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Nationally, cases of COVID-19 have risen for three weeks in a row. Testing is also up slightly over last week and remains well above the late-summer plateau. Our initial research suggests that at least eight US states are lumping antigen tests with PCR tests, and 21 more may be doing so. This muddled test reporting makes it difficult to tell how much of the testing growth of the past two weeks is related to antigen testing coming online, and how much is an increase in the number of PCR tests being performed. (Stay tuned to our blog for a detailed look at antigen testing, how it differs from PCR testing, and how it’s being reported, coming soon.)

The number of people hospitalized with COVID-19 also ticked up this week for the first time since mid-July, about two weeks behind the rise in cases, a time-lag consistent with earlier periods of the pandemic. There were about 30,000 people hospitalized with COVID-19 in the United States this week. Deaths are still dropping, but the decline appears to have slowed. Since last Wednesday, states reported 4,998 COVID-19 deaths, down 2.6 percent from the previous week.

As we usually do in our weekly report, we’ll look more closely at this week’s data from specific states and regions to see where case growth and other indicators are rising and falling—but first, we’ll zoom out a bit and take a wider view.

The view from six months in

As September ends, we think it’s worthwhile to pause and look back over the first six months of the COVID-19 pandemic in the United States. Back in March, the average number of positive cases per day was just under 6,500—though since testing was limited, the number of people who had COVID-19 was likely far higher. (One recent paper estimates the number of “unobserved” COVID-19 infections in the United States as of March 12, 2020, to have been over 100,000. By that date, US states and territories had reported only 2,735 cases.) July 2020 saw the highest number of average daily cases since the pandemic began, at 61,542, with a total of nearly 1.9 million new cases that month. Average daily new cases fell in August and again in September, and in September, there were 700,000 fewer new cases of COVID-19 than there had been in July.

Of course, finding new cases requires tests. In July, states and territories reported an average of about 762,000 tests per day; this number dropped in August, but strong increases in September brought the monthly average to about 820,000 daily tests. There have been four days in 2020—all in the second half of September—when the number of tests reported exceeded 1 million. That degree of testing means that one out of every 359 people in the United States can get tested each day, and it finally surpassed the testing target the Harvard Global Health Institute wanted to see the United States reach by May 15, 2020. (It’s worth noting that the HGHI’s May testing goals were for PCR tests, while the testing figures we’ve seen in September include an unknown number of antigen tests.) 

The HGHI released new testing goals today in conjunction with Microsoft and NPR, calling for 2 million diagnostic tests per day (focusing on symptomatic people and their contacts) and between 4.3 and 14 million screening tests per day (focusing on asymptomatic people in specific settings). 

National hospitalization figures, too, improved in August and September, down nearly 20,000 from July’s high of an average of 51,928 per day. 

The regional breakdown, however, exposes a significant and troubling increase in COVID-19 hospitalizations in the Midwest, as well as slowing declines or plateaus in hospitalizations in the other three US regions. 

The average number of daily deaths from COVID-19 has fallen from the 1,000-plus daily fatalities we saw in mid-summer, ending the month of September at a seven-day average of 714 per day.

This week’s trouble spots

To return to the weekly view, the data for South Dakota, North Dakota, Wisconsin, and Idaho remains worrying. 

For the fourth week in a row, North Dakota has the most cases per capita, at 548 new cases per 1 million residents. To provide context for new outbreaks, media outlets often note that at the height of the COVID-19 outbreak in New York this spring, the state saw 595 cases per 1 million residents per week, but testing was so limited at that time that this comparison can be misleading. (We wrote about the pitfalls of using New York’s experience as a benchmark for outbreaks taking place after testing capacity has increased so sharply.) Nevertheless, North Dakota’s case numbers are alarming, and the state’s COVID-19 hospitalizations are also rising sharply.

In Wisconsin, case numbers continued to increase this week and have more than quadrupled in the past month. The number of people hospitalized across the state more than doubled in September. Sixty-nine people died of COVID-19 in Wisconsin this week, compared to last week’s 31 deaths.

President Donald Trump scheduled campaign rallies in Wisconsin for this coming weekend, raising concerns that the large gatherings could contribute to the spread of COVID-19. Wisconsin Gov. Tony Evers said Tuesday that in order to reduce the risk of the virus spreading, President Trump should either require masks at his events or stay away, the Associated Press reported. Hospitals in Green Bay, one of the locations of a Trump rally, are nearing capacity. After the mayor of La Crosse asked Trump not to visit the city, news reports on Thursday said the campaign had moved that event to Janesville, 175 miles to the southeast. 

Hospitalization numbers continue to go down in the summer hotspot states of Arizona, California, and Florida, but not in Texas, where cases and hospitalizations declined sharply after a summer peak but have begun to tick up again. This week, more states saw increases (29) in hospitalizations than saw declines (21). 

Our recent gains are real. Can we keep them?

The last two months have mostly brought good news about the state of the pandemic in the United States. New cases have dropped from their second-surge peaks, with hospitalizations and deaths following behind in the now well established pattern of lagging metrics. And after a period of wobbly performance in August, testing is once again increasing across the country, though it remains to be seen if antigen testing will allow us to scale up to meet the targets the Harvard Global Health Institute team released today.

In contrast to these encouraging trends, two unsettling facts remain. The first is that despite declines in cases, hospitalizations, and deaths, absolute numbers for each of these metrics remain high. In September, the United States averaged nearly 40,000 new cases of COVID-19 per day—a figure Dr. Anthony Fauci called “unacceptable” in a recent interview with our co-founder, Alexis Madrigal—with a daily average of 31,000 people hospitalized with COVID-19. States reported more than 23,000 lives lost to the pandemic in September alone

The second inescapable fact is that we have arrived at the moment public health experts have been concerned about since early summer. Schools and college campuses have reopened throughout the country. Many states have relaxed the restrictions they put in place to calm the summer case surges. Flu season has begun and temperatures have begun to drop, bringing more in-person interactions into indoor spaces. And as of this week, hospitalizations appear to be following the rise in cases we’ve been watching with concern for three weeks now. If we are on the brink of another surge in cases, that surge will build from a baseline of already high numbers and take place in circumstances public health experts consider especially risky.

We can hope that the country’s patchwork of public health interventions, combined with thoughtful individual choices—and an infusion of rapid testing—will be enough to control the pandemic’s spread. We will continue to watch the data closely in the coming weeks to try to understand where the United States is—and isn’t—holding the line.

To keep up to date on our work, follow us on Twitter and join our low-frequency email list.


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Erin Kissane is a co-founder of the COVID Tracking Project, and the project’s managing editor.

@kissane
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Joanna Pearlstein is an editorial lead at the Covid Tracking Project and a former editor at WIRED and Protocol.

@jopearl

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