Hello, and welcome back to the COVID-19 Data Dispatch!
This Sunday, I’m trying something different. It’s a stressful week here in the U.S., as we face the election and oncoming holidays while cases rise to 100,000 new diagnoses a day—more cases than China has seen in the entire course of the pandemic.
So, I’m giving you all this opportunity to ask me your COVID-19 questions. You can ask about data sources, best practices for the holidays, and everything in between, and I’ll point you to resources which may provide some answers. Just hit that Like & Comment button to get started.
I will be online to answer questions throughout the afternoon; then, in the evening, I’ll send out a brief newsletter with highlights from this thread and a few other news items.
And a quick disclaimer, before we get started: although I volunteer for the COVID Tracking Project, this newsletter reflects only my own reporting and explanations. In any data questions I answer, I am not communicating on behalf of the Project in any way.
Hi Betsy, In this time of pandemic fatigue, I am interested in rankings of reasonable activities to keep some economic sectors going without becoming part of the problem (i.e. infected). What are your favorite (or a favorite) source that ranks activities? Do you know of any detailed studies that gets at nuances (with my pod vs. with people not in my pod)?
Maryn McKenna has actually written a great story about COVID-19 risk charts, including the strengths and weaknesses of a couple of widely-cited resources: https://www.wired.com/story/to-navigate-risk-in-a-pandemic-you-need-a-color-coded-chart/ It has been a couple of months since this story, though, and since then, more interactive resources have popped up. One that I like is the microCOVID project, which estimates your risk based on your location, the number of people you'll be seeing, mask types, and more: https://www.microcovid.org/ Another resource, which I've cited in the newsletter before, is Georgia Tech's COVID-19 Event Risk Assessment Planning Tool. This tool is simpler, but it gets very precise about the risk levels in your state and county: https://covid19risk.biosci.gatech.edu/
I haven't seen specific studies that get at the nuances of risk levels inside/outside of a pod, largely because I think this is a hard thing for epidemiologists to track. (America! Bad at contact tracing!) But I will say that it is important for you to be clear and realistic about who is in your pod. For example, I live with three roommates in Brooklyn. I sometimes visit my sister, who lives in Manhattan. Two of my roommates are commutting to their respective offices on reduced schedules. So, if one of my sister's roommates tests positive for COVID-19, that means that, depending on the timing, I, and all of my roommates, and all of my roommates' coworkers should consider that we may have been exposed. The bigger your pod, the more regular testing can help assuage these types of concerns.
Hi Betsy - long time reader, first time asker. Have we seen significant spikes in COVID in connection with national holidays, or are spikes largely attributable to other factors? Should we be expecting a Thanksgiving spike? What about an election protest spike?
Thanks Ross, that's a good question! First of all, I need to clarify that it's really hard to find a causal association between case spikes and specific events in the U.S., because our contact tracing apparatus simply isn't up to it in most places. We can't conclusively find out how many people were infected at a given event or location unless we can test all of them *and* get those test results to a central location *and* adjust for confounding factors, like other events that people attended/traveling they did. There have been a few scientific studies that look for these associations (Stanford University researchers recently published a paper about Trump rallies, for example: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3722299) but largely it is difficult to make these conclusions as events are ongoing.
That being said, the COVID Tracking Project has noted case spikes in the South after Memorial Day (https://covidtracking.com/blog/weekly-covid-19-data-update-june-18-the-regional-gap-widens), which occurred when many states were loosening lockdown orders. It's important to note here that these kinds of case spikes are usually delayed; it takes a couple of weeks for people to notice symptoms and get tested (causing cases to spike), and then another week or two for hospitalizations to spike, and then another week or two after that for deaths to spike. (Caroline Chen has explained this lag for ProPublica: https://www.propublica.org/article/how-to-understand-covid-19-numbers). But to answer your question of whether experts are expecting a Thanksgiving spike: yes, they definitely are. Here's Fauci talking about it, from a couple of weeks ago: https://www.cbsnews.com/news/fauci-thanksgiving-covid-different/
And as for protests -- this is also difficult to say for sure, as it is difficult to even estimate how many people *attend* a protest, let alone to test and contact trace them all. But, to my knowledge, no protest has been a superspreader event so far: https://www.healthline.com/health-news/black-lives-matter-protests-didnt-contribute-to-covid19-surge#No-evidence-of-protest-spread Health experts cite the fact that protests are usually outside and have high mask compliance as a possible reason why they have not proven to be as risky as, say, Trump rallies.
Hi, Betsy -- Thanks for everything you do. I have a question from a school district leader that you might know offhand: "Do you know where I might find out which districts in the country currently have low positivity rates for staff/students, say under 2%?"
