The Daily Digest, 05Oct2020

Georgia COVID-19 Updates

The World

Globally, the SARS-CoV-2 virus that causes COVID-19 disease has sickened >35.2 million people (+2.2 million since last week) and killed 1,037,400 (+76,588 in the past week, which is larger than the week preceding it) as of this morning.

The US is a warm spot (not red hot as before), as is much of the Western hemisphere. Canada moved up into a higher color category this week. We remain at the 20th rank in the world for weekly case rate. Our weekly case rate per 100,000 is 92 (down from 96). Some of the hottest areas in the world for disease right now are in Europe, the Middle East and Central and South America.

For deaths, our weekly death rate per 100,000 decreased slightly to 1.5 (down from 1.6 last week) and we are ranked #21 in the world for this (down from #20 last week). The top five countries for death rates per 100,000 this week are Argentina, Aruba, Montenegro, Israel, and Turks and Caicos Islands.

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The United States

As hot spots go, they are mainly concentrated throughout the Midwest and much of Wisconsin is bright red. As of this morning, there have been over 7.4 million cases and 209,603 deaths in the US. Keep in mind that both of these numbers are probably an under-count of the situation in our country.

Georgia is ranked #30 in the nation for 7-day case rate per 100,000, a drop from #28 last week. Our case rate is 80 per 100,000 in the past 7 days. This is really, really good news considering at one point we had the highest rate in the nation. However, the state of Georgia only uses PCR testing to confirm and report cases, and probable cases identified using the rapid antigen test that has gained favor over recent weeks aren’t in that total. Meanwhile, over 31 states *are* using rapid antigen test results in their case totals, including fellow southern states like Alabama, Florida, North Carolina, South Carolina, Tennessee, and Mississippi. It’s therefore not really a fair comparison and it’s very likely that our recent case totals are an under-representation of the disease that is circulating. Of the top 10 states for 7-day case rate per 100,000, none are in the South.

Georgia has no counties in the top 20 counties in the nation list for cases per 100,000 in the past week. Our highest ranked county is Chattahoochee, ranked #89. We also don’t have any cities in the top 20 for case rate per population.

University of Georgia remains the #1 college/university in the nation right now for total cases among students, faculty and staff. The state of Georgia ranks #2 for college and university associated cases, behind Texas.

According to the CDC, Georgia has a cumulative test rate of 27,271 per 100,000 residents and we are ranked 37th in the nation for this (down from 36th last week). If we look at percent positive rate using the map below, you can see that all of the South is experiencing a high rate. Again, this is cumulative information, not recent. For two weeks now, Georgia has been in the second color tier, but now we have rejoined our southern neighbors. Note that the CDC does not provide data on rapid antigen test results.

To look at more recent testing data, we have to go back to the New York Times resource. In the past week, it notes that Georgia increased in the rankings from 33rd in the nation (191 tests performed per 100,000 in the past 2 weeks) to 24th in the nation (180 tests per 100,000). Together with the Harvard Global Health Institute, they estimate that Georgia is performing at 63% of the ideal testing target (up from 51% last week).

Georgia is back to being ranked #1 in the nation for proportion of inpatient beds occupied by COVID patients (11.84%), just ahead of Mississippi (11.46%). The top four states are Georgia, Mississippi, South Dakota and North Dakota. These data come from the Health and Human Services dashboard which was last updated on 02Oct.

As our ranking for cases per 100,000 have declined (a good thing), we are also seeing a decrease in our ranking for deaths per 100,000 in the past 7 days. We have moved down in the rankings for death rate per 100,000 in the past 7 days, from #7 in the nation last week to #13. Southern states still make up 5 of the 10 positions on that list, I’m sorry to say.

I’d like to introduce a new resource as we head into influenza season. This is FluView, a helpful tool that CDC has produced for a long time. The map below depicts how states compare when considering the average percent of outpatient (meaning, not warranting a hospital admission) visits for influenza-like illness for the current week compared to non-influenza season weeks.

You’ll notice that we don’t get data more specific than state level, so you could have a situation where influenza is really bad in one city and as a consequence, the whole state appears red, for example. That’s not the case now, but I want to go over how to read and interpret the map. For now, there is only one US territory with moderate influenza-like illness and that’s Puerto Rico. There is slightly more influenza-like illness activity in Idaho and Missouri than the rest of the country, but all of the continental US is in the minimal category for now. I’ll be sure to include this map in future weekly posts since COVID-19 and seasonal influenza share so many symptoms in common.

Speaking of the similarities between the diseases, I’ve reached out to some colleagues at CDC about coming up with a new info graphic that helps us distinguish the symptoms between influenza, COVID-19 and seasonal allergies. I mean, while I lived in Georgia, fall was typically worse for my allergies than spring. We had graphics with this information in the spring but the symptom list for COVID-19 has expanded since then. For now, the less pretty version of what CDC will probably ultimately create is shown in a table below. I gathered the symptoms for each condition on their websites. But, when in doubt, seek a test. Because there are *many* similarities between COVID-19 and influenza.

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Georgia

Here is how the state of Georgia is looking based on the risk tool from the Harvard Global Health Institute. The color coding is explained below the map.

There are some noticeable improvements this week. There are five green counties compared to just one last week. Meanwhile, there are 58 yellow counties this week, one more than last week. For yellow counties, there is community spread that might be manageable with adequate testing and contact tracing. These counties include some of our most populated ones such as Fulton and DeKalb, several of the Atlanta suburb counties, as well as nonrural counties outside of the Atlanta metro. However, the remaining 96 counties have >10 cases per 100,000 people which are color-coded orange and red. So they remain counties of concern. All of the top 10 counties are rural for cases per 100,000 over the past 7 days. Several red counties are concentrated along the Georgia borders.

