Question: I’ve been reading about how many more cases are popping up across the United States. Is it really as bad as it sounds?

Answer: Uggghhh. Yes, it’s bad. COVID case numbers are rising in more than half of the states. And while the US accounts for only 4.3% of the world’s population, we have 25% of the world’s cases. Over the course of April and May, thanks to social distancing and non-medical interventions, the United States had succeeded in flattening the curve and had even begun to bend the curve (Figure 1). Unfortunately, our progress in bending the curve stalled in late May. Since early June, we’ve continued to see a sharp increase in the number of daily cases (Figure 1). It’s important to note, because the initial epicenter in the US was New York, the overall picture of the United States is skewed with New York’s experience. If we take New York out of the picture, we see that the US as a whole merely flattened the curve over April and May; we never really got to bending it (Figure 2a). And since early June, cases are back on the pre-shutdown trajectory (Figure 2b). It’s looking like we gave ourselves so much time to get our testing, tracing, and health facility response together at huge personal, societal, and economic cost just to land back where we started. A few more notes:

• The picture across the US varies dramatically by location (Figure 3) with the Northeast on a sharp downward trajectory and the South and West accounting for the large increases.
• When it comes to tracking cases over time, we do indeed have more testing (good!) (Figure 4a). But… the percentage of tests coming back positive is also increasing (bad!) (Figure 4b) .
• States don’t uniformly report hospitalization data, so we don’t have that piece to compare here. We can use CDC’s hospitalizations tracker, which does show hospitalizations on a downward slope (good!), but was last updated June 13th (bad!), and we know that hospitalizations lag cases. It’s possible that because we are doing more testing, we are capturing more mild and moderate cases as compared with earlier in the epidemic, so the case:hospitalization ratios won’t be as high as what we saw in New York (good!). For a reminder of timing of illness onset to hospitalization, see Q&A of 3/29.
• In spite of limited hospitalization data, CDC’s ensemble forecast of deaths, updated yesterday, suggest that “the number of new deaths over the next four weeks in Arizona, Arkansas, California, Florida, Hawaii, Missouri, Nevada, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, and Utah will likely exceed the number reported over the last four weeks.” (Figure 5)

Figure 1. Daily COVID Cases in the United States (data from covidtracking.com)

Figures 2a and 2b. Daily COVID Cases in the United States Excluding New York (data from covidtracking.com)

Figure 3. Regional Differences in New Cases (chart from The COVID Tracking Project)

Figures 4a and 4b. Tests and Percent of Tests that are Positive in the USA, Excluding New York (data from covidtracking.com)

Figure 5. CDC’s Ensemble Forecast of Total Deaths suggests 130K-150K Deaths by July 18