COVID-19 Cases: The Pandemic’s Future Hangs In Suspense

An illustration of coronavirus cases and hospitalizations overlaid on a photograph of a medical professional looking out a window.

COVID-19 cases dropped about 5 percent this week, while testing rose 12 percent as backlogs in reported tests—always a little slower to recover than reported cases—rolled in following disruptive mid-February storms. The number of people hospitalized with COVID-19 dropped almost 16 percent week over week, making this the seventh straight week of sharp declines in hospitalizations. States and territories reported 12,927 deaths this week, including a substantial backlog from the Commonwealth of Virginia.

4 bar charts showing weekly COVID-19 metrics for the US. Cases fell nearly 5% this week while testing was up over 12%. Deaths continued to drop week over week.

The decline in cases has been a point of confusion in the past week, as daily reports briefly jogged up after a large drop following the long Presidents’ Day weekend and disruptive winter storms in mid-February. A look at percentage change in reported cases since November 1 helps illustrate the dips and rises in reported cases seen around Thanksgiving, Christmas, New Year’s Day, and—more recently—the winter storms in mid-February. (On November 8, California did not report data in time to be included in our daily compilation.) Cases may plateau or rise at any point, and a close watch of the numbers is essential as vaccinations roll out alongside the spread of SARS-CoV-2 variants. But we would urge data watchers to be wary of conflating reporting artifacts with real changes in the state of the pandemic.

Bar chart from Nov 1, 2020 - Mar 3, 2021 showing the daily percent change in the 7-day cases average. The 7-day avg rose for a few days a week ago, but this was likely due to storm reporting impacts.

Although it seems unlikely, based on current figures, that a new surge is showing up in the case numbers, it is quite possible that case declines are beginning to slow. With reported tests up 12 percent this week—likely also because of a storm-related dip and rise—it’s impossible to be certain whether the case decline is slowing because of an increase in testing, or because disease prevalence itself is declining, albeit more slowly. We can look to other metrics, however, to help us interpret the past two weeks of case numbers.

One way to confirm that a change in reported cases—especially one preceded by a disruptive event like a holiday or a major storm—reflects reality is to look at new hospital admissions. This metric, which is available in the federal hospitalization data set, has tracked very closely with cases since the hospitalization data set stabilized last fall, but has not shown the same vulnerability to reporting disruptions produced by holidays or severe weather. Charting federal case data against new-admissions data shows that the decline in new admissions continues, though slightly more slowly than the decline in cases.

Two line charts showing federal COVID-19 data: 7-day average cases over time and 7-day average hospital admissions over time. Admissions are dropping in recent days while cases hit a small plateau due to reporting artifacts.

This signal helps confirm that the brief rise in daily reported cases in the past week was very unlikely to signal a new surge in cases—though, again, cases may not be dropping as quickly as they were in late January and early February. It’s nevertheless important to note that cases remain extremely high, and have only this week dipped below the peak of the summer’s case surge. (Though we’re almost certainly detecting a larger percentage of cases now than we were in the summer, as our testing capacity in the U.S. has increased.) The sustained decline in cases and hospitalizations is very encouraging, but with multiple variants of SARS-CoV-2 gaining footholds in U.S. cities, it remains vitally important to further reduce the virus’s spread via masking, social distancing, and avoiding indoor gatherings.

Although it may seem that the decline in hospitalizations is slowing down in recent weeks, the percentage decrease remains robust.

Bar chart showing daily percent change in the total number of patients currently hospitalized with COVID-19 in the US. This figure has been falling by a consistent percentage in recent weeks (around 2.4 percent)

Reported COVID-19 deaths, too, continue to decline. The particularly sharp drop in the week beginning February 11, which included Presidents’ Day and the beginning of the winter storms that affected data reporting in many states, was balanced by a smaller drop in the week of February 18. This week, deaths dropped by an encouraging 11 percent.

