The Daily Digest, 02Apr2021

Georgia COVID-19 Updates

Earlier this week, Georgia’s Governor announced that he was lifting the remaining pandemic restrictions. Considering that these restrictions were not really enforced across much of the state, you may be wondering why this matters anymore. I’m concerned about it for two reasons: essential workers and the message this sends to the public.

One theme I saw in reviewing the restrictions that were lifted was fewer and fewer protections for essential workers. Employers no longer have to provide hand sanitizer or hand washing stations, they no longer have to provide PPE to their staff, and restaurant staff in particular no longer have to stay home when they have symptoms and no longer have to follow quarantine guidance without penalty of losing income or their job. Restaurants also no longer have to space customers out. Let that sink in. In one of the riskiest activities we’ve identified in this pandemic so far (indoor restaurant dining), the people serving you can be required to work while they’re sick with COVID-19 or risk losing their job. And those same workers are not being provided the PPE they need for their own protection as their dining rooms become even more crowded with maskless patrons. Other than healthcare workers and teachers, essential workers were not prioritized for vaccination by the state of Georgia. This whole thing is troubling because essential workers, many of whom are people of color, took on extraordinary risk to keep us fed, keep the lights on, and keep society functioning. Not only were they not rewarded for their sacrifice with protection as soon as we could provide it to them (in the form of a vaccine), the state has now further increased the risk they face.

Restaurant workers are not the only essential workers, of course. But let’s stay on this population for a moment and the risks both to them and the communities they serve. An article came out yesterday that summarizes what we know so far about the risks of indoor dining, and particularly in the absence of a mask mandate. That is the exact situation we have in Georgia. The section below helps us see the effects on case and death rate. The article they’re summarizing estimated the differences in case and death rate for states with and without mask mandates and the reopening of restaurants over an 8 week time period in the summer of 2020.

So in states where indoor dining reopened in the absence of a mask mandate, the excess case rate was about 10 times higher than in states that reopened restaurants *with* a mask mandate. For deaths, there was a 5-fold increase in death rate among states that reopened restaurants without a mask mandate for the broader community. Obviously, you don’t wear a mask while you’re eating. But I think these things go together because the mask mandate for the community lowered transmission rates, making it safer for indoor dining to happen. The original article included state-level estimates. For Georgia, the estimated difference in the number of deaths associated with indoor dining combined with a lack of mask mandate was 1109 people in 8 weeks than if a mask mandate were in place last summer. In the rush to reopen the economy without basic protections in place (i.e. a mask mandate), one has to wonder how many dollars is a human life worth? If 1109 deaths could have been prevented with a simple policy change in 8 weeks’ time, how many other Georgia deaths could have been prevented since that time?

The authors go on to describe best practices for “safer” indoor dining for both employees and patrons. The things outlined here are all things that the Governor no longer requires.

So unfortunately, when the Governor says that he’s “followed the science,” we know that is incorrect. It’s possible he doesn’t know what the science is. Because we can see what the science says about restaurants and indoor dining right here in the article I provided above. When he says that he’s made this decision in consultation with Dr. Toomey, we can assume that is also incorrect. Just last week we learned through an investigative report that he has consistently ignored her advice since the start of the pandemic. He can make a decision to reopen just because he’s the Governor. That’s his position and his prerogative. But don’t lie and say that it’s based on science. Own the decision and its consequences.

While the easing of the last remaining restrictions will put essential workers at an elevated risk, I think the message this sends will have broader impacts for the state as well. It will lead to a false sense of security among the population that the pandemic is over, in the same week that the CDC Director, Dr. Rochelle Walensky, gave an emotional plea for states and the American people to continue to adhere to public health guidance for a little while longer, mere miles away from the Governor’s mansion. We have not vaccinated enough of the population to give up the best tools we have for protecting our communities - nonpharmaceutical interventions such as masking, social distancing, staying home when you’re sick, etc. Case rates, while lower than they were in January, remain very high. If this decision to lift restrictions could have been delayed by as little as 4 weeks, we’d be in a much safer position. Some of the inefficiencies of Georgia’s vaccine rollout are improving with community organizations banding together with healthcare providers to get doses into arms. Let’s give them time to at least get the newly eligible Georgians through their second dose appointments.

