November 2: Johns Hopkins COVID-19 New Cases in Illinois

COVID-19

Updates on the COVID-19 pandemic from the Johns Hopkins Center for Health Security.

Additional resources are available on our website.

Subscribe to our newsletter

The Johns Hopkins Center for Health Security also produces US Travel Industry and Retail Supply Chain Updates that provide a summary of major issues and events impacting the US travel industry and retail supply chain. You can access them here.

EPI UPDATE The WHO COVID-19 Dashboard reports 46.17 million cases and 1.19 million deaths as of 08:40 am EST on October 26. The WHO reported a new record high for global weekly incidence for the sixth consecutive week. The global weekly total reached 3.33 million cases—an increase of more than 17% over the previous week, continuing a trend of rapid increase. The WHO reported 223,280 new cases on Monday.

Total Daily Incidence (change in average incidence; change in rank, if applicable)

USA: 81,599 new cases per day (+12,804)

India: 45,622 (-5,761)

France: 39,344 (+4,848)

Italy: 26,222 (+10,287; ↑3)

United Kingdom: 23,016 (+1,389)

Brazil: 21,654 (-1,030; ↓2)

Spain: 19,935 (+2,239; ↑1)

Poland: 18,030 (+6,898; new)

Russia: 17,558 (+1,194; ↓3)

Germany: 15,309 (+5,085; new)

Per Capita Daily Incidence (change in average incidence; change in rank, if applicable)

Andorra: 1,455 (+233)

Belgium: 1,271 (-25;↑ 1)

Czech Republic: 1,115 (-9;↓ 1)

Luxembourg: 1,045 (+233; ↑ 1)

Slovenia: 873 (+199; ↑ 2)

Switzerland: 832 (+355; new)

French Polynesia: 745 (-272; ↓ 3)

Armenia: 706 (+25; ↓ 2 )

Liechtenstein: 697*** (+169)

France: 603 (+74; ↓ 2)

*Spain’s average daily incidence is not reported for today; these values correspond to the previous day’s averages.

**Belgium’s average daily incidence is not reported for today; these values correspond to the daily average two days ago.

***Liechtenstein is a member of the UN, but not the WHO. Liechtenstein’s COVID-19 data is reported by Switzerland.

This week, the US continued to remain the country with the highest cumulative incidence and is reporting the highest number of global daily cases. The US, India, and Brazil continue to lead in cumulative incidence, with few signs of leveling off. The United Kingdom is experiencing a resurgence and is among the top 10 countries with highest cumulative incidence this week, with an 18% increase in incidence compared to last week. Germany has also reported an increase of over 5,000 new cases on average per day compared to last week, currently positioned at number 10 among the top 10 countries for daily incidence. Italy’s daily incidence has also shot up 3 spots to number 4 among the top 10 countries for daily incidence, whereas incidence in Brazil and Russia have both decreased.

Belgium now has the second highest per capita daily incidence this week, replacing the Czech Republic which is now in third place. Italy’s daily incidence grew the most this week, moving up to position 7 from position 9 last week. While still not among the top 3 countries with highest per capita incidence, Luxembourg has experienced a 29% increase compared to last week. Additionally, Switzerland has now entered the top 10 countries, with a 74% increase in per capita incidence compared to last week.

UNITED STATES

The US CDC reported 9.1 million total cases and 229,932 deaths. The average daily COVID-19 incidence is currently at 80,932 new cases, which is a slight decrease from 83,851 new cases per day reported last week. Last week, the US set a new record peak for new daily incidence with 101,273 cases on October 31, which is about 20,000 cases higher than the record from last week. Following the expected dip in reporting over the weekend, we will continue to track whether a new record peak will be set later this week.

The US COVID-19 mortality decreased slightly from 900 to currently around 823 new deaths per day; however, data over the weekend generally provides an underestimate of actual death counts. Currently mortality at the national level appears to be stagnating at this level, but it is unclear whether this will remain a longer term trend.

More than half of all US states have reported more than 100,000 cases, including 11 with more than 200,000 cases:

>900,000: California, Texas

>700,000: Florida

>400,000: New York, Illinois

>300,000: Georgia

>200,000: Arizona, New Jersey, North Carolina, Tennessee, Wisconsin, Ohio, Pennsylvania

The Johns Hopkins CSSE dashboard reported 9.2 million US cases and 231,011 deaths as of 11:20 AM November 2.

