The Daily Digest, 07Apr2021

Georgia COVID-19 Updates

First, let’s begin with a look at the latest White House state reports that were finalized last Friday but released to the public yesterday.

For new case rate per 100,000

  • Best states: AR, OK, CA, HI, KS

  • Worst states: MI, NJ, NY, CT, RI

  • 29 states + DC in the red zone (+2 compared to last week)

Test positivity

  • Best states: CA, HI, AR, NM, RI

  • Worst states: MI, PR, SD, NJ, PA

  • 4 states in the red zone (+3 compared to last week)

COVID-19 hospital admission rates per 100 beds.

  • Best states: HI, WY, MS, AR, ME

  • Worst states: MI, NJ, MD, NY, CT

  • 1 state in the red zone (+1 compared to last week)

COVID-19 death rates per 100,000

  • Best states: AK, ND, MT, NE, HI

  • Worst states: GA, WV, NY, MA, NJ

  • 11 states in red zone (-5 compared to last week)

Vaccinations - as of last Friday when the report was produced, 30.7% Americans had received at least one dose of the vaccine. As of today, the number is 32.6%.

  • Top 5: NM, NH, CT, and SD is tied with ME

  • Bottom 5: PR, AL, GA, MS, and TN is tied with IN

The map and graph below show community transmission ratings. You want to be in the blue or yellow categories for this. The table on the bottom of the image below shows you how the state doing this week relative to last week. The graph on the right is sort of a pie chart that trends over time, showing you the percentage of counties that were red, orange, yellow or blue over time. This week there seems to be improvement with fewer red and orange counties getting better and more yellow counties.


Vaccine Update

I’ve been doing a LOT of public speaking lately to increase awareness and confidence in the COVID-19 vaccines. Yesterday I was featured in a webinar hosted by Christy Brown of Launchpad2x, a women’s entrepreneurial organization and you can view it here with the pass code, 4K1gz!DR.

The Georgia Department of Public Health is getting into the public outreach effort too. Yesterday they uploaded a new PSA to their YouTube channel to encourage Georgians to get vaccinated.

It’s alive!!

The Georgia DPH vaccine dashboard is back with improvements. They have mapped and graphed vaccinations by county of residence rather than county of administration. We now are able to see county-level demographic data on vaccine recipients by age, sex and race. However, I will add a caveat that if a person’s county of residence was not entered, then they are not included in the county-level data but only in the state-level data. Just be advised that the county level data may not be a totally accurate depiction of vaccination levels in the area. You can find the demographic data in the upper right of the dashboard. It is set to state-level data as a default. You can explore county level data using the drop down menu in the upper right corner.

It’s improvement to have demographic data at a state and county level, but there’s some confusing things here too that will hopefully improve in the coming days. For example, consider the state level sex data provided below. I think the top section (pie chart) may actually be proportion of RECIPIENTS with at least one dose by sex. Reason being that 1,587,170 females + 1,176,186 males + 57,601 unknown does not equal the state population for Georgia (10.6 million people).

The bottom section may suffer from the same problem: we don’t know what they’re measuring. First, it doesn’t match the breakdown in the pie chart that shows over 50% of vaccine recipients are female. Is it assessing how much of the total female or male population in Georgia has received at least one dose? I don’t think this is likely either because CDC data tell us that only 25.7% of the Georgia population has received at least one dose as of 05Apr. The whole demographic section kind of has this problem, regardless which tab you’re on - it’s unclear what they’re measuring or how to read or interpret the data provided. And if I’m confused about it, I imagine the public will struggle even more.

New data resource

I was also made aware of a new data source for vaccines delivered to each state with respect to which vaccine providers got the vaccines. The US Department of Health and Human Services is really doing a lot in the way of data transparency. The data are available for download and I’ve included a screenshot of those data below, ranked according to Overall Administration Ratio: Unadjusted. As of 01Apr, Georgia had received 6,181,185 vaccine doses, and 4,835,545 of those went to the state government. Other doses were sent to the federal retail pharmacy program, and other programs that are outside of DPH control.

I’ve always been confused why the state says that they’ve used something like 79-80% of the doses they’ve received when the HHS says the number is in the 60s. For the data reported by DPH on 01Apr, the doses administered that day nearly matches the federal number, the DPH number is 98% of the HHS number and that remaining 2% may be explained by reporting lags. It makes sense that these numbers would nearly match, since doses administered anywhere in the state of Georgia are supposed to be reported into GRITS, under state control. However, it’s possible that the state and the federal government are using different denominators to calculate the percent of doses administered. And that isn’t really an apples to apples comparison.

In other words, the DPH fraction looks like 

(all doses administered by all vaccine providers) / doses received by DPH = 81%

Whereas the feds are using

(all doses administered by all vaccine providers) / doses received by all vaccine providers = 64%

81% is closer to what DPH and the Governor’s office report to us on a regular basis. This doesn’t necessarily mean something nefarious is happening. After all, the DPH can only track the doses it knows about in terms of deliveries, even if it is claiming all of the doses administered - regardless who administered them. But I think what this confirms for us is that the DPH / Governor’s office data are not the complete data set and we really shouldn’t rely on that to grade how the state is doing. Whereas the federal government is showing us the receipts of where the doses went, we aren’t seeing that same degree of transparency from the state. So if you had to choose a data set to use to track vaccination progress, I really think we need to go with the federal data set. It is complete and more accurately reflects the situation in Georgia. And what the federal data show us is that Georgia and other southern states are really struggling with getting vaccines out efficiently. The US territories of American Samoa, Guam and Palau are making more efficient use of their vaccine supply than Georgia, Alabama and Mississippi.

