Alexis C. Madrigal is a staff writer at The Atlantic and the author of Powering the Dream: The History and Promise of Green Technology.
The data we compiled from states tells two different stories this week. The first may be an encouraging one: US states and territories reported 5.5 million COVID-19 tests this week and discovered about 468,000 new cases. That’s a very high number of new cases, but the week-over-week rise in newly discovered cases of COVID-19 is more modest this week than it has been for the past four weeks. However, after reaching about 700k tests per day, national testing growth has slowed. The slowdown in new cases is probably in part a reflection of a slowdown in testing growth, but it’s impossible to interpret the changes with certainty.
The second story from the national data is both clearer and more bleak: there are a lot more people in the hospital with COVID-19, and a lot of people are dying. Despite gaps in hospitalization data from states this week as hospitals scrambled to change their reporting processes to fit new HHS guidelines, hospitalizations are up. In the last two days, states have reported more than 1,000 deaths, numbers we haven’t seen in the United States since late May. Our seven-day rolling average of newly reported deaths stands at 834, as of the data update for Wednesday, July 22.
On July 10, Health and Human Services put out new guidelines requiring hospitals to report crucial COVID-19 data through a new system. They had been using a long-established system called the National Healthcare Safety Network, which is run by the CDC. The new system, created by a contractor called TeleTracking, routes around the CDC and directly into the HHS Protect data platform. Around the same time, the CDC temporarily removed one of their hospital data sources from public view, and controversy ensued. Science and medicine publication STAT has provided thorough coverage of the changeover.
While we were initially hopeful that our state-based data gathering would not be affected by the changeover, it turned out that some states were dependent on NHSN for the data they were providing on their dashboards. For several days, states like Idaho, Missouri, South Carolina, and Wyoming were unable to publish all of the hospital data that we normally compile. (Other states may be reporting partial hospital data as a result of the changeover, but without public disclosure.)
Idaho and Wyoming’s hospital data came back online quickly, and although Missouri and South Carolina are experiencing longer delays, no state has communicated anything suggesting that the data will not come back online soon. Our early analysis suggests that the problems will be temporary as hospitals and state reporting systems complete the necessary changes, but it’s a clear burden on some hospital and state systems to change reporting methods in the middle of a pandemic.
[Note: As we were about to publish this update, Texas announced that only 84.5 percent of its hospitals reported complete data today because of the changeover. This reduced the current COVID-19 hospitalization number posted by the state today by approximately 2,000 patients. Our daily update for Texas will retain yesterday’s more complete number today. —ed.]
On Monday, July 20, HHS published a new public dashboard to display the data coming in from HHS Protect, but it’s worth noting that it appears to have some data quality problems. We hope that the new HHS system will ultimately offer better data than the previous system, but we’re now expecting a transitional period of unknown duration in which the national and state data may remain erratic.
These changes come amid the summer surge in outbreaks. A week after cases began to rise in mid-June, hospitalizations began to increase, too. On June 20, there were roughly 28,000 people hospitalized with COVID-19. A month later, that number had more than doubled to 58,000 hospitalized patients.
Now the number of hospitalized patients is approaching the peak that metric reached in mid-April, during the height of the Northeast outbreak. Back then, New York and New Jersey alone represented 45% of the hospitalizations. This time, Texas, Florida, and California are home to roughly half the total number of COVID-19 patients.
While some large, urban hospitals may be prepared to handle the present surge, smaller rural hospitals don’t have access to the same level of resources to handle huge influxes of patients. In South Texas, small hospitals are inundated with acutely ill COVID-19 patients, at least one to the point of drawing up plans for turning away patients with poor survival prospects.
Deaths continue to rise
Three weeks ago, we sounded the alarm about rapidly rising cases in hotspot states, such as Arizona, California, Florida, and Texas. The surge of cases throughout June laid the foundation for rising hospitalizations and now, in July, sharply rising deaths. In these four states, the seven-day rolling average for deaths reported each day has risen from fewer than 150 at the beginning of June to more than 400 now.
The same pattern is beginning to repeat itself across the rest of the South. New COVID-19 cases per million people in many southern states are approaching the levels found in the Northeast during early April. Testing was much more constrained in the spring than it is now, but the rise in cases outpaces the rise in testing. If these outbreaks continue to grow, they will inevitably lead to higher deaths in these states.
Today, we need to sound the alarms again. Rising deaths this month are happening in parallel to continuing high levels of new cases. The clinical lags will continue, as will the reporting lags, and if all these patterns repeat themselves, in three weeks we will be seeing spiking death rates from the tens of thousands of cases we’re seeing today.