HOUSEHOLD TRANSMISSION A new publication from the Morbidity and Mortality Weekly Report examines the risk of SARS-CoV-2 transmission among household members. The authors described findings from a prospective study involving 191 initially asymptomatic household contacts of 101 index patients in Tennessee and Wisconsin. Among 102 of the household contacts who tested negative upon enrollment in the study, 53% later tested positive for SARS-CoV-2. Secondary infection rate was notably lower for index patients aged 12-17 (38%) but not for index patients under the age of 12 (53%) - although only 14 of the index patients enrolled were under the age of 18. Notably, 75% of household infections were identified within the first five days of index patients becoming symptomatic. These secondary infection rates may be an underestimate as household contacts were enrolled 2-4 days after illness onset of index patients, so earlier household transmission may not have been included in the identification of secondary infection rates. Authors recommend that symptomatic individuals promptly isolate from household members as soon as possible after illness onset, even while waiting for testing results and that household members adopt mask usage and distancing when housed with a confirmed infection.

US TESTING DATA Journalists from The New York Times have recently pointed out inconsistencies in types of testing data reported across states. 37 states combine antigen testing with diagnostic testing to report COVID-19 case statistics, six states report antigen testing separately and seven states and D.C. do not report antigen testing results. These inconsistencies can lead to undercounting of COVID-19 cases or an unclear picture of whether public health mitigation measures are sufficiently succeeding in quelling outbreaks. Notably, antigen testing is less sensitive and specific than testing via PCR, but the CDC recommends that states report COVID-19 case statistics using both PCR and antigen testing data.

Other issues with testing data interpretation can also arise due to testing refusals. The New York Times recently alleged that community members in Kiryas Joel, a village in Orange County, New York, may have actively discouraged individuals from seeking or accepting COVID-19 testing in order to artificially lower the village’s COVID-19 test positivity rate. The village reportedly reduced testing positivity from 34% to 2% in only two weeks.

RISK TO HEALTH CARE PERSONNEL Three recent publications have drawn attention to the COVID-19 risked faced by health workers and their households. One study in the Morbidity and Mortality Weekly Report (MMWR) discussed exposure factors and infections among 21,406 Minnesota health worker exposure events. 5,374 of the exposure events included close and prolonged contact with an infected case while not wearing suitable personal protective equipment (i.e. within six feet for at least 15 minutes). While two thirds of high-risk exposure events happened in the patient care setting, one third of exposures involved infected coworkers, household contacts or social contacts. The authors highlighted the need for health workers to remain vigilant regarding COVID-19 prevention measures when not in the patient care setting. Health care personnel working in long-term care or congregate living were also found to be more likely to continue working while symptomatic or after receiving positive test results than those working in acute care settings, emphasizing the need for flexible sick leave policies, access to testing and access to personal protective equipment.

The other two publications discussed hospitalization of health workers and their households due to COVID-19. The study in BMJ identified risk factors for hospital admission across 158,445 health workers and 229,905 household members of health workers in the United Kingdom. 17.2% of COVID-19 hospital admissions in the UK among individuals aged 18-65 were hospital workers or their household members. Risk factors for hospital admission largely mirrored risk factors previously identified for the general population (e.g. age, certain underlying medical conditions) but also included in-person care of patients or being a household member of a health worker who provided in-person care of patients. Health workers in “front door” roles such as paramedics or those working in emergency rooms had a higher risk of hospital admission due to COVID-19 than other in-person patient care workers. The absolute risk of hospital admission due to COVID-19 for healthcare workers and their households was calculated to be 0.5%, similar to the general population.

Meanwhile, an additional MMWR study discussed US hospitalization data for 6,760 adult hospitalized COVID-19 patients of whom 438 were health care personnel. Notably, 36% of hospitalized health care personnel were in an nursing-related profession, 71.9% were female, 52% were non-Hispanic Black and 89.8% had an underlying condition, largely represented by individuals reported as obese (73%). The median age of hospitalization for health care personnel (49) was notably lower than for those hospitalized among the general population (62). One in four health workers in the data set were also admitted to an intensive care unit, which is in line with the proportion admitted to intensive care units among general population COVID-19 hospitalizations for adults aged 18 to 64.

