State of Affairs: Nov 8

We have a steady plateau in the United States, which is making public health officials very uneasy.

First, we’ve idled at a high transmission rate. Our case rate today is higher than the peak of the first two waves. This is not how we want to enter the winter season— when coronaviruses typically thrive.

Second, almost every country in Europe has cases increasing exponentially. Europe has consistently acted as an early warning signal for the U.S. Notably, Germany has the highest case rate since the beginning of the pandemic.

And Europe has much higher vaccination rates than the United States. So if they are doing poorly, we may do worse. Denmark has the highest vaccination rate (76%) in which cases are increasing. Belgium (74%), Italy (73%), France (68%) and Germany (67%) follow. (Interestingly, European countries with the highest vaccination rates [Portugal at 86%; Spain at 79%] are not increasing in cases.)

Increasing cases with a high vaccination rates can mean a few things:

  1. There are still vulnerable pockets; the immunity wall isn’t high enough yet.

  2. This may confirm that SARS-CoV-2 is, in fact, seasonal; it’s getting cold in Europe.

  3. Europe has pandemic fatigue and letting their guard down, like the U.S.

  4. Perhaps most telling is that the case make-up is shifting. In Summer, the European wave was largely driven by younger populations (i.e. unvaccinated). Currently, the wave is driven by all ages equally. This could mean that vaccines are waning, like we saw in Israel a few months ago. The European Medicines Agency has already cleared booster shots for everyone 18 and up but decisions on who should receive the extra dose are up to individual governments. Time to go get those boosters, folks.


Back in the States, all eyes continue to be on the West. Alaska is still the case leader (82 cases per 100,000), but has declined nicely (24%) in the past 14 days. North Dakota (67 per 100K), Montana (62 per 100K) and Wyoming (59 per 100K) closely follow. Cases are increasing fastest in New Mexico (47%), followed by Colorado (36%), Nebraska (33%), and Vermont (32%).

Kids continue to make up more and more cases as this pandemic moves forward.

If anyone is still following CDC guidelines, vaccinated people in “moderate” or “low” transmission counties can now take off their masks inside. This is about 10% of counties, which are largely confined to the South. To check your county’s status, go here.

Test positivity rate

As a nation, we have a fantastic test positivity rate (TPR) at 5%. However, if you look closely, this has started to increase. TPR is an early indicator of what is to come, so cases may follow suit in the next few days too.

Because our testing strategies are shifting (more rapid antigen), it’s still unclear if TPR is still a reliable metric. Time will tell.


Hospitalizations have decreased 14% in the past two weeks and have finally dripped below 50,000. The deceleration is slowing, which is not surprising as hospitalizations lag cases. Hospitalizations will probably start to plateau in the next week or two.


We reached a sober milestone: 750,000 people in the United States have died from COVID19. This includes about 50,000 since the start of October. At this point, deaths are preventable.

It didn’t have to be like this. Other countries, like South Korea, have largely escaped death due to their comprehensive response. I previously wrote about their response here.

And if mortality doesn’t show a grave enough picture, another metric we use in public health care is “years of life lost”. This is a metric that’s calculated by subtracting the expected age of death by the actual age they died from COVID19. A recent study found, among 37 upper-middle and high income countries, the US ranked one of the highest with years lost. This is because a large portion of our deaths are young people, and specifically males.


Vaccines continue to work brilliantly. The CDC hasn’t updated their website since September, so we are at the mercy of states and local jurisdictions. For example, in Oregon’s latest report, cases continue to be largely driven by unvaccinated. There are breakthrough cases, but very, very few result in hospitalizations and deaths.

We’re giving about 1,830,897 doses per day, which includes 421,397 people getting their first shot. In the coming months, vaccination breadth and depth will be key:

  • Breadth: Unvaccinated need to get vaccinated. This includes 5-11 year olds.

  • Depth: Boosters. Only 12.4% of fully vaccinated people have had a booster. 60% of the fully vaccinated are eligible.

What we do today will determine how we fare this Winter.

Love, YLE

If you have questions about the 5-11 year old vaccine, please join me and two pediatricians tomorrow night! We’ll present the latest information and answer specific questions from the audience. Concurrently, we have an army of pediatricians that will individually answer your questions in real time in the chat. Parents find this really helpful! Register here.