Short Wave - Why The Pandemic Is Getting Worse... And How To Think About The Future

Episode Date: July 16, 2020

Rising cases, not enough testing, and not enough people taking the virus seriously. NPR science correspondent Richard Harris explains why the virus is surging again, what's causing lower fatality rates, and how to think about the future of the pandemic. For more on death rates in the latest surge, read: "COVID-19 Cases Are Rising, So Why Are Deaths Flatlining?"Follow Maddie at @maddie_sofia and Richard @rrichardh. Email the show at [e-mail] pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Today we're going to take a look at where we are in the coronavirus pandemic, how we're doing and how we got here. I am concerned that Arizona reopened too quickly. That's the mayor of Phoenix, Kate Gallego, talking to NPR this month. Our governor lifted the stay-at-home order in mid-May and immediately went to situations such as open nightclubs with no masks. We sent a message that we had defeated COVID-19 and we had not. We are really in a bad situation where we need more resources for our medical system and help with testing. Now there are well over 3,000 new cases a day in Arizona.

And Arizona ICUs have been at around 90% capacity for most of July. But the problems the mayor was highlighting, not enough resources, not enough testing, not enough people, taking the virus seriously, those are not limited to Arizona right now. And there's some of the same problems the U.S. was confronting in March and April. Our science desk colleague Richard Harris has been covering the pandemic since then. Richard, this is kind of frustrating, right? This is still like the U.S. in quite a bit of trouble. Indeed, we are still in a lot of trouble or maybe back in trouble again after a period of a few months when things at least have been trending in the right direction. And there are a number of reasons why, for one thing, after a terrible start of the

beginning of the epidemic, testing improved a lot over the spring. But, you know, the number of cases has risen so dramatically over the past month that testing really has not been able to keep up. You've seen the long lines, Maddie, you know, and labs are running short on supplies in some places. That's creating backlogs. Right. Some public health officials have blamed the backlog also in part on the big increase in testing in nursing homes and prisons, which they say is a good thing on balance, but it does stress the system. And of course, as the mayor alluded to, some states have reopened without following public health guidance. And even worse, some people have been ignoring public health guidance to wear masks and keep a safe distance and do things

like that. All of this adds up to a picture of the pandemic that in a lot of ways is looking worse, not better as the summer rolls along and we barrel towards cold and flu season in the fall. So this episode, we're going to talk with Richard Harris, about how we got here and where things are headed. I'm Maddie Safaya, and this is Shortwave, the Daily Science podcast from NPR. Okay, Richard, so there are about 47 different things we could talk about to unpack the story of how we got here and where we're going, but we chose a few of the big ones to focus on in this episode. So testing was a mess at the beginning. It seemed to get better for a little bit, and now it seems like it's a mess again. So what happened, Richard?

Well, it is complicated. Let's take you back to the beginning of the epidemic when the CDC decided to develop its own test for the coronavirus, just standard practice for them. But honestly, they bungled it. And instead of reaching for tests developed in Germany and that were distributed widely by the World Health Organization, the CDC, we could fix this quickly and they kept trying. But really, that turned out to be a big. mistake and it cost us a lot of time. Worse, I think the CDC didn't really realize the scope of this epidemic early on. Federal health officials should have done what South Korea did, for instance. What they did was immediately spur commercial companies to produce large quantities of tests. The U.S. eventually got to that point, but, you know, it was really late. And now, of course, we are in better shape. The U.S. is averaging something like 600,000 tests a day or sometimes even more than that. But, you know, it's still far short of the amount of tests. that experts say we should be doing.