WHO DIRECTOR-GENERAL Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, is now working from home while self-quarantining following exposure to a COVID-19 case, according to a tweet posted on Sunday. The Director-General has not reported any symptoms of COVID-19 thus far.

UNITED KINGDOM On Saturday night, Prime Minister Boris Johnson announced a swath of new restrictions aimed at reducing the spread of COVID-19 within the United Kingdom. New policies included closure of bars, in-person dining at restaurants and other non-essential businesses. Educational institutions and childcare facilities will remain open. A stay-at-home order will also be in place with individuals only allowed to leave their residences for work if remote work is not possible, education, exercise, caregiving or essential shopping. Amateur sports are recommended to cease activities. The measure to pay 80% of wages for furloughed workers has also been extended. New restrictions are slated to be in place through December 2. Parliament will be voting on the new measures this Wednesday. The United Kingdom notably has the highest official death toll for the COVID-19 pandemic in Europe.

ELI LILLY A recent study published in the New England Journal of Medicine last week reported that convalescent plasma derived monoclonal antibody treatment (LY-CoV555), developed by Eli Lilly, showed clinical benefit in patients. The study found that patients experienced decreased viral loads and severity, and had no serious adverse effects in outpatients. The phase II trial involved outpatients that had mild to moderate COVID-19. A total of 452 patients participated, receiving either low, medium or high concentration of the antibody, or placebo. Researchers measured the change in viral load after 11 days of treatment, and the study has reported on interim findings. Patients receiving the medium dose (2800 mg) had about a 3 fold reduction in viral load. Differences among placebo and treatment groups were non-significant and smaller for both the low and the high dosage categories. However, patients receiving any antibody dose had lower symptom severity as well as lower hospitalization rates than placebo. Additionally, the percentage of adverse events was similar across treatment and placebo groups.

The report came after an announcement from the NIH that it was going to halt a trial investigating the antibody after the trial’s Data Safety Monitoring Board reviewed the data on October 26th and recommended that no further participants enroll, as it concluded there was a “low likelihood that the intervention would be of clinical value” for hospitalized patients. Scientists currently believe that while there may be possible benefit among outpatients, as observed in the NEJM study, the longer course of infection and severity among hospitalized patients reduces likelihood of benefit for the treatment. An additional hurdle is that there are highly limited doses of antibody treatments available for both the Eli Lilly and Regeron cocktails. Eli Lilly reportedly anticipates it can ship 100,000 doses of its monoclonal antibody once allowed, and that it can produce as much as a million doses by the end of the year; however, that is at the lowest dosage concentration, which was currently not found to yield significant benefit in the NEJM study. 

BEHAVIORAL DIFFERENCES BY AGE A recent CDC study published in the MMWR assessed self-reporting of recommended behaviors to mitigate SARS-CoV-2 transmission, including mask-wearing, hand washing, social distancing, and staying home when sick. The Data Foundation COVID Impact Survey collected national data on reported mitigation behaviors from April to June among adults. The study found that mask use increased from 78% in April to 89% in June. Other crucial mitigation measures, including hand washing, social distancing, and avoiding crowded areas, stagnated or declined. The prevalence of reported behaviors was lowest among those aged 18-29 years old and highest among those over 60 years. Across all age groups, however, mask wearing increased. Handwashing decreased across all groups from April to June, with the greatest decrease occurring among those aged 30-44 years old (from about 92% to 87%) and those over 60 years old (96.5% to 93%). The proportion of respondents who cancelled social activities and avoided crowded places generally stagnated or decreased from April to June, particularly for those aged 18-29 and 30-44 years old. The study concluded that understanding the factors leading to uptake of each mitigation behavior is important, particularly among the younger age groups. While news media, particularly earlier in the year, generally emphasized and criticized the lack of social distancing among young people at parties and other social events, other factors such as job type could also play a large role in disproportionately preventing younger people from distancing.

SYSTEMIC RACISM & COVID-19 The Johns Hopkins Center for Health Security’s journal, Health Security, issued a call for papers for an upcoming Special Feature on systemic racism in the context of the COVID-19 pandemic (scheduled for May/June 2021). Additional information is available here.

