The Daily Digest, 03Mar2021

Georgia COVID-19 Updates

Vaccine Update

Georgia Public Broadcasting asked me to talk about the latest vaccine numbers for Georgia this morning after the newsletter I wrote on Monday. I wanted to share with you what I sent to Ellen Eldridge. Don’t get me wrong - she did a great job, and I’m grateful for the chance to shine a light on this important problem. But I wanted to provide some of the context that might not fit into a news story because I have space to do so here.

As of yesterday’s CDC update at 12:26 pm, 3,067,745 vaccine doses have been delivered to the state of Georgia and 2,085,047 have been administered (or 68% of the state's inventory). That leaves 982,698 unused, many of which are sitting in a freezer. [Side note: we know there have been some wasted doses, so the actual inventory is probably a little less than this]. When there are over 900,000 doses on hand, the problem is not a shortage of vaccine supply. It's a problem of inefficient logistics - moving the doses to where they're needed, efficient scheduling of vaccinators and vaccine recipients, and barriers to access for those who are currently eligible. The mass vaccination clinics are terrific for the general population. In fact, the Governor announced today that they are opening additional mass vaccine sites in Chatham, Ware, Washington, Bartow, and Muscogee counties. However, one needs a car in order to participate. A lot of seniors don’t have transportation. We need to consider mobile vaccine strategies (think Red Cross blood donation buses but administering vaccines instead of collecting blood) to reach those who can’t come to the mass vaccine sites.  

With improvements in supply chain and better forecasting of expected shipments up to 3 weeks in advance, there is no need to hold more than the supply needed to get through the next few days. On average, Georgia is administering 41,517 doses per day since 19Feb2021. The current supply on hand is enough for 23 days of administration at Georgia's current pace. Meanwhile, only 9.2% of the adult population in Georgia has been fully vaccinated. The unused doses are enough to administer 1+ dose to an additional 12.4% of the adult population in Georgia. 

So the question is, what are we waiting for? Who are these vaccines being saved for? Vaccines don’t save lives when they’re in a freezer.

I would encourage you to pre-register for a vaccine, even if you are not currently eligible. The GEMA site automatically updates your eligibility when the state advances to the next stage and pre-registration holds your place in line. If you are currently eligible, I’m hearing reports that some of the retail pharmacies have appointments available but perhaps people don’t know about them. You can see all of the retail providers in Georgia (Publix, Kroger, Walgreens, Walmart, etc) through this site at DPH.


The situation in Texas & Mississippi

The effort to vaccinate as many people as possible as quickly as possible has taken on new urgency with the announcement yesterday by the governors of Texas and Mississippi that they’re going to cancel their disease control policies such as mask requirements and occupancy limits for restaurants, businesses, etc. They are going back to pre-pandemic standards.

Like virtually every public health professional I know, I think this is premature. It’s analogous to taking your foot off the brake before you put your car in park. We are seeing cases level off at a high rate nationally and locally. In addition, Texas has only vaccinated 9.2% of its adult population and Mississippi has only vaccinated 9.8%. Even if we estimate the proportion of the population who has already contracted COVID-19, we are not close to the herd immunity threshold. In addition, Texas is in the top 10 states for new case rate, test positivity (#2), new hospital admission rate and new death rate. It’s an odd time to declare victory. With the more transmissible variant from the UK in both of the states that are reopening (plus other variants in Texas), it’s kind of a scary thing to see the state lifting restrictions at this point in time.

Where leaders may want to say “Mission Accomplished,” the virus sees a buffet line of new people to infect. Each time the virus replicates in a new human, it has the opportunity to mutate and that can lead to the emergence of new variants. Some of those variants will be harmless, but a few may be like the variants that have arisen in the United Kingdom, South Africa, Brazil, etc, that complicate our efforts to end this pandemic. The people who will probably suffer the most from these decisions will be the essential workers - many of whom haven’t been vaccinated yet.

I’ll tell you what I’ve said since the beginning of the pandemic. This is a scientific and medical problem. Science and medicine will lead us out of it. I’d like to give the benefit of the doubt that leaders are doing the best they can in extraordinary circumstances, but most politicians are not epidemiologists. This virus is not cowed by swagger or bravado. If CDC is telling us it is too soon, then follow their advice. We are close to having enough vaccine soon to vaccinate every adult in the US by the end of May. We just need to hang on a bit longer. Easing restrictions sends a message that undercuts public health - that the pandemic is over (it is not) and those who have ignored the public health guidelines will be more emboldened to do so now. It increases the risk beyond the borders of these states.

At today’s press conference, the Governor continued to use language like “we can’t afford to let our guard up,” etc. So I’m cautiously optimistic that he will choose a more careful path than Texas and Mississippi.


Testing

We have the latest White House state reports on the COVID-19 pandemic. As a reminder, these reports are produced on Sundays and released to us usually on Wednesdays. So by the time we get them, the data are already slightly out of date. Just keep that in mind as we go through some of the numbers. The map and graphs below show how Georgia is doing for PCR test positivity (map) and PCR test output (upper right) and PCR test positivity (lower right). For the graphs, Georgia is in blue, the US trend is in red.