For today, here are the net increases for each key metric for Georgia.

• Testing: 14,139 new tests (a low day for us), 6.1% were positive. 109% of today’s cases were identified through electronic laboratory reporting (ELR), so there are a few duplicate results in today’s report. The state counts tests regardless of whether they come from the same person in their calculation of percent positive rate - it is all positive tests divided by all tests performed (positive and negative). However, multiple positive tests from the same person are de-duplicated when case counts are tallied. So the case count is where the correction is made. Lately, we have seen very few cases being reported prior to the 14-day window of uncertainty. In fact, today we saw only 11% of newly identified cases being backdated prior to the 14-day window. This indicates that we are seeing better turnaround time from test collection to test result and that people are doing better at seeking testing when they first experience symptoms. For our purposes, it tells us that the data we are seeing recently really are recent data. However, when we aren’t able to see what is happening with rapid antigen testing, it’s hard to make any conclusions about how the state is doing for testing or cases.

• Cases: 789 cases (low count for us, probably due to weekend effect). The new statewide total is 323,714. Of today’s cases, 31% came from nonrural counties outside of the Atlanta metro. Atlanta Suburbs and rural counties were nearly equal, contributing 23 and 21% of cases, respectively.

• Hospitalizations: 29 new COVID hospital admissions and 7 new ICU admissions (these are low numbers for Georgia). We typically see low numbers on Mondays due to delayed reporting over the weekend. There are currently 1280 COVID patients hospitalized and this number has been rising slowly for the past three days. Adult ventilators are being used at 29% of our state’s capacity as of today.

  There is just one hospital regions that is using over >90% ICU beds: region E, at 92.9%.

• Deaths: 30 newly reported deaths (a low day, consistent with what we saw last Monday). It should be noted that nursing homes typically do not report over the weekends, and Mondays tend to be low count days for this reason. Nineteen of the deaths reported today came from outside of the Atlanta metro with rural counties leading with 14 newly reported deaths. The new statewide total is 7192.

The Georgia Department of Public Health began producing a new county indicators report a few weeks ago that is available at the bottom of the daily report. The latest report was released today and it includes our first look at the impact of rapid antigen testing. First let’s see the new case definition set forth by Georgia DPH:

A confirmed case is an individual with a positive molecular (PCR) test. A probable case meets at least one of the following criteria: has a positive antigen test on a respiratory specimen; OR has not had a confirmatory COVID-19 test but has symptoms compatible with COVID-19 AND a known exposure to a COVID-19 case; OR the individual has died and the death certificate lists COVID-19 disease or SARS-CoV-2 as an underlying cause of death or a significant condition contributing to death.

So this new case definition includes both the antigen test that is gaining popularity, but also think about families that have fallen ill, but only one member of the family actually was tested. This allows the remaining family members who exhibited COVID-19 symptoms to be counted as probable cases. Below, I’ve shown you how to get to the data in the county indicator report. Click on cases, then probable cases.

If we wanted to see the impact of rapid antigen testing plus the other criteria for a probable case, observe the first arrow I’ve provided. The number (through 02Oct) is 21,348. Adding that to the existing confirmed total as of 02Oct (320,515) and the combined total is 341,863. In other words, rapid antigen tests and other indicators of probable cases account for 6.2% of the state’s combined total. There are data for this for each county and the rate varies. I’m going to be looking at all of these 159 counties eventually, but some of our counties of particular interest because of population density include:

• Bibb: 2% of combined cases are from the probable case category (possibly rapid antigen test)

• Bulloch: 9.1%

• Chatham: 1%

• Clarke: 13.3%

• DeKalb: 4.0%

• Fulton: 5.8%

• Gwinnett: 4.9%

• Hall: 1.1%

• Houston: 6.2%

We do not get additional information on the antigen test in the testing tab or elsewhere in the report. Nor are these data reflected in the daily status report from the Department of Public Health, which means that those data are probably not being communicated to other organizations that track data for Georgia, including the New York Times data hub, the Harvard Global Health Institute, the Georgia GIO data hub, the Atlantic’s COVID Tracking Project, etc. Without that, we still aren’t seeing an apples to apples comparison with other states.

According to the state, most of the state is considered to have high disease transmission over the past two weeks (129 of Georgia’s 159 counties).

Also, the vast majority of the state is above the WHO testing goal of 5% (see all counties that are colored red or blue).

To summarize, Georgia appears to be doing better in many ways…but we aren’t really seeing an apples to apples comparison with other states since the majority of them are using rapid antigen test results in their case and testing totals (including all of the other southern states), whereas we are not. It’s great that we are starting to get data on probable cases, including those identified through the rapid antigen test. But we need to see those data reflected in other parts of the daily report eventually, especially testing data. Because as the rapid antigen test gains in popularity, at the possible expense of the PCR test, then percent positive rate will matter less and less. This will have impacts on K-12 and higher education, businesses, communities of worship, and healthcare infrastructure that use these criteria for decision-making.

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References

https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html

https://khn.org/news/lack-of-antigen-test-reporting-leaves-country-blind-to-the-pandemic/

https://protect-public.hhs.gov/pages/hospital-capacity

https://globalepidemics.org/key-metrics-for-covid-suppression/

https://covid.cdc.gov/covid-data-tracker/#testing_testsper100k

https://www.cdc.gov/flu/weekly/index.htm

https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-seasonal-allergies-faqs.html

https://dph.georgia.gov/county-indicator-reports

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.