November 2: 6222 New COVID-19 Cases in Illinois

What needs to change in US Constitution?

Opinion

I’m a Democracy Expert. I Never Thought We’d Be So Close to a Breakdown.

Our election systems were not built for the modern era. Looking abroad might help.

By Larry Diamond

Mr. Diamond is the author of “Ill Winds: Saving Democracy From Russian Rage, Chinese Ambition, and American Complacency.”

• Nov. 1, 2020

The third pillar of American democracy — the one we have most taken for granted — is most at risk: free and fair elections.Credit...Tamir Kalifa for The New York Times

As this Tuesday’s consequential election nears, my fellow democracy experts and I have often been asked: What is the right historical analogy to America’s current crisis? The truth is, there is no precedent. We have never seen such a longstanding democracy in such a rich country break down before — never. But it could happen this year.

The vulnerability of our democracy today doesn’t come in the form that many feared when Donald Trump was elected in 2016. The good news is that two of the three pillars of American democracy — liberty and the rule of law — endure, even if they have been battered. But the third pillar — free and fair elections — is under far more direct threat than my fellow democracy experts predicted.

Despite liberals’ worries, the United States has not descended into fascism. The president has repeatedly called to “lock up” or arrest his political rivals, but the Justice Department — however compromised its leadership at the top — has not complied.

Mr. Trump has relentlessly denounced the news media as the “enemy of the people,” but America’s vibrant free press continues to expose one White House scandal after another. And civil society organizations remain free to advocate for civil rights, the environment and other causes. Liberty remains essentially intact.

Mr. Trump has inflicted more damage to the rule of law. He has impugned the integrity of judges who have ruled against him. He has demanded loyalty to himself — not the law or the Constitution — from F.B.I. directors, intelligence officials, military commanders and his attorneys general. He has replaced five inspectors general investigating wrongdoing in his administration, withheld his tax returns, pardoned his political allies convicted of felonies, and normalized lying and inflammatory tweets as modes of presidential communication. And recently he issued an executive order undermining the political neutrality and career protections of thousands of senior civil servants.

Yet the judiciary has retained considerable independence. In June, Mr. Trump’s first two Supreme Court nominees, Neil Gorsuch and Brett Kavanaugh, joined a 7-to-2 majority ruling that the president wasn’t immune from a New York state subpoena for his financial documents. So far, the F.B.I. director Christopher Wray has quietly but professionally parried Mr. Trump’s demands for “loyalty” and defended the agency’s autonomy.

As a result, Mr. Trump has not (yet) become a true autocrat. Illiberal populists such as Viktor Orban in Hungary and Recep Tayyip Erdogan in Turkey have gradually strangled their democracies by following an authoritarian playbook: control the courts by appointing subservient judges; conquer the independent media by corrupting or threatening its owners; intimidate business leaders into ceasing support of the political opposition; terrorize civil society groups into muffling their dissents; and assert personal political control over law enforcement and intelligence agencies.

Mr. Trump hasn’t gotten very far in implementing that playbook, though he might well have more success if he is re-elected on Tuesday.

But the third pillar of our democracy — the one we have most taken for granted — is most at risk: free and fair elections. The danger emanates from a singular combination of events, the worst pandemic in a century and the most undemocratic president in our history.

With Democrats accounting for a much larger share of mail-in ballots than Republicans, Mr. Trump has repeatedly challenged the legitimacy of these votes. If he is leading even narrowly on Tuesday night, he could claim victory based only on the votes so far counted — even though Joe Biden might well be on course to win when all valid votes are counted. Worse, he might pressure the Republican legislatures in battleground states, like Pennsylvania and Florida, to award him their state’s electors, even if the formal vote-counting machinery ultimately declares a Biden victory in the state. Then it would fall to the courts and Congress (under the terms of the inscrutable, badly written Electoral Count Act of 1887) to determine who had won in the disputed states.

Such a scenario would be far more dire and polarizing than even the Bush v. Gore nightmare of 2000, with an incumbent president threatening fire and brimstone if the election were not handed to him, while signaling violent right-wing extremists to “stand by” but perhaps no longer “stand down.” Many on the left would no longer be willing to let the presidency (in their eyes) be stolen from them again, and far-left groups might revel in the chance to worsen the crisis. The potential for violence would be alarming.

