The COVID Digest, 20Aug2021

Tracking the numbers in Georgia

Last week I said that things continued to deteriorate in Georgia and across the South. This week, it’s more of the same. It is a frustrating place to be, as the state seems to say “hold my beer” against a virus that is happy to take advantage of relaxed attitudes about the virus and poor leadership that divides the population into those who will be protected against disease and those who will be fed to its wrath. Leaders are gambling with people’s lives and it is not okay. It has never worked for leaders to control disease by asking people to do the “right thing.” And that’s because the public health is not the same thing as individual health. We are in a tug-of-war against the virus and we desperately need all of us to be pulling on Team Humanity’s side of the rope, rather than pulling on the side of the virus or unaware that there is a rope to be pulled at all.

The weekly totals for cases (left y-axis), hospitalizations, ICU admissions and deaths are graphed below. This week we saw…

• Cases rose 32.3%

• Hospital admissions rose 25.1%

• ICU admissions decreased by 12.2%

• Deaths rose 21.5%

As has happened in every surge so far, deaths rise on a delay following the case and hospitalization surge.

Testing volume (blue line) has increased dramatically over the past month for both PCR (left) and antigen tests (right).

High test positivity is an indication that you’re not doing enough testing. So as the testing volume has increased, we are starting to see that test positivity for both test methods is starting to level off. Ideally, further increases in test volume will turn test positivity back downward.

Let’s move on to cases. Both of the graphs below show 7-day case rate adjusted for population for different county types in Georgia. The left graph shows the entire history of the pandemic. The graph on the right shows recent history.

Rural counties have surpassed their previous maximum and the statewide number is not far behind. If we look at the more recent graph, we can see that whereas case rates are rising most in non-Atlanta metro counties, they are either leveling off (Atlanta counties of Fulton and DeKalb) or rising at a slower rate (Atlanta suburbs). This phenomenon of two Georgia pandemics can possibly be attributed to a combination of factors: Atlanta metro has higher vaccination rates, there are different leadership and public health measures, as well as education levels and political leanings that contribute to public attitudes about the virus.

In addition to looking at cases by county type, we can also look at them by age group. The graph below shows the weekly PCR case totals for each age group over the past 8 weeks. The state does not provide demographic data for antigen cases.

Almost all age groups continue to see cases rise. But things have leveled off for those 80+. Interestingly, this is the first time ever that 18-29 year olds have ceded the top spot for new cases. Instead, 10-17 year olds (middle and high school students) are the largest source of cases this week, with cases nearly doubling over the past week.

But as intense as that appears for 10-17 year olds in Georgia, test positivity from Georgia and the top 10 states for new case rate shows us that these states have no idea how intense disease is for this age group. The goal is to be at or below 5%. The higher you are above 5%, the more cases you’re missing. And test positivity is consistently highest for K-12 aged children.

Infections in children are worrisome, for their own health but also for the families and schools to which they belong. Their infections don’t stop with them, but spread to their classmates, teachers and families. We must do more to limit disease transmission among this age group - for their health and for everyone else too. As adolescents and teens take the lead on driving infections, we may need to take a more serious look at whether it makes sense for schools to be open for in-person learning, especially in school districts that do not have a vaccine or mask requirement.

Cases feed hospitalizations and Georgia is back above 5000 patients currently hospitalized for COVID-19 illness. The state will likely surpass the previous maximum by the end of next week. The trend doesn’t show any signs of slowing down. Meanwhile, hospital leaders are begging Georgians to stop transmitting disease to avert hospital system collapse.

If we look beyond the state data into regional numbers, we can see that the situation is even worse for many areas. In hospital region M, over half the patients are there due to COVID-19 and the ICU is maxed beyond capacity. Regions C and E are nearly out of ICU beds also.

The graph below shows us how this week’s hospitalizations are distributed by age group and how they compare to the past 7 weeks. Again, we see a rise for all age groups.

Cases and hospitalizations lead to deaths, often on a delay because people don’t die right away. Georgia has seen the statewide 7-day death rate rise by 166% since 07Jul, the pre-surge baseline for deaths. Similar to previous surges, the death rate is highest in rural counties. The graph on the right shows the cumulative death rate adjusted for population since the start of the pandemic.

It’s past 7:00 pm eastern standard time and the Georgia Department of Public Health has not yet posted the school-aged surveillance data report for this week. When these reports are late, I suspect that the data show an ever-worsening situation and they are double checking their counts and calculations to make sure things really are *that bad.*

The virus has taken so much from us - loved ones and friends, moments and milestones. But we don't have to keep being victims here, passive to these surges. We don't have to keep letting the virus take what it wants from us. Please get vaccinated and mask up. More people are getting vaccinated every day and I want to congratulate and thank these folks for doing their part. But there is still work to do to protect our communities. If we don’t slow this case growth down, I think Southern states risk regional healthcare system collapse.

Hold your leaders accountable who are making poor public health policy. States and schools where leaders have abdicated the responsibility to govern and lead have forfeited the war against COVID-19. In some states, the governors are actively pulling on the coronavirus side of the tug of war rope, unbothered by how many of their own citizens (and especially their own voters) are dying. It does not have to be this way, but this is where things are. The best goal we can hope to accomplish now is to limit the casualties. We do that by avoiding getting sick in the first place and protecting everyone we can. Make good choices and take care of yourselves, your families and your neighbors.

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My Ph.D. is in Medical Microbiology and Immunology and I am Chair of the Division of Natural Sciences and Mathematics at the University of Saint Mary. I've worked at places like Creighton University, the Centers for Disease Control & Prevention and Mercer University School of Medicine. All thoughts are my professional opinion, do not represent the views or opinions of my employer and should not be considered medical advice.