Yeah, and let me ask you about that, Richard, because I've seen estimates that we need to be doing, like, double or triple the amount of tests to really control the virus. Right. And, you know, the number of tests you need to do is really relative to the number of infected people. So since we have so many infected people, and that number is growing, we really need to be doing a lot more testing. For example, scientists at the World Health Organization use as a rule of thumb

that you should have enough tests so that when you get the results back only about 5% are coming back positive. That means that most of the people are negative, which is what you'd hope and what you'd expect. Right now, unfortunately, we have states like Texas and Florida and Arizona where the number of percent positive is like 17 percent or 18 percent or even 25 percent. And, you know, the percent positive rates keep going up, which means it's definitely not true as the president has frequently claimed that the cases are only rising because we're testing more. No, we're seeing more positive cases as we see more tests. So, okay, let's talk about the case numbers a bit. Back in April, we were at about, you know, 30,000 cases per day. And now we're around 60,000 new cases a day, which is objectively worse.

Yeah. And to put that in perspective, 60,000 people wouldn't even fit in Dodger Stadium, which is the biggest baseball stadium in this country. So we're talking about, you know, give you a visual image of what we're talking about here. Right, right. And, you know, some of that is driven by big outbreaks in places like California, Texas, and Florida. Let's talk a little bit more about why cases are up in those places. Yeah, it's a complicated series of reasons. But some of it is that we were talking about a little bit earlier. Some of these were in states like Texas and Arizona that were determined to open really early and where a lot of people, including politicians, thought, you know, jump starting their economies was more important than being really cautious about the virus. there could also be other stuff at play here because, you know, it is summer and those are places that get very hot. So more people are spending more time in air conditioning, that is, to say, indoors. And one thing we know about this virus is it spread more likely indoors among people who are stuck together for at least 15 minutes or longer in an indoor space. Yeah, and honestly, like this idea of being indoors is something I've been thinking about lately because I'm looking ahead, right? And we're looking about the fall in the winter when you're going to have this.

the exact same thing happening all over the country, like more people forced indoors. And that correlates with, of course, the beginning of seasonal flu circulating, some people in the hospital, that kind of stuff. Right. We're going to have both epidemics happening at once. It's going to be a real mess. Okay. Let's talk a little bit about mortality or people dying from the disease.

So the president and others have pointed out in the last few weeks that the numbers of people dying per day are down from early on. the pandemic. And that is true. Back in mid-April, there were days where we had well over 2,000 people dying each day. And in the last week or so, the U.S. is seeing more like 700 people dying every day on average, although that number seems to be rising again. Yeah. So let's talk about a few reasons why that could be, why we're seeing fewer deaths now than earlier. Right. Well, certainly one of the biggest reasons is not the biggest reason that the death rates are so low now compared to the spring when New York City got clobbered.

as you recall, is that nowadays the virus is infecting mainly younger people, and they are just frankly less likely to die. In Arizona, for instance, these days half the cases are in people aged 20 to 44 years old, and only 11 percent of cases are in people over 65. And of course, the people over 65 are really at the highest risk of death. And, you know, that shift to younger age groups is both good and bad. The good part is the disease is hitting a population that can more easily survive, though we should say some people do die. The bad part is that the spread is accelerating and putting vulnerable people at higher risk because now the virus is traveling far and wide and putting more older people and people with underlying health conditions

in harm's way. Right. And, you know, one thing to note, though, is that especially in the younger demographic, this is where we see a lot of the huge racial disparities, but basically which young people are surviving and dying. A paper out of Harvard in June showed that in this 25 to 34 age group, the mortality rate for black people was seven times more than for white people. So it really matters who those young people are, right? It absolutely does. The overall risk of death is very, very low in this age group, but it does absolutely hit some people harder than others, particularly because more people of color are at risk for contracting the disease because of their jobs. They have to be out and about. And also underlying health conditions may also be playing a role here.

Yeah, so it appears more young people are getting sick, fewer of them ultimately die, but to be clear, young people do get very sick and die from the virus. So that's one reason we're seeing fewer deaths right now compared to the beginning of the pandemic. As far as why the numbers of deaths don't seem to be matching up with the increase in cases yet is partially due to the fact that deaths are what we call a lagging indicator. Derek Thompson at The Atlantic wrote a really nice piece on this. We'll make sure to put in the episode notes. But Richard, let's talk about that a little bit. Right, yeah. And so very plainly put, there is a gap in time between the day someone tests positive

until the day they either recover or unfortunately die. And then, of course, there's another lag in which that death is reported to health officials. So what you're seeing now, it really in deaths really reflects people who got sick, you know, two or three weeks ago or even longer ago than that. So that's one reason why deaths have not followed in lockstep with a big spike in cases. Yeah. And then there's also this thing called lead time bias, right? Right.

