UnitedStatesofAmerica CURRENT SITUATION · UnitedStatesofAmerica CURRENT SITUATION Figure4. Meaneﬀective R on 2020-07-23.Theestimateof eﬀectiveR is basedon thecombinedanalysis

IHME’s latest COVID-19 forecasts indicate that the US will reach nearly 300,000 deaths by December 1,

2020. If mask wearing in public increases to 95%, more than 66,000 lives could be saved.

Other major findings include:

1. Infections decreasing in some hot spots: Florida, Texas, California, and Arizona have brought

effective R below 1. Cases and hospitalizations have peaked but deaths are still rising. We expect

deaths to rise for another week and then level off. The peaking of transmission in these states

appears to be driven by the combination of local mandates for mask use and bar and restaurant

closures, along with more cautious behaviors from the public. Media reports of increasing case

numbers and deaths seems to be associated with more cautious behavior by the individuals in these

communities in response to these trends. This will be an important mechanism throughout the

coming year and will likely lead to oscillations in the epidemic in various states.

2. New hot spots: Based on cases, hospitalizations, and deaths, transmission of COVID-19 is increasing

in 11 states: Colorado, Idaho, Kansas, Kentucky, Mississippi, Missouri, Ohio, Oklahoma, Oregon,

Virginia, and Wisconsin. These states may experience increasing cases for several weeks. We hope

to see a behavioral response toward more cautious behavior in these states soon.

3. Mask use increasing thanks to mandates, penalties, and messaging: Since July 15, 12 states have

added mask mandates. Our statistical analysis of mask mandates suggests that a mandate with no

penalties is associated with an 8 percentage point increase of mask use, and a mandate with

penalties is associated with a 15 percentage point increase. These efforts and public information

have led to an increase in the US rate of mask wearing by about 5 percentage points since mid-July.

Mask wearing increases have been larger in states with larger epidemics.

4. Test, trace, and isolate likely no longer feasible in many states: The population protective effect of

testing, which is meant to capture the impact of a test, contact trace, and isolate strategy is

estimated in the model by examining the relationship between testing per capita and effective R.

The strength of this relationship is getting weaker over time. In settings with large-scale

transmission, test, trace, and isolate strategies are likely infeasible because of the huge volume of

contacts. These strategies are likely more important in settings where other measures such as mask

wearing or mandates have reduced transmission to quite low levels.

5. Transmission likely to increase in winter months: Our estimate of the effect of seasonality remains

large, implying that we should expect to see a substantial increase in transmission, all other things

being held equal, in the winter months. The large number of forecasted deaths that we estimate in

the month of November in the reference scenario, nearly 45,000 deaths in one month, is driven

substantially by this seasonal increase in transmission potential along with an assumption of further

relaxation of mandates.

6. 23 states likely need to re-impose mandates before December 1: In our model, we assume that

states will re-impose a package of mandates including non-essential business closures and stay-at-

home orders when the daily death rate reaches 8 per million. This threshold is based on the 90th

percentile of when states/locations imposed mandates in March and April. This threshold implies

that many states will have to reimpose mandates. If they do not, the number of infections and

United States of America CURRENT SITUATION

covid19.healthdata.org Institute for Health Metrics and Evaluation

deaths can be much higher, and this is captured by our mandates easing scenario. More specifically,

our model suggests that the following states will be at the point where they will need to reconsider

re-imposing mandates:

a. August: Arizona, Florida, Mississippi, South Carolina

b. September: Georgia, Texas

c. October: Colorado, Kansas, Louisiana, Missouri, Nevada, North Carolina, Oregon

d. November: Alabama, Arkansas, California, Iowa, New Mexico, Ohio, Oklahoma, Utah,

Washington, and Wisconsin.

If mask use is increased to 95%, the re-imposition of stricter mandates can be delayed 6-8 weeks on

average.

7. We may be over-estimating the impact of schools re-opening on transmission: We currently

assume that 50% of school districts in each state will opt for online instruction only. As data emerge

on actual decisions, we will incorporate this into future revisions of our model. We also assume the

impact of school re-openings on mobility will be of the same magnitude as the impact of school

closures in March, but in the opposite direction. Given mask use, likely restrictions on after-school

activities, and avoidance of social engagement related to schools by some parents, our estimated

impact of school openings may be overly pessimistic.

