Marking one year of COVID-19
According to the Georgia DPH data available for download each day, the first COVID-19 cases in the state of Georgia were reported on 29Feb2020, and they note that by date of symptom onset the first cases began on 01Feb2020. As we go through this month, there will be a lot of reflection of the successes and failures of the past year.
But my initial bit of reflection as I think back on the past year is how incredibly lucky we are that the virus that caused this pandemic wasn’t more contagious or more lethal than it is. As a reminder, coronaviruses are a large family of viruses that cause human disease that spans in severity from the common cold to the SARS virus that swept through Asia in 2002 - 2004 and the MERS virus that appeared in the Middle East in 2012. The MERS virus was less transmissible, but far more deadly than COVID-19. The SARS virus was as transmissible if not slightly more transmissible than COVID-19 and more fatal. For those who are unfamiliar, R0 (pronounced “arr-not”) is the basic reproduction number of the disease, or how many people one sick person is likely to infect, on average. It’s one way to compare the transmissibility of viruses or how contagious they are.
We are lucky because our state and our country clearly demonstrated that our public health infrastructure was not ready for a pandemic. There were challenges with leadership openly conflicting with public health experts that didn’t help the situation, to be sure. But decades of stripping public health budgets at the local, state and federal levels caught up to us in a big way. We also never saw public buy-in to public health guidance as leaders deferred responsibility for containing the pandemic down to individuals (a lost cause because pandemic response requires coordinated action) and the pandemic was heavily politicized. Without a clear and consistent message, people broke into factions that either saw the pandemic as a threat or saw it as a hoax.
Even now, a year and 512,000+ deaths later, many of us in public health are sounding the warnings that we are seeing signs that cases may be rebounding. Yet it is clear that the public is DONE with this pandemic. The vaccine is here and that is definitely the light at the end of the tunnel. But we are seeing governments ease up on restrictions and people relaxing their own disease prevention strategies, assuming we are closer to herd immunity than we actually are. It is nothing short of a miracle that scientists were able to identify the SARS-CoV-2 virus, sequence it and generate not just one but three safe and effective vaccines in a year. But with cases possibly rebounding, more transmissible variants emerging, and pandemic fatigue looming large, we aren’t deploying the vaccine fast enough and especially not in Georgia. So again, although we mourn more than 512,000 dead from this virus, we are lucky that it wasn’t worse. We could be talking about 2.8 million dead as of this week if it had been SARS. I say this not to discount the unimaginable suffering of those who have lost loved ones or who suffered the disease themselves. I say it to remind us that the work here is not finished and we remain a long way off from herd immunity. We weren’t ready for this pandemic, clearly. Let’s do the work to ensure we are ready for the next one.
We can see how the US (and Georgia) is doing with respect to the vaccine administration effort using the CDC’s COVID-19 Data Tracker understanding that delayed reporting can affect the numbers. However, they’ve changed the way that they report data and not really in a helpful way. You can click/hover over a state to see some of the data we used to see, but the data aren’t available in a table format for us to easily sort and determine rankings. Maybe the CDC wants to make this less of a competition or something. NPR has a very helpful resource that uses the CDC data and updates daily, and does allow us to sort and see how states compare. Nationally, 78% of the available doses have been administered, either as a first or second dose. And Georgia’s usage rate is below the national rate, at 72%. It means that Georgia has 808,694 doses of the vaccine sitting in freezers, where they save absolutely no one. There is no need to hold stockpiles of the vaccines for second doses. The supply problem has been remedied with vaccines shipped increasing weekly and states getting a 3 week heads up on what is coming so they can plan. With 800,000+ doses on hand, the issue is NOT a lack of supply and that excuse is simply that - an excuse for poor execution. It’s an issue of not efficiently matching up the dose to a person who needs it. Think about it this way, that 808,694 dose stockpile is equivalent to 7.6% of the total population in Georgia. We could be that much closer to herd immunity if we could just get the vaccine out the door. Let’s compare Georgia’s stockpile of vaccines to some of the more successful states. Four of the five states that have >10% of their population fully vaccinated (2 doses) have used 88-96% of the doses they’ve been provided. While we wait for supply to increase, it is vital that we make the most use of the vaccine we *do* have. So what are the bottlenecks and how do we fix them? The sooner we get to 70% vaccinated, the sooner economies can go back to normal. So even if saving lives weren’t a compelling enough reason, why would we want to hold back vaccine and delay the economic recovery for hard hit businesses and communities? According to CDC, 19.5% of the adult population in the US has received at least one dose. For Georgia, the number is 11.9%.
But vaccine administration isn’t Georgia’s only challenge to reaching herd immunity. At yesterday’s ACIP meeting they discussed the new Johnson and Johnson vaccine. But in one of their presentations they also brought up this survey that was done by the US Census Bureau that asked people who had not yet received a COVID-19 vaccine whether they would definitely get one once it was made available to them. Nationally, 54.5% of those who haven’t yet received a vaccine said they would definitely get one. The leader was Vermont, with 69.9%. Hey that number is pretty close to 70%, the herd immunity threshold, wink, wink. Georgia’s percentage was 44.5% and the numbers were similar across the South. Vermont is going to have a much easier time reaching herd immunity than Georgia will.
We need to start seeing a much more aggressive public messaging campaign from the state to educate the public about the safety and effectiveness of the vaccine. We need to have more outreach efforts to answer people’s questions and raise their confidence in the vaccine and the process so that they’re ready to be vaccinated when it is their turn. The responsibility for this effort can’t just fall on people like me. We need the state to put up resources and get going.