And that's basically a phenomenon where data can make it seem like something new is happening, but actually it's just about how you're collecting the data. With the increases in testing we've seen in these past few months, we may simply be detecting more of this virus earlier in people than we did before. People may have been really sick and not get tested until they got to the hospital. now people are driving up in their cars, right? And feeling okay. And so they're earlier on in the course of the disease. But that doesn't really change the percentage of cases that wind up being fatal. It will just take longer than it did early on in the epidemic for those fatalities to show up.

And, you know, of course, Richard, there are a ton of complications that we don't have time to get into, you know, more hospital capacity and ventilators. So what shape the hospitals in actually plays a role in who survives and who doesn't. And then, you know, even though there isn't a cure, of course, doctors have had more time to learn how to treat this disease. So we don't have a lot of data on this yet in the United States, but it seems like perhaps more people are surviving this disease than right in the beginning. Right. I think that is clearly the case. And, you know, as long as hospitals aren't totally overwhelmed with patients, they can make use of what they've learned so far to improve treatments. I'll give you just one example. Steroids, which are used to reduce inflammation, turn out to be quite useful in many instances. Yeah. So, Richard, I'm curious, like, overall how you're feeling, like looking at where we are compared to, let's say, April, there are ways in which I feel like we are a lot more prepared. Like, we understand the virus a little better. We're obviously farther along on a vaccine and some potential treatments, but we still don't have adequate testing. You know, cases are at an old time high. We're heading into the fall, which means we're going to have this, you know, consolidation of cold and flu and corona season, plus the school is potentially over. opening up. Yeah, you're really cheering me up here. Yeah. But maybe the most concerning thing, just to keep you down, Richard, is that I just don't feel like we are a country with like one

central goal to fight this thing together. Yeah, well, I think I would agree with that. First off, a coronavirus vaccine is not going to help much, at least not in this coming flu season. Right. Even if one is amazingly enough approved by the end of the year, it will take really a long time to vaccinate enough people to make a big difference. You know, what really could help would be a good flu vaccine. I think only about half of Americans typically get the flu shot every year. And public health officials say if they can dramatically increase that, it would really help a lot against the sort of one-two punch that we're going to have to be confronting come the fall. But you're right about the country not working well together on this, starting with leadership both at the federal level and also in some

states, but, you know, also including people who are ignoring all the guidance that's going out, all the good advice from scientists. And people are hesitant to get vaccines because of misinformation campaigns. As for testing, you know, by the fall, there will be some help, I expect. Doctors' offices should have a supply of rapid COVID tests. They're like rapid strep tests or whatever. They aren't super accurate, but they can help relieve some of the testing bottleneck. And sort of looking down the line a little bit farther, scientists are also working on next generation of tests that you might even be able to do at home. And, you know, those might be ready sometime next year. Next year seems pretty discouraging, doesn't it? It's pretty far off. But, you know, I'm pretty well resigned to the fact that we're going to be in this for the long haul. COVID-19 is going to be with us for years. So, you know, even technology that seems far off right now will still be needed when we can finally get it.

Okay, Richard Harris. I appreciate you. Thank you for this check-in. I appreciate you, Maddie. This episode was produced by Brent Bachman, fact-checked by Yo-Wei Shaw and edited by Jeff Brumfield. I'm Maddie Safaya, back tomorrow with more shortwave from NPR. you do when you have too many pickles in Alaska and not enough pancake syrup in New Jersey? On the next episode of Planet Money Summer School, we send supply and demand to the rescue. It's the economics education you always wanted, but never got around to. Every Wednesday, listen now to Planet Money from NPR.