Amid a slow and uneven rollout of vaccines and increasing concern about new variants of SARS-CoV-2, the pandemic indicators we’ve been watching since March reveal that outbreaks are easing all over the country. For the second week in a row, new cases and COVID-19 hospitalizations dropped nationally—17 percent for cases and 10 percent for hospitalizations—though cases and hospitalizations remain much higher than at any point before the fall/winter surge. Tests have also declined, which is not what we’d like to see—drops in tests may mean that more cases are being missed—but this decline follows two weeks of testing data that may have been artificially elevated by the resolution of holiday-reporting backlogs, so it’s difficult to interpret.
Reported deaths rose 7 percent this week, with states reporting a total of 22,797 lives lost to COVID-19. Deaths lag behind cases—both because it takes time to die of the coronavirus and because the reporting process for deaths is very slow. Even with cases falling across the United States, we may have another week or more of very high death numbers to come.
Residents and staff in nursing homes and other long-term-care facilities are also seeing much-needed improvements. The week running January 15 to January 21 was the first time in four months that both new cases and new deaths in long-term-care facilities decreased at the same time without a holiday-reporting delay. Deaths among residents—who make up about 99 percent of COVID-19 deaths associated with LTC outbreaks to date—remain very high. States reported 5,883 COVID-19 deaths associated with long-term-care-facility outbreaks the week of January 15—about twice as many as were reported at the peak of the summer case surge. The data we publish about long-term-care facilities now include the CDC’s Pharmacy Partnership for Long-Term Care vaccination data.
The figures we are able to provide for long-term-care facilities in the United States are an undercount—and we still don’t know how many cases and deaths we’re missing. New York, the epicenter of the deadly first U.S. surge, does not report case numbers for long-term-care facilities, and its death count excludes residents who died in hospitals or other locations outside the facilities where they lived. New York’s attorney general has released a report stating that Governor Andrew Cuomo’s administration has undercounted deaths in nursing homes and other LTC facilities by up to 50 percent. Additionally, neither Arizona nor Missouri releases any cumulative data on LTC cases or deaths. For these states, we’ve partly filled in the missing data by including the figures reported by the states’ largest counties.
Nationwide, new cases among white and Black people are down more than 10 percent compared with the previous week, and new cases among Latino people are down more than 20 percent, the second week in a row with fewer new cases for all three groups. Cases among Indigenous people were also lower the past two weeks than during the previous two weeks. We would like to provide similar reporting on race and ethnicity among hospitalized COVID-19 patients, but only 23 states report any race or ethnicity data for hospitalization. The number of new deaths rose this week compared with the previous week for all the race and ethnicity groups for which we have data.
A county-level view using case data compiled by USA Facts shows a marked reduction in particularly severe outbreaks in the past month. On December 20, there were 515 counties with a seven-day average of more than one case per 1,000 residents. As of January 24, only 287 counties had outbreaks that were equally severe. This measure tends to highlight areas with small populations and severe outbreaks—even devastating outbreaks in major metro areas have not recently reached such high case concentrations—and this tendency highlights the smaller and more rural counties that may experience locally intense outbreaks without causing state-level numbers to move substantially.
The national improvements in hospitalization figures this week reflect a drop in hospitalizations in almost every state—a mirror image of the awful weeks in November when hospitalizations were rising almost everywhere at the same time. Only a single state, Vermont, saw hospitalizations rise this week, but by only 2 percent. (Vermont currently has fewer than 50 people hospitalized with COVID-19.) It’s the first week since November 5 that no state has reached a new record high for current hospitalizations.
Hospitalizations are still very high—much higher than at any time before the third case surge arrived this fall—but they are now about one-quarter of the way back toward the baseline of about 30,000 hospitalizations that we previously experienced in early October. The number of people with COVID-19 in U.S. hospitals is also dropping faster now than it did in August, when we previously saw a sustained drop in hospitalizations.
In California, cases are down 50 percent over the past two weeks on the seven-day average, from 42,000 new cases reported each day two weeks ago to just over 21,000 new cases a day yesterday. Hospitalizations are following behind more slowly—about 18,000 people are currently hospitalized with COVID-19 in California, down from a January 7 peak of about 23,000. California has lifted its stay-at-home orders throughout the state this week, which will allow outdoor dining and personal services to resume. A new preprint from UC San Francisco’s Department of Epidemiology and Biostatistics covered in Eater Los Angeles found that food-service and agriculture jobs occupy three of the five occupations associated with the greatest risk of dying of COVID-19 in California, with restaurant cooks at the top of the list. (This research is based on death records from the California Department of Public Health and has not yet been peer-reviewed.) Latino Californians make up more than half of the food-service workers classified as essential, and 85 percent of agricultural workers, according to the Los Angeles Times.
Deaths are still rising in California, and more than 10,000 of the state’s total 36,000 COVID-19 deaths were reported after January 1; 4,500 of these deaths were reported in L.A. County. CBS Sacramento is investigating why so many California counties say they’re out of vaccines despite the state’s Vaccine Dashboard showing more than 2.1 million unused vaccine doses at the end of last week.
Arizona is still reporting the highest number of COVID-19 hospitalizations per capita in the country, but its outbreak continues to ease, though much less dramatically than California’s. New daily cases are down 28 percent from two weeks ago on the seven-day average, from about 9,600 on January 13 to about 6,900 yesterday. COVID-19 hospitalizations in Arizona are down 16 percent from the state’s January 12 peak. Despite this, 92 percent of all ICU beds were occupied on Tuesday, more than half with COVID-19 patients. Also on Tuesday, of the 91 percent of inpatient beds that were occupied, 49 percent were occupied by COVID-19 patients. Vaccines continue to be distributed throughout Arizona, including to a homeless-health-care nonprofit in Maricopa County that hopes to serve state residents who lack access to traditional vaccination sites and processes.
Georgia is now reporting the second-highest number of COVID-19 hospitalizations per capita in the country. The state saw its highest-ever number of hospitalizations on January 13, and has seen that figure fall about 17 percent since. This comes as Atlanta Magazine reports that the Georgia Registry of Immunization Transactions and Services has experienced technical difficulties resulting in “dramatically underreported levels of vaccine administration statewide.” Simultaneously, the NAACP has filed a lawsuit alleging that conditions in a privately owned Georgia prison—including crowding, poor sanitation, and minimal testing for COVID-19—have led to increased exposure to the virus within the prison.
Concerns over known and newly emerging variants of SARS-CoV-2 continue to grow. As scientists scramble to determine how potentially more-transmissible versions of the virus may affect vaccine efficacy, public-health officials are doubling down on the importance of reducing transmission to avoid another surge in new cases. In several states and metro areas, added stress on already overtaxed health-care systems would be catastrophic for patient care and outcomes. Outbreak epicenters such as Los Angeles are starting to see an uptick in the percentage of variant cases among samples that are tested, and any new, variant-worsened surge in an area where hospitalizations are still very high would be devastating.
Unfortunately, the U.S. is still not doing enough genomic sequencing to understand how widespread the variants have become. During yesterday’s White House COVID-19 press briefing, CDC Director Rochelle Walensky stated that resources are available to support states in processing thousands of samples. But until we get more complete data, we can’t know whether the variants we see in the headlines are to blame for any increase we may see in COVID-19 cases or hospitalizations. Although the virus is (expectedly) changing, the ways to prevent infection are not, so our best weapon against existing SARS-CoV-2 variants and to prevent the evolution of more variants is to keep doing what we know works: Wear masks, practice physical distancing, wash your hands, and avoid indoor gatherings.