June 26, 2020

America likely has had 10x more coronavirus cases than reported

Daily Briefing

    As the United States on Thursday reported another single-day record of 41,000 new coronavirus cases, CDC expanded guidance to warn that many younger adults are at risk of developing severe cases of Covid-19—and CDC Director Robert Redfield said testing suggests the country's epidemic has been much more widespread than reported cases have shown.

    US reports another single-day record of new coronavirus cases

    U.S. officials as of Friday morning reported 2,435,200 cases of the new coronavirus—up from 2,394,100 cases as of Thursday morning.

    America's coronavirus epidemic had seen a downward trend in newly reported coronavirus cases for six consecutive weeks, as states had closed nonessential businesses, implemented stay-at-home orders, and imposed social distancing and other protocols to curb the virus' spread.

    However, the country's daily number of newly reported coronavirus cases now has grown for more than a week and has surpassed America's previous peak of the epidemic. U.S. officials on Thursday reported 41,100 new cases of the coronavirus, which is the largest single-day increase in new cases that the country has reported so far. Thursday marked the second consecutive day that the country reported a record-high single-day increase in new cases.

    Data from the New York Times shows that Guam and 29 states—Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Kansas, Louisiana, Mississippi, Missouri, Montana, Nevada, New Mexico, Ohio, Oklahoma, Oregon, South Carolina, Tennessee, Texas, Utah, Washington, West Virginia, Wisconsin, and Wyoming—saw their average daily numbers of newly reported cases of the novel coronavirus rise over the past 14 days.

    In Texas, the state's spike in new coronavirus cases and surge in hospitalizations related to the virus prompted Gov. Greg Abbott (R) on Thursday to suspend the state's reopening plans—and on Friday, Abbott ordered bars in the state to once again close down and restaurants to scale back from 75% to 50% capacity, and implemented other restrictions aimed at curbing the coronavirus' spread. Abbot on Thursday also announced that the state is suspending scheduled surgeries in Bexar, Dallas, Harris, and Travis counties to expand capacity as hospitals in those counties grapple with influxes of patients with Covid-19, the disease caused by the virus.

    Meanwhile, the New York Times' data shows that the average daily numbers of newly reported cases over the past two weeks remained mostly stable in 11 states: Connecticut, Indiana, Iowa, Kentucky, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Carolina, and Pennsylvania.

    In addition, Puerto Rico, Washington, D.C., and 10 states—Illinois, Maine, Maryland, Nebraska, New Hampshire, North Dakota, Rhode Island, South Dakota, Vermont, and Virginia—saw their average daily numbers of newly confirmed cases decrease over the past 14 days, according to the data.

    As of Friday morning, officials had reported a total of 124,393 U.S. deaths linked to the new coronavirus—up from 121,926 deaths reported as of Thursday morning.

    Redfield says serology testing suggests 24M Americans may have contracted new coronavirus

    But CDC Director Robert Redfield on Thursday said America's reported tally of coronavirus cases is an undercount, and the actual number of Americans who've been infected with the virus likely is 10 times higher than the current count—which would mean the country's actual total is about 24 million cases.

    Redfield said that estimate is based on data collected from coronavirus serology tests that have been conducted throughout the country. The tests detect whether a person has developed antibodies to the new coronavirus, which can indicate previous infection. Testing positive for antibodies does not mean patients are currently infected with the pathogen.

    However, the data suggests there also could be more current cases of the novel coronavirus than are diagnosed and reported. "Our best estimate right now is that for every case that's reported, there actually are 10 other infections," Redfield said.

    Redfield said the large shares of people who become infected with the new coronavirus but who don't develop symptoms of Covid-19 make it more difficult to accurately count cases. "This virus causes so much asymptomatic infection. The traditional approach of looking for symptomatic illness and diagnosing it obviously underestimates the total amount of infections," he said.  

    Redfield added, "This [epidemic] is not over. The most powerful tool that we have, a powerful weapon, is social distancing."

    CDC warns that many younger adults are at risk of severe Covid-19

    Separately, CDC on Thursday updated of its guidance regarding who is at high risk of developing severe cases of Covid-19. The agency said older adults and individuals with certain underlying conditions continue to have an increased risk for severe illness, but "further defined age-and condition-related risks."

    Regarding the age-related risks, the update represents a shift in the agency's warnings, which previously suggested that mainly people ages 65 and older were at high risk of developing severe cases of the disease. CDC in a release said, "As more information becomes available, it is clear that a substantial number of Americans are at increased risk of severe illness—highlighting the importance of continuing to follow preventive measures." As such, the agency said it "removed the specific age threshold from the older adult classification," and "now warns that among adults, risk increases steadily as you age, and it's not just those over the age of 65 who are at increased risk for severe illness."

    Regarding the condition-related risks, CDC in the updated guidance notes that "[p]eople of any age" with certain health conditions—including Type 2 diabetes, obesity, heart conditions, and more—"are at increased risk" of developing severe cases of Covid-19, and that people with certain other underlying conditions—including asthma, high blood pressure, pregnancy, Type 1 diabetes, and more—"might be at increased risk" of developing severe cases of the disease.

    CDC said it added pregnancy to the list based on a study of more than 8,000 U.S. women with Covid-19. The study found pregnant women were 50% more likely than women who were not pregnant to be hospitalized for Covid-19, and 70% more likely to need mechanical ventilation than non-pregnant women.

    CDC also decreased its threshold related to obesity and increased risk of severe Covid-19. The agency previously had warned that individuals with a body mass index (BMI) of 40 or higher were at increased risk, but has now dropped that threshold to a BMI of 30 or higher.

    "Younger people are in no way completely immune to the effects of [the new coronavirus] nor are they at zero risk of severe manifestations," said Jay Butler, incident manager for CDC's Covid-19 response. "And among young people, that risk is elevated in those with underlying illness or health conditions, including things like diabetes or obesity," he said.

    CDC also updated its list of Covid-19 symptoms to include four additional signs of illness: congestion or runny nose, diarrhea, fatigue, and nausea or vomiting. The new additions expand the list from its previous total of seven symptoms, which had included fever or chills, cough, headache, muscle or body aches, new loss of taste or smell, shortness of breath or difficulty breathing, and sore throat (Svitek, Texas Tribune, 6/26; Katov, NPR, 6/26; Higgins-Dunn, CNBC, 6/25; Allassan, Axios, 6/25; Fernandez, Axios, 6/26; Sun/Achenbach, Washington Post, 6/25; Associated Press/Modern Healthcare, 6/25; Branswell, STAT News, 6/26; Walker, MedPage Today, 6/25; Fernandez, Axios, 6/25; Vaidya, Becker's Hospital Review, 6/26; New York Times, 6/26 [1]; New York Times, 6/26 [2]; CDC release, 6/25; CDC guidance, 6/25).

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