A political leader has to weigh the many needs and concerns of the community they serve. Sometimes certain needs outweigh others, and I understand that public health will not always be the primary concern. However, I want to make it clear that the decision to lift restrictions has no basis in science or public health. It contradicts public health guidance in favor of other (mostly economic) priorities. And so, if a surge does reach Georgia it will again be important to ask how much money is a human life worth that we could have saved? If another surge comes, the deaths that come with it will be the most tragic of all because they were preventable deaths that we could have saved with vaccines if not for human impatience.

In public health, our “patient” is an entire community. As those of us in public health are trying to save our patient, our patient is continuing to be harmed by things both within and outside of their control including policy decisions and contradictory messaging. Imagine a doctor performing heart surgery as someone stabs their patient in the abdomen. You can see how this is counterproductive and complicates the safety of the patient, right? We need to be working toward the same goal, because our communities are the patient at stake here.

With the decision to lift the last restrictions while only 12% of the Georgia population is fully vaccinated, the race to vaccinate as many people as we can as quickly as we can has taken on new urgency. I’m working with a variety of community organizations to remove barriers to access and improve vaccine confidence. I’m willing to partner with anyone who is committed to doing the work to move vaccines from freezers to arms, and especially for those who have been disproportionately harmed in the pandemic. If you have vaccine events coming up that you want to amplify, send them to me. If it would help to have me or colleagues speak to your organization or community, ask me. There is no more important work than getting vaccines into arms right now.


Post-vaccine life

Today the CDC issued new guidance on travel for people who are fully vaccinated against COVID-19. The infographic below highlights the things you no longer need to do in order to travel within the United States once you’re fully vaccinated.

For those traveling internationally, you may still be subject to requirements of your destination. Even if you’re vaccinated, the CDC still wants you to get tested before returning to the US. This is to prevent the arrival of vaccine-resistant COVID-19 variants in the US, should they emerge internationally.

Because disease rates remain high both within the US and abroad, they are asking us to limit non-essential travel for the time being. The way I read this is, yes you can travel but don’t go wild with it for now. But it’s a good incentive to get vaccinated - no testing needed if you’re traveling domestically!


The latest Georgia COVID-19 trends

Testing

Today there were 22,927 newly reported PCR results, 4.4% of which were positive. There were 8506 newly reported antigen test results and 5.5% of them were positive. PCR testing identified 72% of today’s newly reported cases.

Cases

There was a net increase of 1143 newly reported PCR cases and 439 antigen cases for a combined total of 1582. We find ourselves on a second plateau in the post-winter surge descent. Case rates are lowest in rural counties and highest in the Atlanta suburb counties.

Hospitalizations

Today there was a net increase of 100 new COVID-19 hospital admissions and 15 admissions to the ICU. Only one hospital region is using >90% of its hospital beds, region A in northwest Georgia. Patient census is decreasing slightly for the state (certainly welcome news!) but increasing in regions A, B, C (all in the northern part of the state) and region I (mid-Alabama border). Some good news is what we’re seeing in hospital region D (Atlanta). If you look at the graph, you’ll see that there was a plateau about a week ago that started to trend up for a couple days. But since that time the COVID-19 patient census has continued to descend. Atlanta is not quite yet back to pre-winter surge levels. But this is a good trend to see. Hopefully it can keep going.

Deaths

Today there was a net increase of 63 newly reported confirmed COVID-19 deaths and a correction of -6 probable deaths. That doesn’t mean these folks came back to life, but most likely they were entered in the wrong column (maybe actually confirmed deaths), were duplications, or simply data entry error.

That’s it for today. Have a great weekend!


References

https://www.savannahnow.com/story/news/2021/04/01/health-experts-wary-lifting-covid-restrictions-georgia-too-soon/7053092002/

https://jamanetwork.com/journals/jama/fullarticle/2778233?guestAccessKey=391068ae-5cd0-412f-acf2-ddc1ce226483&utm_source=twitter&utm_medium=social_jama&utm_term=4688033213&utm_campaign=article_alert&linkId=115111142

https://link.springer.com/article/10.1007/s11606-020-06277-0

https://www.ajc.com/news/coronavirus/georgia-governor-ignored-experts-as-the-pandemic-raged/M24YAXPPTFBPXA5HMV7I4LGWOY/

https://www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel-during-covid19.html

https://dph.georgia.gov/covid-19-daily-status-report

https://covid-gagio.hub.arcgis.com/


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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.