Why COVID-19 is Overrunning the US in Late 2020: Overlapping Epicurves

Data in simulated epicurves show frequencies and explain outbreak timing

Many countries have gotten the COVID-19 pandemic under control, but not my beloved country, the United States. We know many reasons for this, including – as I will cover in this blog post – overlapping epicurves. Sadly, even though we have a pretty good public education system, and we have close to 100% literacy and many people with college degrees, somehow, a good chunk of the US still thinks COVID-19 is not real, and rejects the science. A lot of these people are in areas with rickety or sparse health systems, and therefore, a lot of those exact people and their families will meet a morbid or mortal COVID-19 fate. It is largely a crisis of knowledge.

A Pied Piper Plays a Soothing but Deadly Tune

This tragic circumstance got this way due to a certain social engineering orchestrated by US leaders. A Pied Piper played a tune that said that even though a lot of us out there got good grades in biology, chemistry, and physics classes, we should suddenly believe that science isn’t real. Many Americans resisted the melody, but others, perhaps in an emotional state, found it soothing. Throughout 2020, those who caught the tune blissfully floated along to the notes of the song, arguing with everyone who did not enjoy the music. They continue to do this, until one day, they realize there is no longer ground under them.

In the meantime, they act as superspreaders.

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The Problem Isn’t One Epicurve, it’s Overlapping Epicurves

First, let’s make sure we know what an epicurve is. It’s a visualization that helps us understand the pace of outbreak spread. I’ll put one here from a really nice CDC tutorial you should go through to better understand epicurves.

The data in the epicurve is from the population and includes frequencies

As you can see, in this CDC tutorial example, we are talking about an outbreak with a longer incubation period, meaning it takes longer between the time of infection when you can test positive for the disease (“seroconversion”) and time symptoms show. When we see symptoms, we say the disease “becomes clinical”, because it means you have to throw healthcare resources at it.

How you can tell that this example is about a disease with a longer incubation period that is that the x-axis is listed in months, not days. In COVID-19, the incubation period is as long as 14 days, with the median being 4 to 5 days, so for a COVID-19 epicurve, it’s better to use days on the x-axis. But the reality is that with some diseases, including COVID-19, you can seroconvert but not get any symptoms. So then you are infectious, but have no symptoms, so we might not think to test you, and even put you on the epicurve diagram.

So if we are not testing you, and you are not on the diagram, and you are not in the ICU, you are probably out there superspreading, especially if you are a member of the part of America following the Pied Piper’s tune. On the y-axis, we have the frequency of cases diagnosed each day. You can see in the tutorial example how it starts with under 50 in February and March, then explodes in May and June, climbing up to almost 450 cases in June. But then we have a happy ending, when it peters out by October. This assumes that we get community spread under control sometime in May and June, and keep it that way until it fades away.

How the Superspreaders and US Holidays Cause Overlapping Epicurves

Using a modified version of the epicurve shape from the CDC, I created a simulation of how the Pied Piper’s tune, US holidays, and these epicurves work together in COVID-19 to effectively overlap, keeping the background prevalence so high it continuously overruns our local healthcare systems here in the good ol’ US.

Data in simulated epicurves show frequencies and explain outbreak timing

Let’s start at the left side and unpack this diagram of doom. I start with a white epicurve indicating high background prevalence that was already happening on Thanksgiving, November 26. On Thanksgiving, we normally celebrate the genocide of Native Americans and the founding of the new world order through meeting together and eating slain animals (I avoid participation for obvious reasons). The leaders aligned with the Pied Piper’s message encouraged these gatherings, much to the chagrin of US scientists like myself, so they occurred this year even though they should not have.

Continuing on left-to-right on the x-axis, we see that because the background prevalence was already out-of-control before Thanksgiving, now on November 30, we have the infections that started before Thanksgiving becoming clinical. But then we have the Thanksgiving spike around December 3 (I’m just guessing at these dates given the widely individually-varying incubation periods). Now you can see how we can get overlapping epicurves.

When a person becomes clinical, they tend to hyper-expose others simply because they need to use healthcare. A person bedridden at home is not exposing as many people as someone being transferred to the ICU. So just becoming clinical and needing healthcare resources can cause an explosion of exposure in the community. This can lead to secondary infections – see December 10 on the diagram, where that batch of secondary infections become clinical.

Merry Christmas! Can We Please Stop These Overlapping Epicurves?

And the train just won’t stop. The Pied Piper is still playing the same tune. Just look at the diagram where I simulate what I expect for Christmas, and then the following secondary infections. What’s really heartbreaking is that we have vaccines, and if these infections would just stop and we could flatten these curves (remember when we used to talk about that in the US?), a lot of these people would survive to get the vaccine, and then survive – like, survive, period. Like, not die.

So what is the answer? How do scientists convince the people listening to US leaders singing the Pied Piper’s tune, leading them (and the rest of us, through community spread) to morbidity and mortality?

That has been a long-asked public health question about a lot of diseases and the misinformation that goes with them. We do not have a good answer, but here is my best advice:

  1. Do NOT insult the people who are following the fatal tune. Remember, many of these people are highly educated or have real lived experience that they are actively ignoring to believe such garbage. So that means that they are really hurting. This is how smart people are lured into cults – it means they are really hurting. Give them compassion.
  2. DO remind these people of the facts. This can be done in a calm way without argumentation. In the US, when asked by journalists, our top coronavirus doctor Dr. Anthony Fauci often responded saying that it was not useful for him to contradict leaders, and instead, he just wanted to be a firehose of facts, and keep saying the facts over and over, and hoping people would listen.

I would also suggest that we do not guilt trip these people, even though in reality, they have had a hand in murdering a lot of people by ignoring the science. I know they should feel guilty, but I think they will do that naturally, once they come around, and we really do not need to help them descend into that depressing place.

Updated December 18, 2020. Epicurve from tutorial by the United States Centers for Disease Control and Prevention, available here. Painting of the Pied Piper by Agapishe, available here.

While other countries have found a way to control their community spread of COVID-19 while waiting for the vaccine program to be implemented, the United States has totally failed at this. An epicurve is a diagram of the timing of an outbreak, and in other countries, this curve has been flattened. But in the United States in this holiday season of November through January, we are seeing overlapping epicurves, which I explain in this blog post.

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