The Rise in COVID-19 Cases Explained

Rachel del Guidice /

Dr. Kevin Pham, a contributor to The Daily Signal and a former graduate fellow in health policy at The Heritage Foundation, joins the podcast to discuss the rise in cases, if wearing a mask really helps, if it’s true—as The New York Times says—that the coronavirus “has infiltrated Sunday services,” with “more than 650 cases … linked to reopened religious facilities,” and more.

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Rachel del Guidice: I’m joined today on the Daily Signal Podcast by Dr. Kevin Pham. He’s a medical doctor who is a contributor at The Daily Signal and a former graduate fellow in health policy at The Heritage Foundation. Dr. Pham, it’s great to have you on The Daily Signal Podcast.

Kevin Pham: Thanks so much for having me.

Del Guidice: To start off, with the coronavirus pandemic we’re seeing very different things happen in the U.S.; some states are doing quite well while others are struggling. What do you see is going on here?

Pham: The number of cases in the country has started to not just rise, but it’s starting to surge. And that is definitely concerning. It’s something that we should pay attention to.

It’s not something that we can just laugh off or brush off as if it was nothing because even though the number of cases seems to be predominantly in the younger age groups now, a low risk does not mean no risk. So anybody who gets this virus, they may eventually get some of the more severe disease manifestations. And as we’ve seen, that can be pretty crippling.

That having been said, we also need to consider that this is the lower risk group that seems to be making up the bulk of these new cases, and so we have the temper our concern with the knowledge that people who are getting it now seem to be more resilient to getting the more severe disease manifestations; they should be able to weather it a lot better. So it’s sort of a mixed picture that we’re looking at right now.

Our control of the pandemic is breaking down right now, just because all these cases are coming up. However, our ability to withstand it, where we seem to be protecting the people who need to be protected more, and the people who are able to withstand it are the ones who are getting it.

You know, there’s some good news and bad news with this. I don’t like that we’re getting all these new cases, but it’s not all bad news.

Del Guidice: We’ve specifically seen rising cases in Florida, Arizona, Texas, and then even in California. Why do you think these states are having particular problems?

Pham: There’s a lot of reasons for this probably, but I think the biggest reason is that these are fairly populous states and these are states where people go outside for the summer and then they come back into the air conditioned areas.

So they go out and then they go into establishments all around. In those establishments is going to be air conditioned. The air is recirculating. You’re in close proximity with other people. And then you’re going to take that, you go back home, and then you might infect someone else in your household.

The fact that it’s summer right now, it just makes it so that these states that are pretty hot, people are staying inside more often. And it’s a little bit harder to stay outdoors and away from other people. You want to get out there. You want to be with other people. Because of that, they’re sort of being a little complacent with regards to this ongoing pandemic and it is still going. And that’s sort of the gist of what’s going on.

Of course, one of the things we can’t ignore is the fact that Memorial Day happened, and then right after that, George Floyd was killed by the police, and then all these protests started happening, these things kind of mixing together, and it resulted in the month of June being just a completely abnormal month. It’s not something that we normally see.

So all these people who are out on the streets protesting and marching, they are in close proximity. And even though it was outdoors, being that close to other people for that much time, it’s going to spread the disease a lot faster than it would otherwise.

And other people, they’re seeing that public health officials were encouraging these protests, and so they’re seeing that they never really meant it when they said that, “You have to stay indoors to protect people,” if they’re encouraging people to get outdoors and start protesting.

And so when they see this, they’re saying, “Well, if people can do that, then I’m just going to go to the bar.” And the bars are, frankly, one of the worst places to go if you’re trying to control disease. And that includes COVID-19, not just the other diseases you tend to find at bars. And so all of these things put together just created a storm of new cases that we’re seeing right now.

Del Guidice: With these rising cases, are they mostly younger adults or people of all ages?

Pham: It seems to be it’s mostly with the younger adults. And that seems to be consistent for Florida, Texas, and California, and Arizona. The majority of these new cases are in the group that’s probably between 20 and 40 years old.

Different states measure the statistics differently, they break down the age groups differently, but predominantly it’s under, let’s just say under 50 years old. Whereas the portion of hospitalizations continues to be in the people who are 55 or 65 and older.

And so again, that tells me that we’re spending a lot more time protecting the people who need to be protected. There’s a lot of lessons learned.

So people who are trying to avoid the disease, they are doing a pretty good job avoiding it. The people who are a little bit more resilient are getting too complacent and they’re putting themselves in the path of the virus, which is not a good thing, obviously, but they are going to be able to better get out of this if they do catch the virus.

Del Guidice: CBS had reported on Wednesday that in 22 states, hospitalizations are rising significantly. And what do you think are the different factors here why we’re seeing this, as you mentioned, is it due to more just people getting complacent or are there other factors at play?

Pham: I think the biggest issue, the lowest common denominator is that people are getting complacent. They’re going out to bars, or going to gyms, or packing into crowded areas. And we’ve seen pictures of packed bars and like Austin or in Los Angeles.