The two graphs below look at how well Georgia is doing at vaccinating its population (this is by state of residence, not administration) compared to the national trend for first doses full course administered to all adults. These data come from the White House State Report, I just graph them week to week. For first doses administered, the state is matching the pace of the US, even if it has vaccinated less of its population. I don’t think anyone expects perfection and, yes, Georgia was caught unprepared for this. But seeing Georgia keep pace with the national pace is a good sign. For the percent of adults who are fully vaccinated (right side), the gap widened this week. I suspect that this gap may narrow in 3-4 weeks when those who took advantage of expanded eligibility right away get their second doses.


Testing

For each of these sections, you’re going to see a graphic similar to what’s provided below. The map comes directly from the White House state report and gives us a look at where we are now. The graphs on the right are related to that same metric, but show us how Georgia and the US have trended weekly over time (where we’ve been). The graphic below all relates to testing. Georgia is ranked #32 in the nation for test positivity (with #52 being worst) and in the yellow zone.

For the map, you want to be in the green categories as much as possible. And the state is doing pretty well here. But there are a lot of yellow and orange counties, clustered in the northwest corner of the state. In the upper right, we can see how Georgia (blue line) has compared to the US (red line) for tests performed per 100,000 residents. Here too, you will see that Georgia has always underperformed relative to the national average. The lines tend to move in parallel, but right now testing is increasing nationally whereas it remains flat over the past couple weeks for Georgia.

Test positivity is shown over time in the graph on the lower right. The gray dashed line shows the WHO goal line (5%). The US rate has risen to meet the Georgia rate, at 5.3%. Test positivity is often considered alongside case rate to gauge how much the case rate might be an undercount of present disease burden. Seeing a test positivity rate at or below 5% means we are unlikely to be missing very many cases with the current level of testing. It doesn’t mean the pandemic is over. It means that case rate numbers are more accurately capturing disease burden. All the same, it is concerning to see test positivity rise again on a national level. It takes a lot to move the national needle - more than for a smaller population size like an individual state. The rise suggests that cases may be growing at a rate that current testing is less able to adequately monitor. I hope we can take this as a reminder to keep up with disease transmission mitigation strategies like wearing a mask, social distancing, avoiding large crowds, etc.

Today, Georgia reported 21,044 PCR test results and 11,748 antigen tests. Of today’s PCR tests, 4.9% were positive. Of the antigen tests, 6.1% were positive. PCR testing identified 63% of today’s newly reported cases.


Cases

Case rate per 100,000 is improving a lot compared to where Georgia has been in the recent past. For the map, it’s best to be in the yellow or green categories - or better yet, the gray counties where there are too few cases to categorize here. Many of the red zone counties are clustered in the northwest corner of the state. Georgia is ranked #20 for case rate (with #1 being best and #52 being worst) and in the orange zone.

If we look at where we’ve been (on the right), we can see that Georgia’s case rate has hit a second plateau in its descent from the winter surge. Georgia’s weekly case rate has almost reached pre-winter surge levels. Nationally, case rate has been pretty flat for the past month or so.

Today, Georgia reported a net increase of 961 newly reported PCR cases and 567 antigen cases, for a combined total of 1528. The 7-day case rate per 100,000 for the state of Georgia (black line below) is nearly back to pre-surge baseline, only 6.8% above the low point on 02Oct. This is really good news and I hope we can stay low for a while - it just depends on whether people are willing to continue to do the work of limiting transmission and getting vaccinated.


Hospitalizations

The map below shows how regions compare for COVID-19 hospital admission rate. If we look at the trends over time (upper right) then we can see that hospital admission rates for COVID-19 have sort of leveled off over the past three weeks for Georgia and the same is true for the US. This week, Georgia is ranked #47 in the US (with 52 being the worst) for COVID-19 hospital admission rate, in the orange zone.

In the lower right, we can see that the COVID-19 burden on ICU beds in the state has come down dramatically from the peak around 50% in mid-January. The state is nearly down to national levels for this metric, another positive sign.

Today Georgia reported a net increase of 164 new hospital admissions and 27 admissions to the ICU. 77% of the state’s ICU beds are in use and the HHS Community Profile Report tells us that 11% of those ICU beds are being used by COVID-19 patients (#12 state in the US). As I discussed last week, something might be going on in Hospital Region A, in the northwest corner of the state. COVID-19 patient census there has doubled in the past two weeks. And today, for the first time since 08Mar, we have a region in the red zone for patient census. Guess which region it is? Region A.

In addition, region A is in the red zone for ICU bed usage, along with region N, just to the south. Region N also has a higher than average COVID-19 patient census, at 13.5% of all hospitalized patients.


Deaths

The map on the left shows how Georgia counties are doing with respect to new death rate per 100,000. I should note that delayed reporting impacts deaths even more than for cases, so some of these deaths are not recent and likely happened during the winter surge. All the same, this week’s map looks worse than the previous week in terms of how many red and dark red counties there are. That makes sense when you look at the graph on the right where an increase in death rate was noted for the state.

The death rate for Georgia has been above the national average since late January. The state’s death rate remains 94% above the national rate. Georgia is ranked #52 (with 52 being the worst) in the US for new death rate.

Georgia reported a net increase of 66 newly reported confirmed deaths and 1 probable death. Despite those numbers, some good news is that the 7-day death rate for the state has returned to pre-winter surge levels.


References

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

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

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

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

https://beta.healthdata.gov/Health/COVID-19-Community-Profile-Report/gqxm-d9w9

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/distributing/jurisdiction-portfolios.html


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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.