The Daily Digest, 02Sep2020

Georgia COVID-19 Updates

Good evening! I think there is so much news to talk about today. But first, a small bit of housekeeping. For those who were Patreon contributors, your complimentary month of service on Substack is coming to an end. So if you are getting the email from Substack indicating that your service is about to be interrupted and wish to continue, you’ll need to provide new payment information through Substack. I’m ever so grateful for your support.

First in news, Georgia Emergency Management Agency announced today that under their new leadership, they will no longer be producing the coronavirus situation report, starting September 5th. The data that were sourced to produce that document are available through the Georgia Geospatial Information Office COVID-19 Data Hub. The hub is a great resource, in fact, I helped to develop it with the state’s COVID-19 Data Task Force (much of the blurb writing should sound familiar). But change is hard for everyone, and especially when tensions are high in a pandemic. I hope to record a voice over tour of the site to show you around in the coming days since we’re going to be relying on it more now. However, the Data Hub is not perfect. Where the GEMA situation report compiled information from multiple tools in the Data Hub into one document, we will have to hunt down the information from each of those tools now. Second, the Data Hub isn’t formatted for mobile device or tablet use. It is best visualized on a desktop or laptop.

Second, the CDC announced that they are invoking the rarely used Public Health Service Act to suspend evictions through the end of the year. I’m not a lawyer, I’ll lay that out first and foremost. But here’s what the laws that were referenced in the CDC order say:

I agree that sudden homelessness is not going to help control this pandemic. But if CDC is going to break out the Public Health Service Act (which is rarely used) for this issue, then why haven’t we used it for things that would have a more proactive impact on curbing disease transmission, so that evictions might not be necessary in the first place? Like requiring masks nationwide or at least in states that they have identified as being in the red zone? I think the White House Coronavirus Task Force has already identified that Georgia’s measures were “insufficient to prevent the spread of” coronavirus in the reports we’ve read and Congress has agreed. Or why not use the law to implementing any of the interventions that have been recommended by the White House Coronavirus Task Force? The whole thing just seems really strange and arbitrary.

A third piece of news is what we’re starting to see happen in at least two college campus counties around Georgia. University of Georgia reported a very large increase in cases among their population and even this large increase is likely an under count since much of it relies on self-reporting. Meanwhile, we see big increases in the 14-day window of the case graph by date of symptom onset for Clarke county that hosts UGA.

A similar trend can be observed for Bulloch county, that hosts Georgia Southern University.

And Georgia Tech is seeing enough case growth that they are transitioning to single occupancy dormitories to limit the spread of the virus and better facilitate isolation and quarantine.


Testing

Another piece of news today was that the North Central Health District announced the final results of their cleanup of the large data dump that we saw for Bibb county (added 778 cases that day) and its other counties. In the end, there was a net decrease of 81 duplicated cases for Bibb county alone, and many of these cases were backdated into June. Other cases were deduplicated for other counties in the North Central Health District. So what this means is that there was even more disease than we were aware of during the summer surge for central Georgia.

For the state, it was a dismal day of testing, with only 13,139 new results reported. We haven’t had a number this low since early July. Meanwhile, the percent positive rate for today’s results was 8.5%. The graph below shows you the total tests performed each day (blue) and how many were positive (total counts, in orange).

Something weird about today’s cases and tests is that only 58% of today’s identified cases were reported through Electronic Laboratory Reporting. So the percent postive rate for today might be inaccurate since non-ELR cases are not used for this calculation and the number of non-ELR cases today was disproportionately large. The counties with the highest positivity rates in the past 2 weeks are Wheeler (31.3%) and Johnson (29.3%). Any county darker than the lightest shade of yellow is above the 5% goal set by the World Health Organization.


Cases

Today there was a net increase of 1916 newly reported cases. That brings the statewide total to 274,613. Of those, 846 came from nonrural counties, our largest contributor to cases recently.

The graph below shows us how the summer surge impacted each age group differently. So keep in mind that the time starts over when you get to the next age group. It’s a complicated way to look at the same timeline for different age groups, but it allows us to see differences between them when they’re side by side like this.