2 bar charts one on top of the other - the first showing the percentage change in weekly COVID-19 deaths in the US, the second showing just those weekly deaths. Deaths fell 11% from last week

It’s important to note that many states have recently added large numbers of COVID-19 deaths from previous months to their totals. In Virginia, cases and hospitalizations have been dropping for weeks, but after reporting fewer than 100 deaths a day for the entirety of the pandemic up to this week, the Commonwealth is now reporting hundreds of deaths every day—most of which occurred in December and January.

4 daily bar charts with 7-day lines overlaid showing key COVID-19 metrics for Virginia since the beginning of 2021. Deaths have spiked drastically in recent days - however, these deaths are reconciled from older dates and do not reflect the true state of COVID-19 fatalities in VA at the moment.

The addition of these backlogged deaths—like the 4,000 deaths from previous months recently reported by Ohio—obscures the reality of rapidly declining recent deaths. It also underlines the fact that deaths at the peak of the winter surge were actually much higher than the already-devastating numbers reported in December and January.

For the week ending February 25, COVID-19 deaths in long-term-care facilities have continued to decline as a share of all COVID-19 deaths in the U.S. (As we did in last week’s analysis, we have excluded from this chart all data for four states—Indiana, Missouri, New York, and Ohio—that recently added large numbers of undated deaths from previous months to their totals. The addition of these historical death figures to recent weeks made it impossible to follow recent trends at the national level without this exclusion.)

Bar chart showing the share of weekly COVID-19 deaths occurring in LTC facilities. The percentage is down to 13% in the most recent week after being over 30% for months.

It’s our final week of compiling and interpreting data here at the COVID Tracking Project, and we’ve spent much of the past few weeks explaining how to use data from the federal government in place of our patchwork data set. We’ve packaged up everything we’ve learned about federal case numbers, death numbers, hospitalization data, and testing data, as well as long-term-care-facility data. For more casual data users, we’ve also written a short primer on how to find easy-to-use charts and metrics from the CDC. It’s even possible to replicate three-quarters of our daily four-up top-line chart using data from the CDC, although the data are one day behind the state-reported data we compile.

4 charts showing key COVID-19 metrics over time from the CDC: Cases, Hospitalized, Hospital Admissions, and Deaths. All 4 charts show a declining trend.

In this version, new hospital admissions are included instead of tests—test data are available from the federal government, but are not in a date-of-report arrangement that matches the other top-line metrics. (We’ll be publishing a separate post showing how to produce this visual within the next few days.)

Long-term-care data wrap-up: Tonight marks our final compilation of data at the Long-Term-Care COVID Tracker, and we’ve just published a look at the subset of long-term-care-facility data available in the Centers for Medicare and Medicaid Services Nursing Home data set. This federal data set includes only nursing homes and accounts for about 27 percent of all COVID-19 deaths in the U.S. to date. The long-term-care data set we stitched together from state reports, by contrast, includes assisted-living facilities where states report them, and accounts for at least 35 percent of all U.S. COVID-19 deaths.

Race and ethnicity data wrap-up: For 11 months, we have shown that the COVID-19 race and ethnicity data published by U.S. states are patchy and incomplete—and that they nevertheless have indicated major inequities in the pandemic’s effects. Both of these things are true of the demographic data available from the CDC: Many data are missing, and what data are reported show ongoing disparities. Our introduction to the federal data will be posted later this week, and we’ll be publishing deeper analyses in the coming weeks.

As we wind down our compilation efforts, the United States is at a crucial moment in the pandemic: Decisive action now is our best chance at preventing a fourth surge in cases and outpacing the variants, which may be more transmissible than the original virus according to preliminary (preprint) data. Over the weekend, the FDA issued a third Emergency Use Authorization for a COVID-19 vaccine, this time for Janssen/Johnson & Johnson’s adenovirus vector vaccine, which showed impressive safety and efficacy results in its global clinical trials. The Biden administration announced Tuesday that the U.S. should have enough COVID-19 vaccine doses for every adult by the end of May—a dramatic acceleration from previous timelines.

Meanwhile, concerns over an uptick in variant cases are growing in Florida after researchers noted that 25 percent of analyzed samples from Miami-Dade County’s Jackson Health public hospital were cases of B.1.1.7. Although partnerships between the CDC and other labs have increased the number of specimens sequenced from about 750 a week in January to 7,000–10,000 a week in late February, this still allows for the sequencing of less than 3 percent of all cases in the United States.