I wish this were easy for me to answer! Unfortunately, school-specific positivity rates are hard to come by and harder to compare, because most states/counties are not doing widespread testing of students. New York is the only state that publishes school district testing numbers, as far as I'm aware, but the NY health department does not report positivity rates on its school dashboard because those in-school tests represent a pretty small fraction of students and staff. (NY dashboard: https://schoolcovidreportcard.health.ny.gov/#/home) And even if positivity rates for school districts were widely available, I would advise you to be wary in comparing numbers from region to region, because test positivity can vary widely depending on which tests you are using and in which units those tests are being reported (specimens, people, or something else) -- and every health department is reporting tests in a slightly different way. This COVID Tracking Project blog post does a good job of explaining the issue: https://covidtracking.com/blog/test-positivity-in-the-us-is-a-mess
However! If you're okay with using data that aren't school-specific, it is actually pretty easy to compare county positivity rates thanks to the Center for Medicare & Medicaid Services dataset: https://data.cms.gov/stories/s/q5r5-gjyu Comparisons are fine to do here because the positivity rates are all coming from a single source, and have been calculated in the same way. These county-level data are compiled for nursing home administrators to see how their counties are faring and test their residents and staff accordingly. It seems reasonable to me that school administrators should be able to use these data as well. The dataset is updated weekly on Mondays.
Thanks! So when we see things like this in the NYT they probably refer to city- or county-level data? "SF currently has 4.7 daily new cases per 100,000 people, a little more than half the rate of new cases in NYC. The share of coronavirus tests coming back positive averaged 0.89 percent... lower than NYC's average of 1.8 percent for that week." https://t.co/MluTg2TtSU
Hi Betsy, my extended family (3 households) have been extremely conservative throughout the pandemic and haven’t seen each other at all indoors. We’re thinking ahead to the holidays and trying to figure out the nuances of having a period of isolate-then-test before then “podding” in the same household for a week. For one person in one of the households, work restrictions mean that the longest that that person can work from home and thus isolate before the holidays is one week. Basically, we’re trying to decide if this is a reasonable decision. My question is, where can we go for trustworthy information about the risk curves associated with isolating for, say, 1 week vs. 2 weeks?
There is a recent CDC assessment which somewhat answers your question. The agency reports that adults with mild to moderate COVID-19 are not infectious 10 days after they begin demonstrating symptoms, and that it is rare for adults to infect others more than 6 days after they begin demonstrating symptoms: https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html My personal interpretation of these results (though I am far from an epidemiologist!) is that any length of isolation period is good for lowering your risk, but at least 7 days is good, 10 days is better, and 14 days is of course the standard. It also helps if your relative can get a PCR test 3-4 days into their isolation period, then receive results before traveling. (I specify PCR test here because, as I've discussed in the newsletter before, rapid nucleic acid tests and antigen tests are both less accurate for asymptomatic patients.) Another good resource on holiday risk levels, which I'm planning on sending out to the full list this evening, is this FAQ sheet from Boston University: https://sites.bu.edu/covid-corps/covid-holidays/
This thread is now closed; I won't be answering more questions today. Thank you to all who participated!
Hi Betsy, In this time of pandemic fatigue, I am interested in rankings of reasonable activities to keep some economic sectors going without becoming part of the problem (i.e. infected). What are your favorite (or a favorite) source that ranks activities? Do you know of any detailed studies that gets at nuances (with my pod vs. with people not in my pod)?
Maryn McKenna has actually written a great story about COVID-19 risk charts, including the strengths and weaknesses of a couple of widely-cited resources: https://www.wired.com/story/to-navigate-risk-in-a-pandemic-you-need-a-color-coded-chart/ It has been a couple of months since this story, though, and since then, more interactive resources have popped up. One that I like is the microCOVID project, which estimates your risk based on your location, the number of people you'll be seeing, mask types, and more: https://www.microcovid.org/ Another resource, which I've cited in the newsletter before, is Georgia Tech's COVID-19 Event Risk Assessment Planning Tool. This tool is simpler, but it gets very precise about the risk levels in your state and county: https://covid19risk.biosci.gatech.edu/
I haven't seen specific studies that get at the nuances of risk levels inside/outside of a pod, largely because I think this is a hard thing for epidemiologists to track. (America! Bad at contact tracing!) But I will say that it is important for you to be clear and realistic about who is in your pod. For example, I live with three roommates in Brooklyn. I sometimes visit my sister, who lives in Manhattan. Two of my roommates are commutting to their respective offices on reduced schedules. So, if one of my sister's roommates tests positive for COVID-19, that means that, depending on the timing, I, and all of my roommates, and all of my roommates' coworkers should consider that we may have been exposed. The bigger your pod, the more regular testing can help assuage these types of concerns.
Hi Betsy - long time reader, first time asker. Have we seen significant spikes in COVID in connection with national holidays, or are spikes largely attributable to other factors? Should we be expecting a Thanksgiving spike? What about an election protest spike?
Thanks Ross, that's a good question! First of all, I need to clarify that it's really hard to find a causal association between case spikes and specific events in the U.S., because our contact tracing apparatus simply isn't up to it in most places. We can't conclusively find out how many people were infected at a given event or location unless we can test all of them *and* get those test results to a central location *and* adjust for confounding factors, like other events that people attended/traveling they did. There have been a few scientific studies that look for these associations (Stanford University researchers recently published a paper about Trump rallies, for example: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3722299) but largely it is difficult to make these conclusions as events are ongoing.