The 18-29 year group is our biggest contributor to cases, that’s not new information. But they saw the fastest increase and steepest dropoff. A similar trend was seen for those 30-39. But things flatten out as you get younger and older than these age groups. In fact, for those ages 70-80+, they saw a delayed increase that showed more of a bell-shaped distribution over time. These data might suggest that transmission among younger populations eventually reached the elderly, perhaps through family gatherings, spread within a nursing home setting, etc. The problem with this is what happened with deaths as a result of the summer surge.

This graph is formatted in the same way. The timeline starts over once you get to the next age group. It allows us to see how the summer surge impacted each age group side by side and over time. So over the exact same period of time that we were examining above for summer surge cases, these are the deaths that took place during that time. Deaths were relatively flat for young populations up to age 49. But as cases surged, deaths surged for all populations above age 50, increasing with each decade. For all but one of these age groups, we haven’t seen them start to decline yet (exception being 70-79 year olds). Hopefully we start to see those declines with this week’s data when I look at them this weekend.


Hospitalizations

The number of patients currently hospitalized for COVID-19 continues to decrease, however we remain at a high level - 122% higher than we were prior to the summer surge for those currently hospitalized.

New hospital admissions and new ICU admissions continue to level off. But they, too, are higher than they were prior to the summer surge.

Despite these good signs, statewide, the ICU bed capacity is strained once again in multiple regions according to today’s GEMA situation report, including hospital regions E (7 beds), H (1 bed), L (6 beds). Region H has been plagued by ICU bed capacity strain for much of the pandemic. But it is especially concerning to see the strain there now since that is one of the regions with the most intense rates of illness recently. Region E is home to Athens-Clarke county which is starting to see its own case surge. And Region L covers much of the southern I-75 corridor. They have seen their ICU beds strained before during the summer surge.


Deaths

There was a net increase of 62 deaths newly reported today. Twenty six came from rural counties and 24 came from nonrural counties that aren’t part of the Atlanta metro. In other words, 50 of today’s cases (81%) came from outside the Atlanta metro. The new statewide total is 5795 Georgians lost. As our reported deaths continue to climb as cases slow their increase, the case fatality rate is increasing and now stands at 2.11%. I’ve seen some comments that this number may be higher than reality since we are only capturing the tip of the iceberg when it comes to cases and there are many asymptomatic cases out there. However, I wouldn’t be quick to assume that we are accurately capturing COVID deaths either - we are very likely under counting the deaths too, as we see when looking at excess deaths and the gap between the deaths above that threshold for “normal” and the number of COVID deaths we’ve identified. That gap probably contains a fair number of additional COVID deaths.

All of this to say that while we definitely have some signs that things might be improving with respect to case and hospitalization declines, it is important to remember that we remain at a high level of disease transmission in our communities and several hospitals remain strained for ICU beds. The momentum we have heading in the right direction can turn very quickly if we take unnecessary risks that facilitate further transmission of illness. It’s critically important that we make good choices that are community minded to keep our downward trajectory moving in that direction. It is especially important since we have introduced new avenues of transmission through K-12 school reopenings and the return of students to college and university settings that feature the age group that contributes the most cases to our overall total.

Be safe and be well!


References

https://gema.georgia.gov/press-releases/2020-09-02/gio-covid-19-data-hub-replaces-gemahs-covid-19-sitrep-sept-5

https://s3.amazonaws.com/public-inspection.federalregister.gov/2020-19654.pdf

https://ecfr.io/Title-42/Section-70.2

https://www.govinfo.gov/content/pkg/USCODE-2011-title42/html/USCODE-2011-title42-chap6A-subchapII-partG-sec264.htm

https://www.gpb.org/news/2020/09/02/uga-finds-798-student-coronavirus-cases-in-first-week-of-classes

https://www.ajc.com/education/get-schooled-blog/to-further-combat-covid-georgia-tech-will-move-students-to-single-rooms/IGO7B26U2BAKHAA3D6A5YEOYYY/

https://northcentralhealthdistrict.org/north-central-health-district-completes-data-cleaning-following-august-24-data-dump/#more-13002

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

https://coronavirus.house.gov/news/press-releases/select-subcommittee-releases-eight-weeks-coronavirus-task-force-reports-kept


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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.