8. Lack of data sharing by the US government hampers our research: Our understanding of the drivers

of the pandemic beyond mask use, mobility, testing, and seasonality is hampered by the lack of

access to data. US CDC has many relevant datasets on the pandemic that they have refused to share

with the research community. The switch of data reporting from US CDC to the US HHS has had little

impact on our models since neither group is sharing much of their data with the research

community. Some data that are critical to monitoring the response to the pandemic, such as mask

use, are only collected through private-sector initiatives such as surveys conducted by Facebook,

Premise, and SurveyMonkey. Federal government efforts to fill these critical data gaps have been

limited to date.

Figures related to these findings may be found here. The new death projections and other information, such

as hospital resources usage, are available at https://covid19.healthdata.org.


covid19.healthdata.org Institute for Health Metrics and Evaluation

https://covid19.healthdata.org/


COVID-19 Results Briefing: United States of America

Institute for Health Metrics & Evaluation (IHME)

07 August 2020

This short briefing contains summary information on the latest projections from the Institute for HealthMetrics and Evaluation (IHME) model on COVID-19 in United States of America.

Current Situation

Figure 1. Reported daily COVID-19 cases

0

30000

60000

90000

Apr May Jun Jul AugMonth

Cou

nt

Daily cases

covid19.healthdata.org 1 Institute for Health Metrics and Evaluation


Figure 2. Reported daily COVID-19 deaths and smoothed trend estimate

0

1000

2000

Apr May Jun Jul Aug

Dai

ly d

eath

s

Figure 3. Estimated distribution of cumulative COVID-19 deaths by age group

0

5

10

<5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 99

Age group

Sha

re o

f cum

ulat

ive

deat

hs, %



Figure 4. Mean effective R on 2020-07-23. The estimate of effective R is based on the combined analysis of deaths, case reporting, and hospitalizations where available. Current reported cases reflect infections 11-13 days prior so estimates of effective R can only be made for the recent past. Effective R less than 1 means that transmission should decline all other things being held the same.

<0.87

0.87−0.92

0.92−0.94

0.94−0.96

0.96−1

1−1.02

1.02−1.03

1.03−1.05

1.05−1.08

>1.08

No data

Figure 5. Estimated percent infected with COVID-19 on August 03, 2020

<4

4−6

6−8

8−10

10−12

12−14

14−16

16−18

18−20

>20

No data



Figure 6. Percent of COVID-19 infections detected. This is estimated as the ratio of reported COVID-19cases to estimated COVID-19 infections based on the SEIR model.

0

10

20

30

Mar May Jul

Per

cent

of i

nfec

tions

det

ecte

d

Italy Republic of Korea United Kingdom United States of America

Figure 7. Daily COVID-19 death rate per 1 million on August 03, 2020

<1

1 to 2

2 to 3

3 to 4

4 to 5

5 to 6

6 to 7

7 to 8

>8

No data


United States of America CRITICAL DRIVERS

Critical Drivers

Table 1. Current mandate implementation

All

gath

erin

gs r

esric

ted

All

none

ssen

tial b

usin

esse

s cl

osed

Any

bus

ines

ses

rest

ricte

d

Sch

ool c

losu

re

Sta

y ho

me

orde

r

Trav

el li

mits

WyomingWisconsin

West VirginiaWashington

VirginiaVermont

UtahTexas

TennesseeSouth Dakota

South CarolinaRhode IslandPennsylvania

OregonOklahoma

OhioNorth Dakota

North CarolinaNew York

New MexicoNew Jersey

New HampshireNevada

NebraskaMontanaMissouri

MississippiMinnesota

MichiganMassachusetts

MarylandMaine

LouisianaKentucky

KansasIowa

IndianaIllinoisIdaho

HawaiiGeorgiaFlorida

District of ColumbiaDelaware

ConnecticutColoradoCaliforniaArkansas

ArizonaAlaska

Alabama

Mandate in place No mandate



Figure 8. Total number of mandates

WyomingWisconsin

West VirginiaWashington

VirginiaVermont

UtahTexas

TennesseeSouth Dakota

South CarolinaRhode IslandPennsylvania

OregonOklahoma

OhioNorth Dakota

North CarolinaNew York

New MexicoNew Jersey

New HampshireNevada

NebraskaMontanaMissouri

MississippiMinnesota

MichiganMassachusetts

MarylandMaine

LouisianaKentucky

KansasIowa

IndianaIllinoisIdaho

HawaiiGeorgiaFlorida

District of ColumbiaDelaware

ConnecticutColoradoCaliforniaArkansas

ArizonaAlaska

Alabama

Feb Mar Apr May Jun Jul Aug

# of mandates

0

1

2

3

4

5

6

Mandate imposition timing



Figure 9a. Trend in mobility as measured through smartphone app use compared to January 2020 baseline