That being said, the COVID Tracking Project has noted case spikes in the South after Memorial Day (https://covidtracking.com/blog/weekly-covid-19-data-update-june-18-the-regional-gap-widens), which occurred when many states were loosening lockdown orders. It's important to note here that these kinds of case spikes are usually delayed; it takes a couple of weeks for people to notice symptoms and get tested (causing cases to spike), and then another week or two for hospitalizations to spike, and then another week or two after that for deaths to spike. (Caroline Chen has explained this lag for ProPublica: https://www.propublica.org/article/how-to-understand-covid-19-numbers). But to answer your question of whether experts are expecting a Thanksgiving spike: yes, they definitely are. Here's Fauci talking about it, from a couple of weeks ago: https://www.cbsnews.com/news/fauci-thanksgiving-covid-different/
And as for protests -- this is also difficult to say for sure, as it is difficult to even estimate how many people *attend* a protest, let alone to test and contact trace them all. But, to my knowledge, no protest has been a superspreader event so far: https://www.healthline.com/health-news/black-lives-matter-protests-didnt-contribute-to-covid19-surge#No-evidence-of-protest-spread Health experts cite the fact that protests are usually outside and have high mask compliance as a possible reason why they have not proven to be as risky as, say, Trump rallies.
Hi, Betsy -- Thanks for everything you do. I have a question from a school district leader that you might know offhand: "Do you know where I might find out which districts in the country currently have low positivity rates for staff/students, say under 2%?"
I wish this were easy for me to answer! Unfortunately, school-specific positivity rates are hard to come by and harder to compare, because most states/counties are not doing widespread testing of students. New York is the only state that publishes school district testing numbers, as far as I'm aware, but the NY health department does not report positivity rates on its school dashboard because those in-school tests represent a pretty small fraction of students and staff. (NY dashboard: https://schoolcovidreportcard.health.ny.gov/#/home) And even if positivity rates for school districts were widely available, I would advise you to be wary in comparing numbers from region to region, because test positivity can vary widely depending on which tests you are using and in which units those tests are being reported (specimens, people, or something else) -- and every health department is reporting tests in a slightly different way. This COVID Tracking Project blog post does a good job of explaining the issue: https://covidtracking.com/blog/test-positivity-in-the-us-is-a-mess
However! If you're okay with using data that aren't school-specific, it is actually pretty easy to compare county positivity rates thanks to the Center for Medicare & Medicaid Services dataset: https://data.cms.gov/stories/s/q5r5-gjyu Comparisons are fine to do here because the positivity rates are all coming from a single source, and have been calculated in the same way. These county-level data are compiled for nursing home administrators to see how their counties are faring and test their residents and staff accordingly. It seems reasonable to me that school administrators should be able to use these data as well. The dataset is updated weekly on Mondays.
Thanks! So when we see things like this in the NYT they probably refer to city- or county-level data? "SF currently has 4.7 daily new cases per 100,000 people, a little more than half the rate of new cases in NYC. The share of coronavirus tests coming back positive averaged 0.89 percent... lower than NYC's average of 1.8 percent for that week." https://t.co/MluTg2TtSU
https://www.nytimes.com/2020/11/01/us/san-francisco-coronavirus-schools-reopening.html#click=https://t.co/MluTg2TtSU
Yes, exactly--they're using regional data to show what's going on in the communities around these schools.
Hi Betsy, my extended family (3 households) have been extremely conservative throughout the pandemic and haven’t seen each other at all indoors. We’re thinking ahead to the holidays and trying to figure out the nuances of having a period of isolate-then-test before then “podding” in the same household for a week. For one person in one of the households, work restrictions mean that the longest that that person can work from home and thus isolate before the holidays is one week. Basically, we’re trying to decide if this is a reasonable decision. My question is, where can we go for trustworthy information about the risk curves associated with isolating for, say, 1 week vs. 2 weeks?
There is a recent CDC assessment which somewhat answers your question. The agency reports that adults with mild to moderate COVID-19 are not infectious 10 days after they begin demonstrating symptoms, and that it is rare for adults to infect others more than 6 days after they begin demonstrating symptoms: https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html My personal interpretation of these results (though I am far from an epidemiologist!) is that any length of isolation period is good for lowering your risk, but at least 7 days is good, 10 days is better, and 14 days is of course the standard. It also helps if your relative can get a PCR test 3-4 days into their isolation period, then receive results before traveling. (I specify PCR test here because, as I've discussed in the newsletter before, rapid nucleic acid tests and antigen tests are both less accurate for asymptomatic patients.) Another good resource on holiday risk levels, which I'm planning on sending out to the full list this evening, is this FAQ sheet from Boston University: https://sites.bu.edu/covid-corps/covid-holidays/
Thanks! This is very helpful. I appreciate the time you spent on the weekend doing this!