When you’re in a bar, you’re shouting orders at the bartender, you’re very close to other people, no one’s wearing a mask because you’re trying to drink at the same time. And you’re just spreading out all these aerosols and all these respiratory droplets in an area that’s very tight, and that’s sort of a microcosm for what’s happening on a broader scale.

We have done very well as a country in mitigating the spread of this disease. If you look at the curves, when we talk about finding the curves, we didn’t just find it; we sliced the top off of it since April, and that was really encouraging, I think, because of that, because we were doing so well, that Americans started thinking that we were out of the woods, … we had gotten off.

But there’s no free pass in this and … I think what we’re dealing with is in large part … cases that didn’t happen before are happening now, and so that’s kind of why we’re getting this exponential curve right now. Essentially, I think that’s what’s happening.

Del Guidice: The New York Times, they recently had a piece out this week saying that coronavirus has infiltrated Sunday services, church meanings, and youth camps, more than 650 cases have been linked to reopened religious facilities. Do you think that this is a fair representation of what’s happening?

Pham: No, because 650 cases would be a lot if it’s in one small city, but if we’re talking about New York City, 650 cases is not very much when they were racking up several hundred a day at the peak of the pandemic. In fact, it may be up to several thousand a day at the peak of the pandemic in New York City.

But this is not just New York City, this was 650 over the entire country. And that’s a very small number considering we have, I forget what the latest numbers is, but 650 is essentially statistically zero with regards to the number of cases in the country right now.

That’s not a very good representation of what Sunday church services are responsible for because there’s so many other things that are probably responsible for everything else. And so it doesn’t really tell us much.

And youth camps, I didn’t see where they said that, but youth camps are attended by people of the lowest risk groups and are watched over by people of the slightly less low risk group.

So even if they do get coronavirus or the COVID-19, they’re most likely going to be fine going through this. So even though there may be some spread and a lot of the new evidence now shows that school-aged children are the least likely to even contract this viral, much less spread it, so even if you’re getting cases that show up in these youth camps, I think it’s still safe to open them up again. It’s a huge factor for families, family planning during the summer, family activities, and stuff like that. It’s something that we can do relatively safely.

Del Guidice: … In the past few months, as more data has come in, as different people in the medical field—doctors, nurses, other caretakers—study this disease, what would you say has been learned in the past couple months?

Pham: In the past couple of months, the biggest thing that we have sort of changed our perspective on the paradigms on is, when this first started spreading out of China, the initial report said, “Avoid anti-inflammatory treatments and ventilate patients aggressively and early.” And what we found out is that is exactly the wrong thing to do. The thing that seems to be killing the younger people is the inflammatory patients.

When you get what’s called the cytokine storm, the body starts dumping all of these signals into the body that causes an enormous inflammatory response. And that’s what’s doing the damage.

So it’s not the direct action of the virus that we’re dealing with; it’s the body’s overall response to the virus that seems to be doing all this damage. And if you avoid anti-inflammatory treatment for inflammatory process, then you’re not going to be treating what’s actually doing the damage.

And if you’re ventilating patients early, just as they’re beginning to develop this inflammatory response … ventilating is not a very benign process; it exacerbates any kind of inflammatory response, and it creates its own inflammatory response. So what we’re doing is not treating the thing that was doing the damage, and we were doubling down on what was causing the damage.

So it’s a really unfortunate situation, but probably a lot of the mortality early on was due to doctors ventilating the patients way too early and avoiding the anti-inflammatory.

What we’re seeing now is that, if we’re starting to see that process begin to happen and it’s best to treat them with what … I had written about Dr. [Thomas] Yadegar, he was using tocilizumab, which is a newer drug, but there’s also the much older drug dexamethasone, which has been in the news too. It’s very cheap, it’s a steroid, a lot of people have used it before.

What steroids do is, it just blankets the inflammation, and then tones it down quite a bit. And so that’s been having a huge impact on mortality, and I think that knowledge has spread throughout the medical community and that’s really changed the way we treat this thing.

Del Guidice: Something that has been a point of contention between a lot of different people is mask mandates, is it effective to wear a mask? What would you say as a doctor? Is mask-wearing effective or not?

Pham: Yes, it is. And there’s a lot of the people who are against mask-wearing. They cite the fact that there’s not a lot of direct evidence showing that wearing a mask prevents transmission of COVID-19. Well, that’s because there’s not a lot of research being done on it. It’s a lot of clinical knowledge. Surgeons wear masks in the OR to prevent them spreading their respiratory droplets onto the patient.

It’s not about protecting yourself from viruses; it’s very counterintuitive the way masks work with regards to COVID-19. It doesn’t protect the person wearing the mask. It protects everyone around the person wearing the mask. And so you’re not trying to stop virus from coming in; you’re trying to prevent viruses from going out.

And then, cloth masks don’t stop everything, but what we’re trying to do is slow down the spread of the respiratory spray in front of you. If you have nothing in front of your face, you can spray pretty far, pretty wide, but you have some kind of mass covering, some kind of fabric covering, even if it doesn’t stop everything, it’s going to slow down that spread.

So that 6-feet distance that we have in front of you, it might reduce down to 3 feet, or 2 feet, or 1 foot—depends on what happens. Obviously, if you sneeze inside of your mask, you’re going to shoot it a little bit further, but regardless, we’re trying to slow it down, we’re trying to reduce the spread and spray. And that’s kind of the working mechanism of it.

