Let’s run through some questions and answers to parse out where we are with the virus and where we may be headed…
1) Is the prevalence of the virus rising or falling?
In the US as a whole, it is rising.
We are moving past the data interruptions from Thanksgiving and new cases continue to hit new highs, averaging 177,848 per day over the past week.
Regionally, new cases hit new highs in the Northeast, South, and West while the Midwest (hardest hit during the current wave) is showing some signs of improvement.
Here’s a per capita breakdown of new cases by State…
2) Are new cases rising only because we are testing more?
We know this this is true for a number of reasons:
a) Percent Positive: the percentage of positive tests is rising, currently at 11.3%. If more testing was the sole reason for more cases we would see the percentage of positive tests stay flat or move down with more testing.
Instead, 11.3% is the highest percentage positive we’ve seen in the US since May 4.
b) Hospitalizations in the US continue to hit new highs (101,276), up 13% in the past week and 94% in the past month.
Looking at the breakdown by region, we see the West is at new hospitalization highs, the South is approaching its highs from the summer, and the Northeast is moving sharply higher. The Midwest peaked on December 1 and has moved down slightly over the last few days.
Most states (38) are seeing rising hospitalizations over the last 2 weeks…
Here are the hospitalization trends in the most populous US States…
c) Deaths in the US average 1,951 per day in the last week, the highest since April 23. With hospitalizations still rising, it now seems likely that we’ll surpass the prior highs from April (2,067/day).
Deaths are rising in all US regions…
3) Can we adjust case levels over time for changes in testing rates in order to get a more accurate picture of the prevalence of the virus over time?
This is not an easy endeavor but I’ve attempted to do so with a simple methodology in the chart below. What is shows is that covid-19 is likely at its most widespread level today in the US as a whole, higher than it was at the peak back in April.
4) What impact will Thanksgiving have on the virus?
It is still too early to tell, but given what we know about the virus and how easily it can spread, we are likely to see an increase (this was the busiest travel week since March with many household gatherings).
Before Thanksgiving, the US was lagging the trend in Europe in the current wave by about a month. With many countries in Europe trending lower few a few weeks, we could have seen a peak in the virus by mid-December.
With Thanksgiving, this trajectory may be pushed out, but hopefully we won’t see another spike higher in the coming weeks.
5) What impact will the vaccines have on the virus?
With the Pfizer and Moderna vaccines showing around 95% effectiveness, they will have an enormous impact, hopefully bringing an end to the virus at some point in 2021.
But it will take some time for the vaccines to be approved and distributed.
The FDA is set to meet next week (Dec 10) to discuss the emergency use authorization for Pfizer and the week after that (Dec 17) to discuss Moderna.
The chief scientific advisor for Operation Warp Speed (Moncef Slauoui) said the following…
“Our plan is to be able to ship vaccines to the immunization sites within 24 hours from the approval, so I would expect maybe on day two after approval on the 11th or the 12th of December.” – Moncef Slauoui
Slauoui believes that “about 20 million people” in the US could be immunized in the month of December.
The vaccines require 2 doses (3 weeks apart for Pfizer, 4 weeks apart for Moderna) to be fully effective.
6) Who will receive the vaccine first?
The CDC is recommending the following prioritization for distribution in phase 1:
The very first to get the vaccine will be the groups most at risk, including heath care personnel and Long-Term care facility residents.
The sooner we vaccinate those in long-term care facilities, the more lives we will save, as 40% of the recorded deaths in the US have come from these facilities.
Children will be the last group to be vaccinated as we need more studies on kids and they have the lowest risk of serious illness or death.
7) When will herd immunity be achieved?
That will depend on many factors, including the speed of manufacturing, distribution, and the willingness of Americans to take a vaccine.
But Slaoui estimates that 70% of the population could be immunized somewhere in the month of May 2021.
A few months ago, that projection would have seemed impossible. But through human grit and ingenuity, we have seen a modern-day miracle.
There’s finally a light at the end of the tunnel, and it’s a bright at that. But the virus is not over yet (as the charts above illustrate) and we must all do our best to protect the most vulnerable in the coming weeks and months as we approach herd immunity.
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