For the map, you want to be in green or gray. There are probably 2 dozen counties in those categories. There’s room for improvement, of course, but it’s a much better looking map than a month ago. In the upper right we can see that test output decreased last week for Georgia and increased for the US. The Georgia test rate per 100,000 is 45% less than the national rate. Georgia is ranked #44 in the nation for test rate. Test positivity has decreased for both the state and the nation, moving more or less in parallel. The US positivity rate is 5.1% which is SO CLOSE to the goal line. Perhaps we will get there next week. For Georgia, the positivity rate as of Sunday when the WH report was generated was 7.5%. We are on a good course if we can keep it going.

Today in Georgia there were 16,983 new PCR tests reported through Electronic Laboratory Reporting (ELR). However, only 66% of today’s newly reported PCR cases were reported through ELR, so there were a lot of cases reported through other mechanisms. Non-ELR test reporting does not include data on total tests performed so we can’t use them to calculate percent positive rate. What this means is that the percent positive rate for today (5.9%) may not be a reliable estimate since it only accounts for 66% of the cases reported today. The positive rate could be higher or lower than that if we had a more complete data set. For antigen testing there were 15,760 new results reported today through ELR and 103% of the antigen cases were reported through ELR (so there was some de-duplication going on in the net numbers). So whereas the PCR positivity rate may not be reliable today, the antigen positivity rate is reliable and 7.9%. Antigen testing accounted for 44% of the net increase in total cases reported today. We are seeing antigen testing taking a larger role in recent days.


Cases

Looking at the state versus national trend, case rate has dropped in a big way since mid-late January. But case rate has leveled off for Georgia and the US. The national case rate is 92% higher than the pre-winter surge bottom and for Georgia it is 150% higher. Seventy five percent of Georgia’s counties are in the red, orange or yellow zones.

I want to take a moment to look at the state versus national trends for skilled nursing facilities. I don’t often show these, due to limited space, but we’re seeing trends in the data that agree with an analysis I showed you earlier by the Kaiser Family Foundation. We are seeing a giant drop in COVID-19 cases and deaths since the vaccines were authorized and administered in long term care facilities. So if you need proof that the vaccines are working, this is where we expected to see it first. I think it’s important to remember that this will continue to be a population we need to protect and keep up on vaccinations. The resident population is transient and new people arrive all the time. Hopefully vaccines can be made available to all incoming residents.

Today Georgia reported a net increase of 1526 newly reported PCR cases and 1209 newly reported antigen cases for a combined total of 2735. This is a mid-range number for Georgia based on recent trends. The leveling we’ve seen in the 7-day case rate per 100,000 remains.


Hospitalizations

The graphic below shows data from the WH state report for Georgia. For the graphs, the state is represented by the blue line, the US is the red line. The map shows where admission rates are more or less intense. Things are more intense in the northern half of the state.

If we look at the graphs, we see that the burden on hospitals in Georgia has been quite a bit bigger than the burden nationally for ventilator usage, ICU usage and how many hospitals are experiencing staff shortages.

Today Georgia reported 118 confirmed COVID-19 admissions and 28 admissions to the ICU for COVID-19. COVID-19 hospital admissions are trending down, a very good thing. But we haven’t yet reached the pre-winter surge baseline.


Deaths

The map on the left shows where new death rate is most intense. Any county shaded in top 3 color tiers is above the national death rate. The graph shows that the death rate has dropped off for the state and the nation. However, we’re seeing that the descent has leveled off for the US. It’s possible that death rate will continue to decrease with next week’s report. At present, the death rate for the state is 27% higher than the national rate. But the disparity has narrowed a lot in the past week.

It was a high day for deaths in Georgia, with 140 newly reported confirmed deaths (net increase compared to yesterday’s total) and 5 probable deaths. Thirty eight percent of today’s newly reported confirmed deaths came from rural counties and the next highest county type was nonrural counties (29% of newly reported confirmed deaths). Because we’ve had low death counts in recent days, today’s big number hasn’t dramatically impacted the 7-day death rate per 100,000. We’ll see what the next few days bring. As of today, the death rate per 100,000 is 24% below the summer peak and 122% above the pre-winter surge bottom.


References

https://beta.healthdata.gov/browse?tags=covid-19-spr

https://www.kff.org/coronavirus-covid-19/slide/new-covid-19-cases-and-deaths-among-nursing-home-residents-have-dropped-since-vaccinations-began/

https://dph.georgia.gov/covid-vaccine

https://myvaccinegeorgia.com/

https://www.gpb.org/events/news/2021/03/03/gov-kemp-covid-19-vaccine-update-briefing

https://www.gpb.org/news/2021/03/03/georgia-in-last-place-for-distribution-has-vaccine-sitting-in-freezers

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.