Now, with regards to mandates, I don’t find that mandates are necessary because public health in America has taken quite a beating with regards to credibility. And when you have a blanket mandate, you’re going to end up mandating people to wear masks when they’re out for a walk or in their cars or something like that. And that’s not helpful at all. It doesn’t do anything.

Masks are mostly effective, again, if you’re trying to prevent transmission from one person to the next person, that is going to be most effective when you’re in close proximity to other people and you can’t avoid close distances. So this is inside of a grocery store or at a movie theater or something like that. If you’re in tight proximity, then you can’t avoid that, then wearing a mask is going to be most effective.

Del Guidice: With the increase of cases that we have been talking about, could this increase in the long run, possibly be helpful for herd immunity long term?

Pham: It might be helpful. If we assume that a vaccine will never come, then this surge of new cases is going to accelerate the herd immunity, but we should not want people to get this disease.

As I said, the risk might be low for younger people, but the risk is not zero for younger people. A 1% risk of just hospitalization, that’s still going to be a lot of people because we have a lot of people in this country, we have 330 million people in this country, 1% of that is quite a big number.

So we should continue to try to prevent cases from happening. It would be much better to get a vaccine first. And there are several, I think there’s almost a hundred trials right now. So it would be better for us to try to hold out for that than to actively try to spread this disease around because that’s not helpful either.

Del Guidice: Many international countries claim to have largely gotten rid of COVID-19, or at least have it under pretty good control. Does this show that the United States approached it wrong? And are there any lessons we could learn from other countries?

Pham: In a lot of other countries, the virus has gotten much further as a proportion of their population than it has here. And we’re starting to catch up to that with all these new cases.

If there’s anything to learn, I think a lot of the European countries have begun to reopen things a little bit sooner, and a lot of them are reopening their schools, which is something that we should absolutely do. I know the president talked about this recently.

Schools are full of school-aged children, obviously, who are at the lowest risk of getting it and of transmitting it. And we should be able to open schools up safely doing that. And once we do that, I think that’ll help us mitigate the fear of this virus, which is something that’s having a large detrimental effect on the country.

I think we’re dealing with, I don’t want to call it a psychosis, but we are dealing with a sort of a generalized fears, generalized anxiety that’s spreading through the country, and that’s not helpful either.

So the one thing I think we can learn from the Europeans with regards to COVID-19 is to sort of take this, not in stride, but to take it with a holistic picture of, the grander picture of what’s going to happen, that at some point, we’re going to need to live with this thing.

Del Guidice: As a follow-up, the European Union is saying that the U.S. can’t visit because they’re not sure that we have COVID under control and they do. And should we be jealous of the EU, or are there problems with how they’ve handled it, where maybe we have excelled?

Pham: I don’t think we should ever feel jealous of the European Union, but I think it’s entirely appropriate for them to restrict travel from the United States. It is very clear that we are not controlling the spread of the disease right now, so if they’re looking at us and seeing that we’re having a huge number of new cases, I think it’s appropriate for them to say that we shouldn’t expect travel from the United States into the EU.

I mean, if we reverse the situations, if the EU was still in this situation back in April and March, then I think it would have been appropriate for us to restrict travel from there. I think that we did not restrict travel from Italy soon enough. If we had, we would have saved, I think, a lot of cases along the East Coast.

No, I think it’s entirely appropriate for them to do so. And I think it’s helpful in the long run too, because if they start dealing with outbreaks that come from here, those outbreaks over there [are] eventually going to come back to here, if we got it under control.

So, pandemic control is a national issue, it’s a local issue, and it’s also an international issue. Every single level is involved with this thing. And I think it’s an entirely appropriate response, on their end.

Del Guidice: As we wrap up, do you have any predictions about what will happen in the next few months regarding how we handle COVID-19?

Pham: I think that the states that are slowing down the reopening, halting the reopening process, and rolling back some of the reopening process, I think that’s going to spread through more states in the country. But as that happens and the surge starts to taper off, then it will start to relax these mitigation efforts again. And I think all of that is extremely appropriate.

All of this is part of a robust reopening strategy that we’ve always had. There was always going to be the possibility that we’d have to roll something back. And the fact that these states are doing it, and doing it in response to real-world data that’s happening right now, I think that’s a really good sign that shows us that we know what to do if things get bad. We know what to do if things start getting better. And I think late summer, we’ll start to reopen things again.

What I’m worried about is come fall, when the second wave may or may not hit, it’s going to be when people start going back into their homes and staying inside more, and that could increase the household spread of this disease. We might see another surge in cases, but again, because of lessons learned, we’re protecting the people who need to be most protected.

I think mask-wearing is starting to get a little bit more purchase in the community. And as that happens, it will sort of blunt any effect of a second wave. I think we’ll get out of this year looking a little worse for the wear, but I think we’ll be able to get out of 2020 OK.

Del Guidice: Dr. Kevin Pham, thank you so much for joining us today on The Daily Signal Podcast, it’s great to have you.

Pham: Great to be here.

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