−80

−60

−40

−20

0

Feb Apr Jun Aug

Per

cent

red

uctio

n fr

om a

vera

ge m

obili

ty


Figure 9b. Mobility level as measured through smartphone app use compared to January 2020 baseline(percent)

<−46

−46 to −40

−40 to −34

−34 to −28

−28 to −21

−21 to −15

−15 to −9

−9 to −3

−3 to 3

>3

No data



Figure 10a. Trend in the proportion of the population reporting always wearing a mask when leaving home

0

20

40

60

80

Feb Apr Jun Aug

Per

cent

of p

opul

atio

n


Figure 10b. Proportion of the population reporting always wearing a mask when leaving home on August 03, 2020

<34%

34 to 37%

37 to 41%

41 to 45%

45 to 49%

49 to 52%

52 to 56%

56 to 60%

60 to 64%

>64

No data



Figure 11a. Trend in COVID-19 diagnostic tests per capita

0

50

100

150

200

250

Mar May Jul

Test

per

100

,000

pop

ulat

ion


Figure 11b. COVID-19 diagnostic tests per 100,000 people on July 29, 2020

<150

150 to 210

210 to 270

270 to 330

330 to 390

390 to 440

440 to 500

500 to 560

560 to 620

>620

No data



Figure 12. Increase in the risk of death due to pneumonia on February 1 compared to August 1

<−80%

−80 to −60%

−60 to −40%

−40 to −20%

−20 to 0%

0 to 20%

20 to 40%

40 to 60%

60 to 80%

>80%

No data


United States of America PROJECTIONS AND SCENARIOS

Projections and Scenarios

Figure 13. Cumulative COVID-19 deaths until December 01, 2020, for three scenarios. The reference scenario is our forecast of what we think is most likely to happen. The mandate easing scenario is what would happen if governments continue to ease social distancing mandates. The universal mask mandate scenario is what would happen if mask use increased immediately to 95%.

0

100,000

200,000

300,000

400,000

0

500

1000

1500

Feb Apr Jun Aug Oct Dec

Cum

ulat

ive

Dea

ths

Cum

ulative deaths per 100,000

Continued SD mandate easing

Reference scenario

Universal mask use

Figure 14. Daily COVID-19 deaths until December 01, 2020, for three scenarios. The reference scenario is our forecast of what we think is most likely to happen. The mandate easing scenario is what would happen if governments continue to ease social distancing mandates. The universal mask mandate scenario is what would happen if mask use increased immediately to 95%.

0

1,000

2,000

3,000

4,000

5,000

0

5

10

15

20


Dai

ly D

eath

sD

aily deaths per 100,000


Reference scenario

Universal mask use



Figure 15. Daily COVID-19 infections until December 01, 2020, for three scenarios. The reference scenario is our forecast of what we think is most likely to happen. The mandate easing scenario is what would happen if governments continue to ease social distancing mandates. The universal mask mandate scenario is what would happen if mask use increased immediately to 95%.

0

250,000

500,000

750,000

0

1000

2000

3000


Dai

ly In

fect

ions

Daily infections per 100,000


Reference scenario

Universal mask use

Figure 16. Forecasted percent infected with COVID-19 on December 01, 2020

<4

4−6

6−8

8−10

10−12

12−14

14−16

16−18

18−20

>20

No data



Figure 17. Daily COVID-19 deaths per million forecasted on December 01, 2020, in the reference scenario

<1

1 to 2

2 to 3

3 to 4

4 to 5

5 to 6

6 to 7

7 to 8

>8

No data

Table 2. Ranking of COVID-19 among the leading causes of mortality this week, assuming uniform deathsof non-COVID causes throughout the year

Cause name Weekly deaths RankingIschemic heart disease 10,724.0 1COVID-19 7,238.4 2Tracheal, bronchus, and lung cancer 3,965.3 3Chronic obstructive pulmonary disease 3,765.9 4Stroke 3,643.4 5


UnitedStatesofAmerica CURRENT SITUATION · UnitedStatesofAmerica CURRENT SITUATION Figure4. Meaneﬀective R on 2020-07-23.Theestimateof eﬀectiveR is basedon thecombinedanalysis

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