The State of the Union on Covid-19

The virus is moving South and Midwest in the US, “super-spreader” data is favorable to containment, and disease spread in South America is accelerating

Andy Slavitt
Medium Coronavirus Blog
5 min readMay 26, 2020


Photo by Alexi Rosenfeld/Getty Images

Today I’m sharing short updates on four Covid-19 topics: spread of the disease, science, political discourse, and global hotspots.

As expected, the disease is moving South and Midwest as the Northeast improves. Regions with early May openings are seeing increased hospitalizations. Why? Because that’s what outbreaks do. They find the open areas. Good early states — like West Virginia and Montana — are seeing growth now. Alabama, Wisconsin, and Texas are also seeing growth.

The most concerning development is pointed out here by Scott Gottlieb. Hospitalizations, after a decline, are moving back up. With 20,000 new cases, this means 800 new hospitalizations/day. If this continues, it will put hospitals in some areas under pressure.

Since 20 states don’t report, and it’s hard to get a complete picture of ICU beds, if hospitals in a state get 70% full and cases are growing, it’s a concern. This is a list I monitor:

The cause and effect of states loosening up their standards may be seen in Wisconsin. The Supreme Court overruled the Governor and people were forced to vote in person in early April.

  • Cases up 42% over last 2 weeks
  • Symptom monitors are off the charts

The best look at who is dying from Covid-19 is to look at NY.

  • 52% of the deaths were people under 75
  • 28% were people under 64
  • ~4 out of 5 had an underlying medical condition
  • In every age group, more people of color

Science: Our understanding of this disease, which we knew nothing about, is advancing! Why are we able to reduce R0 (the rate of infection) so quickly? Big events and super spreaders May hold the key.

It looks like a small number of people in large concentrated events are bigger drivers. Cancelling flights, closing bars, halting sporting events and religious services likely was responsible for a large number of the 20,000 lives saved in May.

As this report from Israel shows, a small number of infected people do most of the spreading. These are the “super spreaders”. This would mean that 80–95% of infected people are not very contagious or don’t behave in a manner which increases spread.

If true, this would make Covid-19 much easier to control. It doesn’t reduce the risk when someone’s infected, but it does mean we can learn to live with and control Covid-19. Avoiding large gatherings is key.

The dumbest thing of the week is Trump turning Covis-19 into a culture war by declaring houses of worship an essential service. Please have faith. But put some of it in good science.

When bars and restaurants closed in March, transmissions dropped significantly. Old hot spots will become new again. Even while we haven’t made nursing homes, jails, and meatpacking factories safe, we risk adding to the list.

Vaccines: I have been quite purposely not falling into the optimism that many are, but I have moved from a five to a six on the optimism scale. To be clear, vaccines are a 2021 event. Mid-2021 if things are going well. But so far things are going well. The reason it’s hard to get past a six on the scale, is despite the rapid work from Moderna, Oxford, Pfizer, and Sanofi, in the end how many people the vaccine works for and who can take it will be unknown for some time.

The state of discourse is dishonest. An example: Suicide has been en epidemic for the last two decades, growing to record numbers each year. 47k died from suicide and 70k from overdoses in the US in 2017. And support to fund mental health during this time has been just a joke.

But now, Trump says more have died from overdoses and suicide than Covid-19. Recall that 100,000 people (but likely many more than 100k), have died in the last two months. It’s a cynical lie, resting on the backs of people with mental illness. And the lie is filled with fake sources fake data.

Please listen to Jason Kander as we talk about the real issues that are sadly ignored. Ignored for the purposes that this crisis too can be ignored.

The state of the world, particularly in South America, is frightening. Brazil is now going through its peak season and yesterday Brazil almost precisely equaled US case count on the way to surpassing it:

Brazil: 20,803
US: 20,806

The death toll projection in Brazil is now 125,000 by August 4th. Chile, Peru and Mexico are in real trouble as well. Having seen hospitals in all three countries, I am profoundly worried.

This is supposed to be our off season. And it’s too active. On the other hand, spread is going to occur and cases will occur. We have the ability to reduce it by what we are learning about how it spreads and by making it less lethal. We make decisions now in the name of the economy that can be made wisely if we follow the #OpenSafely guidance.

A reason for optimism is science, altered a bit by human behavior. Always the hard part.