The integrity of the election is further challenged by the rising pace of voter suppression. In 2013, the Supreme Court gutted the Voting Rights Act, throwing out the formula requiring nine states (and other localities) with a history of racist voter suppression to obtain federal permission before changing their voting requirements. Since then, these and other Republican-controlled states have imposed legal and administrative changes that have made voting more difficult for Black Americans, Hispanics, young people and city dwellers — all heavily Democratic constituencies.

It would be undemocratic enough for the loser of the national popular vote to again be elected (for the third time in the past seven presidential elections) by winning the Electoral College. But if Mr. Trump were to win re-election by narrowly prevailing in two or three states through extensive disqualification of mail-in ballots or through voter suppression, the legitimacy of the 2020 election could be questioned far more intensely than those of 2000 or 2016. And if Mr. Trump failed to win the Electoral College but was nonetheless declared president thanks to partisan electors, it would signify a grave breakdown of American democracy — even if people remained free to speak, write and publish as they pleased.

The very age of American democracy is part of the problem. The United States was the first country to become a democracy, emerging over a vast, dispersed and diverse set of colonies that feared the prospect of the “tyranny of the majority.” Hence, our constitutional system lacks some immunities against an electoral debacle that are common in newer democracies.

For example, even though Mexico is a federal system like the United States, it has a strong, politically independent National Electoral Institute that administers its federal elections. The Election Commission of India has even more far-reaching and constitutionally protected authority to administer elections across that enormous country. Elections thus remain a crucial pillar of Indian democracy, even as the country’s populist prime minister, Narendra Modi, assaults press freedom, civil society and the rule of law. Other newer democracies, from South Africa to Taiwan, have strong national systems of election administration staffed and led by nonpartisan professionals.

The American system is a mishmash of state and local authorities. Most are staffed by dedicated professionals, but state legislatures and elected secretaries of state can introduce partisanship, casting doubt on its impartiality. No other advanced democracy falls so short of contemporary democratic standards of fairness, neutrality and rationality in its system of administering national elections.

More recent democratic countries have adopted constitutional provisions to strengthen checks and balances. Like many newer democracies, Latvia has established a strong independent anti-corruption bureau, which has investigative, preventive and educational functions and a substantial budget and staff. It even oversees political and campaign finance. South Africa has the independent Office of the Public Protector to perform a similar role.

The United States has no comparable standing authority to investigate national-level corruption, and Congress largely investigates and punishes itself.

Newer democracies also take measures to depoliticize the constitutional court. No other democracy gives life tenure to such a powerful position as constitutional court justice. They either face term limits (12 years in Germany and South Africa; eight in Taiwan) or age limits (70 years in Australia, Israel and South Korea; 75 in Canada), or both. Germany depoliticizes nominations to its constitutional court by requiring broad parliamentary consensus. In other democracies, a broader committee nominates Supreme Court justices. In Israel this involves not just the executive branch but the parliament, some of the existing justices and the bar association.

Many of these ideas simply didn’t occur to America’s founders, who were framing a modern democracy for the first time, for a largely rural society with more limited levels of education, communication and life expectancy. The result is that American democracy lacks national checks on executive corruption and national guarantees of electoral integrity that have become routine in other democracies around the world. And nominations to our Supreme Court have become far more politicized than in many peer democracies.

Throughout most of our history, America’s democratic norms have been strong enough and the outcomes have been clear enough to avoid catastrophic conflict over a national election. But several times (most notably with the Hayes vs. Tilden presidential election of 1876), we approached the precipice — and only avoided falling off through luck and painful compromises.

Today, we are far closer to a breakdown than most democracy experts, myself included, would have dared anticipate just a few years ago. Even if we are spared the worst, it is long past time to renew the mechanisms of our democracy, learn from other democracies around the world and again make our republic a shining city on a hill.

Larry Diamond is a senior fellow at the Hoover Institution and at Stanford University’s Freeman Spogli Institute for International Studies. He is the author, most recently, of “Ill Winds: Saving Democracy From Russian Rage, Chinese Ambition, and American Complacency.”

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.

Above is from:  https://www.nytimes.com/2020/11/01/opinion/election-vote-2020.html?action=click&module=Opinion&pgtype=Homepage