Bar chart with genomic sequencing volume from the CDC. Sequenced specimens peaked at 7,000-10,000 per week in February
Genomic sequencing volume chart from the CDC

New York City has promised to quadruple the number of samples it sequences during the month of March, from 2,000 to 8,000 a week, which is more than the entire country’s labs sequenced in the week ending February 27.

Today’s weekly update is our 39th and last. We began writing them back in June 2020 as a way of offering a deeper interpretation of data points that was less jittery than those in the daily tweets. As we puzzled through the data and watched for indications of changing trends, we’ve tried to help people understand what has happened to us as the pandemic has ebbed and surged.

Although our data compilation will come to an end on Sunday, March 7, our work at the COVID Tracking Project will continue in other forms for another few months, as our teams complete their long-term analyses and wrap up documentation and archiving efforts. We’ll continue to post our work on the CTP site and link to it on Twitter until we finally close up shop in late spring.

Throughout the year that we’ve compiled this data, we’ve tried to explain not only what we think the data mean, but how we came to our conclusions—and how we tested and challenged our own analyses. We hope that one result of our doing this work in public is that our readers feel better prepared to do the same for themselves and their communities.

The federal government is now publishing more and better COVID-19 data than ever before. Some gaps remain, but far fewer than at any previous moment in the pandemic. To those of you who have relied on our work this year, thank you for your trust. We’ve tried very hard to deserve it, and we believe that we’re leaving you in good hands.


Mandy Brown, Artis Curiskis, Alice Goldfarb, Erin Kissane, Alexis C. Madrigal, Kara Oehler, Jessica Malaty Rivera, and Peter Walker contributed to this report.

The COVID Tracking Project is a volunteer organization launched from The Atlantic and dedicated to collecting and publishing the data required to understand the COVID-19 outbreak in the United States.

Source: COVID-19 Cases: The Pandemic’s Future Hangs in Suspense – The Atlantic

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How Greece Avoided the Worst of the Coronavirus Pandemic

This weekend’s Orthodox Easter celebrations in Greece were a low key affair for Michalis Stratakis and his wife Nancy. They still ate lamb, but the meat was oven-cooked instead of carved off a whole animal that had been spit-roasted for hours over charcoals. They painted eggs red according to Greek tradition and played games with family members in Athens, but over cell phone screens from their home on the Greek island of Crete on Sunday, rather than at the usual raucous feast of about 20 friends and relatives.

“It was heartbreaking, to tell you the truth, because we didn’t have the feeling of family,” says 44-year-old Stratakis, an accountant. “We spoke to them through the camera, but it’s not the same when you can’t hug your parents and your sisters and your friends.”

Still, Stratakis is aware that the pared-down Easter celebrations were a necessary sacrifice to protect elderly relatives and his country, too. Greeks traditionally depart urban centers for the countryside and islands in advance of the Orthodox calendar’s most sacred date. But this year, authorities monitored churches, enlisted street patrols, and deployed drones to enforce strict bans on movement amid a plethora of other measures taken to prevent the spread of COVID-19. Experts say that both the stringency of those measures, and the way Greeks have largely abided by them, have been key to Greece avoiding the worst ravages of the global pandemic.

How Greece is coping

The coronavirus outbreak in Greece should have been a disaster. As a popular tourist destination, Greece received 27.2 million visitors in 2019 alone—presenting a potentially significant risk of COVID-19 from international travelers. The country’s population is the second-oldest in the E.U. (behind only Italy), its health sector has been ravaged by austerity, and its crippled economy is still nearly 40% smaller than it was in 2008, before the last global financial crisis. Officials said in 2019 that, after three bailouts and drastic cuts to its public healthcare system due to austerity, there were only 560 ICU beds in the entire country of 11 million. (That’s 5.2 beds per 100,000 people, compared to Germany’s 29.2.)

