge of the Sun Belt surge, what you see is that deaths are clearly rising in Arizona, Florida, and Texas since about the first week of June. And then if you look at the other states, they’ve been falling. What you have in the death data is the same thing that we actually saw in the case data for a long time during that false plateau. We had falling cases in the Northeast and in places that weren’t having major outbreaks. And then we had rising cases which were sort of drowned out by what was happening in the Northeast. And what we saw with cases is eventually the Northeast bottoms out. When the Northeast bottoms out and these other states have continued to rise, you do see the numbers then start to trend upwards. We saw that happen first with cases and we saw it with hospitalizations. And, sadly, there’s kind of only one thing to really expect with the death data.

Hamblin: I’m wondering if these national averages are useful or should we be talking less about national numbers and more about just the local picture?

Madrigal: The national numbers do matter for things like the supply chains. That said, this is an infectious disease. The big question for New Yorkers and everybody else in the Northeast and the Midwest is: Do we really think that this will be contained to the South and West if it continues going like this?

Wells: Is there any stopping this?

Madrigal: Well, what needs to happen hasn’t changed for months. I think we need to get people to be taking a lot of precautions and reducing the risk of getting infected and spreading infection. But I also think we need people to live sustainably—where they might imagine being able to live like this for a year, because we have no path to suppression right now.