At the end of June, it appeared COVID was on its last legs. But it has staged an alarming comeback in July, with hospitalizations and case counts increasing dramatically. The good news is that, at least so far, fatalities have not increased correspondingly.

Hospitalizations

US hospitalizations nearly tripled during July, jumping from about 12,000 at the end of June to over 35,000 by the end of July.  Daily new hospitalizations also tripled from just over 2,000 to just over 6,000.

In Texas, hospitalizations increased fourfold, rocketing from approximately 1,600 to over 6,500.  COVID ICU bed usage did not increase by quite as much but still ended the month about 2.5X higher (481→1,776).

All of Texas’ reporting regions saw fairly similar increases over the month of July.  There was not a disproportionate increase along border. 

As you can see from the chart, hospitalizations are back to their previous highs in April but are still only about a third of the January levels.  But the alarming aspect of the hospitalization data is that the increases have been nearly straight up since beginning to move up in early July and show no signs of slowing.

Fatalities

The only bright spot in COVID data for July is that, at least so far, fatalities have not risen at nearly the rate of hospitalizations.  The CDC’s seven-day average for fatalities, which had fallen to below 200 per day in early July, broke 300 again at the end of the month.  Nonetheless, fatalities nationwide are less than 10% of what they were in January.

Texas’ date of death analysis bottomed out at about 20 per day at the end of June and has only marginally increased.  The last data which should be mostly completed stood at about 26.

The CDC Excess Death Analysis, which is based on actual date of death, continues to show that since mid-March, fatalities have been running between 103-108% of their model’s prediction.  However, since the CDC did not adjust for population growth, anything about 103% or below should be considered normal.  Also, there are a number of factors other than COVID currently contributing to higher than normal fatalities, including a nearly doubling of drug overdoses this year.

Vaccines

Vaccinations began to slow in mid-June.  At that time, the CDC’s seven-day average was about one million shots per day.  That fell to as low as 430,000 by mid-July but rebounded to about 550,000 by the end of July, probably a sign the latest wave of cases has caused some of the hesitant to get off the fence.

The percentage of the US population fully vaccinated only rose by just under 3% (46.7%→49.6%).  The rate for seniors increased by a little over 2% (78.0%→80.1%).  The latter is a remarkable achievement.  However, it still leaves about 10 million seniors unvaccinated.

Texas only added about 2% to the total population and the over-65 population fully vaccinated. Texas lags the national average in both categories (43.9% vs. 49.6% and 76.2% vs. 80.1%, respectively).  Texas ranked about two-thirds of the way down the list of states for the largest portion of their population vaccinated. 

Testing Results

Nationwide, testing has held steady at about 700,000 tests per day.  The CDC’s daily “new case” count increased nearly sixfold from 12,500 to over 72,000.  The seven-day average for positivity is now over 8%.

Texas’ seven-day average for  “new cases” has shot up from 1,000 to 10,000 per day.  The positivity rate for the State’s date of specimen testing jumped from 4.4% to over 16%. 

Conclusion

The consensus among researchers is that the delta variant is the principally to blame for COVID’s comeback.  It appears to be able to replicate in the upper respiratory track much more rapidly, not only making it more contagious but also improving its chances of overwhelming immunity previously acquired in an infection or by vaccination.  In addition, most Americans have gone back to many of their normal activities.

We also may have more susceptible individuals than many of us previously believed.  The CDC has estimated that about 110-120 million Americans had recovered from infection, acquiring some degree of natural immunity in the process.  That number, when added to the number of Americans fully vaccinated, comes to about 80% of the total population.

However, a recent study has estimated that the number of COVID infections is significantly lower.  These researchers concluded that only about 65 million Americans had recovered from COVID as of early March. I am a little skeptical of their conclusion but if they are right,  we may have as few as 60% of the population with some immunity.  That means there could be as many as 140 million Americans still susceptible to COVID. 

There has been a lot of media attention on breakthrough infections - people getting COVID a second time or after being vaccinated.  We always knew that the vaccines effectiveness in preventing an infection was in the 70-95% range.  And because vaccines essentially mimic natural immunity, it is a reasonable guess that it has a similar reliability.  At, say, 90%, with 165 million Americans fully vaccinated and perhaps another 100 million with natural immunity, that is potential for 26 million breakthrough infections.  We have not seen anywhere near that kind of number yet.  Nonetheless, you can see from the numbers even a small percentage of breakthrough infections can make a significant contribution to a rise in cases.

The good news is that the vaccines continue to be very effective at preventing serious COVID cases.   According to a Kaiser Foundation study, there have been less than 1,000 COVID related deaths in people who have been vaccinated and virtually all had serious comorbidities.  That is less than .5% of the COVID related deaths since February 1. That study and numerous surveys have found that well over 90% of those hospitalized with COVID have not been vaccinated.  Hopefully, that is why we are seeing the disconnect between cases and hospitalizations from fatalities that many of us have been expecting.  Of course, fatalities trail cases and hospitalizations, so we may yet see a more dramatic increase, especially considering that about 10 million seniors have not been vaccinated.

The United Kingdom’s recent experience may provide some hope that we will see this wave peak soon.  The UK is about 10% ahead of us on vaccines and saw the delta variant a few weeks before we got it.  After a similar surge in cases, they began to see a decline a couple of weeks ago.  Also, Canada and Israel, which are also ahead of us on vaccines, have experienced much milder increases.  Hopefully, as we see the immunity rate creep up with more vaccinations and more recoveries, we will see our wave top out as well.

I am going to post on the numbers again in about week to let you know if we are beginning to see any hint of that in the data.