And to make matters worse, the Greek Orthodox Church announced on March 9 that coronavirus could not be transmitted by communion wine or wafer — a doctrine that was immediately disputed by health experts. (The Greek Church’s governing Holy Synod subsequently said that Easter would be marked “on a small scale behind closed doors”, according to the Church Times.)

And yet, Greece has avoided the worst of the global pandemic so far, with only 2,245 confirmed cases and 116 deaths as of April 21, one of the lowest counts in the European Union.

Greece’s Mediterranean neighbors are not so lucky. To its west, Italy is one of the worst-affected countries in the world, with nearly 200,000 confirmed cases and more than 23,000 deaths; Spain has been similarly hit, with slightly more confirmed cases than Italy but fewer deaths. To its east, Turkey, which did not record its first COVID-19 case until March 11, now has more than 90,000 infections and 2,140 people have died because of the virus—although comparisons of Istanbul’s 2020 death rate to previous years’ figures hint the actual death toll could be much higher.

Recent spikes in countries with low case counts, like Singapore, show that the virus can quickly gain a foothold even in countries doing well. But experts say there are still lessons to be learned from Greece.

Keep up to date on the growing threat to global health by signing up for our daily coronavirus newsletter.

Municipal workers disinfect Syntagma square on March 23, 2020 in Athens, Greece.

Municipal workers disinfect Syntagma square on March 23, 2020 in Athens, Greece.
Milos Bicanski/Getty Images

What Greece did right

The key to Greece’s success, analysts say, was the government’s early steps to contain the virus ahead of most of Europe. In late February, before a single death from the disease had been recorded, carnivals were canceled. Schools and universities nationwide were closed on March 10, when there were just 89 confirmed cases in the country. Cafes, restaurants and tourist spots were closed three days later.

The Greek government moved quickly not despite its crippled public healthcare system, but because of it, experts say. “I don’t think it was a very difficult decision, because of knowledge that the health system wouldn’t be able to cope,” says Dr. Stella Ladi, a former public policy adviser to the Greek government and currently an assistant professor in public management at Panteion University in Athens and Queen Mary, University of London.

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When the government banned all non-essential travel starting from March 23, it was with one eye to the situation in Italy, where hospital ICUs were overwhelmed and people with the disease were lying untreated in hallways. Officials knew it would take a far smaller outbreak for the same scenes to repeat themselves in Athens. “In Italy unfortunately, one person is lost every two minutes,” said Prime Minister Kyriakos Mitsotakis, announcing the lockdown on March 22. “We have to protect the common good, our health.” At the time, there were 624 confirmed cases and 15 deaths in Greece. By comparison, when the U.K. announced its own lockdown the same day, it had 6,650 confirmed cases and at least 335 deaths.

The government also began daily television broadcasts about the situation, warning citizens that the weak healthcare system meant harsh measures had to be implemented early in order to save lives, even if the economy was hit hard. “The communications strategy was equally important as the early measures,” Ladi says. “Every day at 6 p.m., people stop doing whatever they’re doing to see what the developments are,” says Panos Tsakloglou, a Professor at the Athens University of Economics and Business.

The lockdown measures have been greeted with widespread support for the same reasons, experts say. “The public knew the healthcare system was not going to work, so they accepted it,” Ladi says of the early lockdown.

The importance of good health in Greek culture, Ladi says, is another reason for Greeks’ easy acceptance of the lockdown. “From a cultural perspective, every discussion, every wish for the future, always ends with a word for good health,” she tells TIME. “It’s not debatable whether health is more important than keeping your shop open. Health is more important and the shop comes second. It was not a contested issue like in other places.”

The government also used the lockdown to increase healthcare capacity, growing the number of ICU beds from 565 in early March to 910 at the end of the month. And an agreement between the Greek government and private hospitals means they have begun taking on patients with non-coronavirus-related ailments, freeing up space for COVID-19 patients in public hospitals.

Migrant camps

A woman helps a child with a mask after members of NGO  Team Humanity  gave out handmade protective face masks to migrants and refugees in the camp of Moria in the island of Lesbos on March 28, 2020.

