Throughout the month of October, COVID was in retreat throughout the country and most of the world.

Hospitalizations

US hospitalizations dropped by about 40% during the month (72,000→41,000).  We are now at less than half the height of the Delta peak in mid-September.  New daily hospitalizations are also down by over half since the peak.

Hospitalizations are clearly past their peak in all ten of HHS’s regional reporting areas, except the Mountain Region.  However, even in the Mountain Region, where vacation rates have been lower and there have been fewer cases to drive natural immunity, it appears that hospitalizations leveled out in the last couple of weeks. Texas hospitalizations have fallen by 75% from their peak in late August (13,900→3,400).  ICU bed usage took a little longer to peak but has also been falling rapidly in the last two weeks.

New daily COVID hospitalizations in Texas, which had reached over 1,800 in late August and early September, finished the month at 329 - a stunning 82% drop.

Hospitalizations were down across the State.  In Harris County, hospitalizations have dropped from just under 2,200 in early September to 470 at the end of October.  COVID hospitalizations currently are 6.5% of all hospitalizations in the County.  Inexplicably, the Harris County threat level is still at the Code Red/Stay Home.  The fact that tickets to tonight’s Astros game are going for over $2,000 each suggests that few in Harris County are paying much attention to the County’s warning system.

Fatalities

The CDC data continues to show that fatalities peaked around the middle of September but has increased the peak from about 1,700 to just over 1,850.  It is showing the seven-day average at approximately 1,150 per day as of the end of the month, but that will likely drift higher as late filed death certificates come in.

Similarly, the Texas date of death analysis is showing that fatalities peaked in the first week of September.  The highest daily toll was 341.  The seven-day average for the latest date the DHHS considers to be “complete” (mid-October) has dipped just below 100 deaths per day.

INSERT TEXAS DOD FAT CHART

The CDC Excess Death Analysis is now showing that excess deaths topped out in late August-early September at about 35-40% above what would be normal for that time of year.  That is comparable to the December-January peak but it appears this peak will be much more short-lived.  For the first week of October, the CDC data currently shows that fatalities were nearly back to their normal level.

Vaccines

In spite of the media’s reports of widespread vaccine hesitancy, Americans continue to be vaccinated at a steady pace.  With seniors qualifying for boosters, daily shots rose in early October and then settled back to about 600,000 per day.  There has been another surge in recent days taking the seven-day average to over 1 million again.

The percentage of the US population fully vaccinated continues to gradually rise, reaching 58% and 85.4% for seniors.  Approximately 25% of seniors have received a booster.  The percentages in Texas also gradually increased, now at 53.4% and 81.8%, respectively.

Testing Results

Nationwide, testing, which had surged to 1.9 in early October, fell dramatically in the second half of the month, standing at just a million per day by the end of the month.  The CDC’s daily seven-day average of “new cases” continued to steadily fall.  As of the end of October, it stood at ~70,000, down from 160,000 at the Delta peak.  The current nationwide positivity rate dropped to 5.28%.

Texas’ seven-day average for “new cases” has now dropped below 3,000 per day, down from 15,000 during the Delta peak.  The positivity rate for the State’s date of specimen testing has continued to decline steadily, ending the month at 5.27%.  At the Delta peak it was over 15%.

Conclusion

In retrospect, I think the data is suggesting that in the US we have had three distinctive waves of COVID.  The first, which hit the northeast in the spring and most of the rest of the country in summer, was brought to heel with a low level of natural immunity and a change in our behavior, primarily people disengaging and staying home.

However, that was not sustainable and as people reengaged, the level of natural immunity was not enough to prevent the second wave that occurred last winter.  The second wave was initially turned back with growing natural immunity and then supplemented with the vaccines, leading to the dramatic decline we saw in the spring.

That would have probably been the end of COVID in the US had it not been for the emergence of the Delta variant.  That variant, which appears to have a R₀ that is off the chart, also happened to come along at a time when the immunity from earlier cases and vaccinations was probably waning. We also still had a relatively low rate of vaccinations then.  I think it is noteworthy that the Delta surge has subsided almost entirely to growing immunity.  There are essentially no containment measures being taken at this point, as is readily apparent from watching any college football game.

I also think it is important to emphasize that the Delta wave was not driven by break-through infections, although they contributed to it.  All of the data continues to show that the vast majority of the people that got sick during the Delta wave did not have immunity from a vaccine or a previous infection, and this was especially the case for serious cases. More on this in an update soon.

Absent a new variant that alters the current trend, I suspect that the country’s mania over COVID is going to rapidly dissipate.  Most of the doctors and researchers I have been visiting with are doubtful such as variant is in our future.  Certainly, a new variant that would bring on another massive wave of infection would be inconsistent with the history of previous epidemics.  How COVID will play out in the rest of the world is a little less clear to me.  Delta seems to be working its way through various countries.  In those that have high vaccination rates, fatality counts are kept in check despite surges in cases.  Incredibly, over 2.9 billion people in the world are now fully vaccinated, which is about 35% of the world’s population.  The only part of the world which is largely unvaccinated at this point is Sub-Saharan Africa.

I am beginning to believe that the herd immunity threshold for the Delta variant must be close to 60% range, compared to probably something in the low 40% range for the original strain.  Most of the world is moving rapidly toward that level, either with vaccination or naturally-acquired immunity.  It will take some parts of the world longer to get past COVID than the US, but we seem to be headed inexorably in that direction.

Unless something changes in the current trajectory, this will be my last periodic report on COVID.  I will be sharing some retrospective thoughts on the pandemic, especially on some of the demographic characteristics and updating the break-through data. I will also continue to post the current numbers on my social media.

This is my 109^th post on COVID.  Looking back over those posts reflects what an incredible sojourn this has been.  There is much to be learned from this pandemic, but I fear many of the lessons have been misread. I also think there were many missteps along the way by the public health establishments, especially as it relates to the information and messaging shared with the public.  For that reason, I am also giving some thought to a book on how this pandemic looked from a layman’s perspective.  I will let you know if I decide to undertake that chore.

In the meantime, stay well.  Get vaccinated.