According to the New York Times Coronavirus Tracker, the SARS-CoV-2 virus that causes COVID-19 disease has sickened >114.1 million people (+2.7 million since last week) and killed at least 2,532,000 (+65,100 in the past week) worldwide as of this morning.
The US is ranked #40 in the world for average daily case rate per 100,000 people over the past 7 days (last week #38) with a rate of 20 that is equal to the rate last week. The top five countries for average daily case rate per 100,000 in the past week are Czech Republic, San Marino, Montenegro, Estonia and Malta.
For deaths, the US average daily death rate per 100,000 over the past week is 0.62 (previous week was 0.58), and we are ranked #14 in the world for this (last week we were ranked #18). So deaths increased only slightly last week, but our ranking jumped 4 spots. The top five countries for average daily death rate per 100,000 in the most recent week are Slovakia, Czech Republic, Gibraltar, Montenegro and Hungary.
The United States
The map above comes from the New York Times Coronavirus Tracker. As of this morning, there have been over 28.6 million cases (+500,000 in the past week) and 512,979 deaths in the US (+14,325 in past week). Keep in mind that both of these numbers are probably an under-count of the situation in our country. Note: Iowa stopped reporting cases by county last week which is…bizarre.
According to data from the 28Feb2021 HHS Community Profile Report (the source document for the White House Coronavirus Task Force reports), the top five states in the nation for new case rate per 100,000 residents are New York, New Jersey, Rhode Island, Delaware and Texas. Georgia is ranked #6. The top five states in the nation for new death rate per 100,000 in the past 7 days are Virginia, Rhode Island, California, Alabama and Arizona.
The table below tells you where we are this week and how that compares to the previous week (in parentheses). The data for everything comes from the HHS Community Profile Report from 28Feb2021.
Georgia remains in the top 10 for case rate, death rate and percent of hospitalized patients who are being treated for COVID-19. That’s despite decreases for all of those metrics within the state. That means that even though things are getting better for Georgia, they are getting better to greater degrees for other states. Test output dropped 19% for Georgia while it rose 12% for the nation. Georgia is 42nd in the nation for tests per 100,000.
I’m sharing the map that’s formatted the same way as the Brown University School of Public Health tool but includes Georgia’s antigen cases. Last week there are 61 counties in the red category, 80 in the orange category and 17 in the yellow category. This week there are 71 counties in red, 77 counties in orange, 9 counties in yellow and 2 counties in the green category. So there have been some shifts and not necessarily in a good direction. You can click on the map below to see the live image that allows you to click/hover over your county. Many of the red counties are clustered together but overall the state is improving quite a lot compared to recent weeks.
Let’s discuss today’s numbers for Georgia.
Testing: a really low day for PCR testing, lower than most Mondays we’ve had recently. There were 13,195 new PCR results reported, 8.1% of which were positive. There were 8312 new antigen tests reported today and 12.7% were positive.
Cases: cases are often lower on Mondays due to weekend effect. But today’s total is greater than last Monday, mainly due to antigen cases. Today there was a net increase of 2139 newly reported cases (1214 by PCR, 925 by antigen test).
In Friday’s newsletter, I focused on Vaccines Q&A, but the School Aged Surveillance Data report came out that day too. Most trends are going down for children, however the graph below shows the case rate per 100,000 (by both PCR + antigen cases) in children and college-aged adults. We’re seeing the descent from the winter surge level off for 18-22 year olds. However, cases continue to trend down for children.
The trend among 18-22 year olds matches what we’re seeing with the overall adult population in Georgia - cases are leveling off from the descent, at a rate that is similar to the peak during the summer surge. The New York Times has been tracking COVID-19 cases at college campuses of varying enrollment size since the start of 2021. This would suggest that the trend we’re seeing among 18-22 year olds in Georgia is being seen elsewhere too.
I discussed the CDC’s most recent guidance on K-12 school reopening in this newsletter two weeks ago. If you’d like to see how the Georgia counties are doing in terms of CDC’s school reopening criteria, I have the maps updated for test positivity and case rate. Remember, you want to be in the blue or yellow category for both maps. If the two maps don’t agree for your county, you’re supposed to use the higher of the two rankings. Using these criteria, there are only five counties in Georgia where test positivity AND case rate are in the low - moderate categories that are compatible with safe school reopening and they are all clustered in the southern half of the state. They are Webster, Crawford, Crisp, Telfair and Wheeler counties.
Hospitalizations: Usually we see small numbers for the weekend that show up on Sunday and Monday. There were 50 new hospital admissions for COVID-19 today (last week, 130) and 6 admissions to the ICU.
Some happy news to share is that there is not a single hospital region in Georgia today that is using >90% of their ICU beds. We haven’t had a day like this since 07Nov2020. Only two regions (A and N) have a COVID-19 patient census that puts them in the red zone.
According to the HHS Community Profile Report, the Georgia counties with the highest COVID-19 admission rate per 100 beds are Evans, Bacon, Troup, Jefferson and Crisp.
Deaths: there were 80 newly reported confirmed deaths compared to yesterday’s total and 1 probable deaths. Death reporting on Mondays is typically low due to weekend effect. So 80 is high for a Monday. However, keep in mind that we saw an atypically low number on Friday. So some of this may be delayed reporting. For today’s deaths, 38% came from nonrural counties and 26% came from Atlanta suburb counties. The state 7-day death rate per 100,000 residents is 18% lower than the summer peak but 138% above the pre-winter surge baseline.
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My Ph.D. is in Medical Microbiology and Immunology. 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 and should not be considered medical advice.