A woman helps a child with a mask after members of NGO “Team Humanity” gave out handmade protective face masks to migrants and refugees in the camp of Moria in the island of Lesbos on March 28, 2020.
Manolis Lagoutaris/AFP via Getty Images)

But just like everywhere else, the virus and the lockdown are colliding with longstanding inequalities. That means that even as Greece performs well compared to other countries, many of its inhabitants are more at risk than others.

That’s especially true when it comes to the five refugee camps on the Greek islands, where around 40,000 people are held in legal limbo in squalid conditions. In the most overcrowded camp on the island of Lesvos, which is served by just three doctors, more than 18,000 people are crowded into less than a tenth of a square kilometer, according to the International Rescue Committee (IRC). Many live under sheets of tarpaulin or in makeshift huts in the camp, which was originally designed to hold less than 3,000 people. The population density there is six to eight times higher than the Diamond Princess cruise ship, where the virus spread even faster than it did in Wuhan at the peak of China’s outbreak, according to the IRC.

So far, there are no cases of COVID-19 in the most overcrowded camps on the Greek islands. But two camps on the mainland have been put under quarantine after 44 cases were confirmed among migrants being held there, according to Apostolos Veizis, the director of medical programs at Medecins Sans Frontieres in Greece. And on Tuesday, 148 people were reportedly diagnosed with COVID-19 at a hotel holding refugees southwest of Athens. “When we talk about social distancing, it is something that cannot be applied in this reality,” Veizis tells TIME. “I can guarantee you if a case were to happen tomorrow in Moria [the camp on Lesvos], it would not be easy to manage.”

On April 16, the Greek government said it would relocate 2,380 people (the most elderly migrants and those with preexisting health conditions, along with their families) away from the Greek islands to camps on the mainland. But it also announced on Monday that nationwide restrictions on the movement of migrants would continue until May 10 — 13 days longer than the rest of the country. “Such restrictions put people trapped in the camps more at risk,” Veizis says. “Forcing people to live in overcrowded and unhygienic camps as part of Europe’s containment policy was always irresponsible but now more than ever due to the COVID-19 threat.”

Economic toll

Despite managing to keep its overall case count and death toll low so far, the coronavirus crisis is shaping up to have dire effects on Greece’s already struggling economy. “Greece’s output relies quite extensively on sectors that are particularly hard hit by the crisis,” like international shipping and tourism, says Tsakloglou, the economics professor. Tourism directly made up 11.7% of GDP in 2018, and as much as 30.9% when indirect income is included.

And while the government has brought in stimulus measures to shore up businesses during the lockdown, the country’s high debt to GDP ratio means it might be difficult for the country to continue borrowing if the crisis stretches into months or years. “As a result the fiscal measures that are available are relatively limited,” Tsakloglou says. Still, he says the likelihood of Greece needing yet another bailout remains low.

It will be lower still if Greeks continue to abide by government restrictions. After the Easter weekend, Deputy Civil Protection Minister Nikos Hardalias acknowledged the difficulty of remaining under lockdown and said the government would begin to ease restrictions bit by bit at the beginning of May. Hardalias also thanked citizens for “the very high level of collective responsibility” they showed over the holiday.

For Stratakis in Crete, the sense of responsibility is keenly felt. Although people do not like following government orders, he says, close family ties and respect for the elderly are emphasised in Greek society. “Nobody would forgive themselves if they had the virus and they gave it to their parents,“ he tells TIME. “We couldn’t imagine not celebrating Easter with our relatives next year because they got the virus and left this world.”

Please send tips, leads, and stories from the frontlines to virus@time.com.

Correction: April 22

The original version of this story misstated the dates on which Greek schools and universities were closed, and cafes and other businesses shuttered. Greek schools and universities were ordered closed nationwide March 10; cafes and other businesses were allowed to stay open until March 13.

By Billy Perrigo and Joseph Hincks  Updated: April 22, 2020 7:16 AM EDT | Originally published: April 21, 2020 12:15 PM EDT

Source: How Greece Avoided the Worst of the Coronavirus Pandemic

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