The Daily Digest, 08Jan2021

Georgia COVID-19 Updates

Vaccine Update

Earlier today, Governor Kemp held a press conference to update the state on vaccine rollout in which neither Public Health Commissioner, Dr. Kathleen Toomey, nor any other official from the Department of Public Health was present.

In his remarks, he indicated that Georgia has the ability to vaccinate just under 12,000 individuals per day, averaging 80,000 per week. He noted the difficulty that Georgians are having with scheduling appointments to get vaccinated, or even to gain information with overwhelmed phone lines and websites crashing. He did not indicate any allocations of money or staffing to augment those appointment systems. He just asked Georgians to be patient. When asked why Georgia was doing so poorly compared to other states (Georgia has the second worst vaccination rate in the country), he said it’s a heavy logistical lift.

At this pace, it will be years before we reach herd immunity. I don’t think Georgia has the appetite for that or for maintaining the pandemic mitigation efforts for that long. Some of this glacial pace is due to limited supply from Operation Warp Speed, but some of it is due to poor planning and execution of a mass vaccination strategy, if Georgia ever actually had one. Instead, the responsibility for vaccinating a population of 10.6 million people has been pushed down to 18 underfunded public health districts, operating with a skeleton crew. And they have no money, because like all other state agencies they took a big budget cut last year, DURING A PANDEMIC. So is it any wonder that the appointment systems are clunky or nonoperational? Is it any wonder that public health districts are having to rely on free web apps like EventBrite and SignUpGenius to schedule appointments? This isn’t a parent teacher conference or a potluck. We need a centralized appointment scheduling system on the DPH website. This vaccination effort IS a heavy logistical lift, but that’s true for 50 states and US territories and yet we have the worst vaccination rate in the country. We need to bring every resource the state has to this effort. Many of the roles that need to be filled in mass vaccination efforts do not require medical expertise. Activate the Georgia National Guard, get GEMA involved along with the American Red Cross. This pandemic is a catastrophic event. We need to stop acting like this is something we’ll deal with when we get to it. What we have here is a failure to sense the urgency of the situation, a failure of imagination and a pile of excuses. People are dying.

The second thing I’d like to point out about this press conference is what happened during the Q&A portion when the Governor was asked why no additional measures were being used to limit disease transmission when hospitals are overwhelmed and the White House Coronavirus Task Force has been warning the state for the past month to ramp up mitigation efforts. The Governor said that actually, hospitals are managing. And that they need to be this full in order to make money. So rather than having a “come to Jesus” with the Georgia public and leveling with them about how serious this surge is, he brushed it off and said Georgians just need to keep doing what they’re doing. He said that the problem wasn’t the growing percentage of patients who are being treated for COVID, it was the other 70% of patients who were there for other reasons. I’m sorry, no. Those 70% need to be there too, for ongoing medical conditions and emergencies. We need to alleviate the burden of COVID-19 on our hospitals, which is within our power more so than limiting the number of heart attacks, cancers, etc. Let me be abundantly clear. The surge we are experiencing shows no signs of slowing. We have multiple regions of the state that are out of ICU beds and operating in an overage of ICU demand. We are not far away from running out of beds. We have to do something now. The people who are exposed today will be our cases next week and our hospitalized patients two weeks from now. Some of them will be our deaths 3-4 weeks from now. So the increasing surge we are seeing for our hospitals is going to continue to build until the Governor does something. His strategy of asking people to do the right thing clearly isn’t working. In addition, the Governor has limited the ability of local jurisdictions to enact more stringent disease control measures. He has no problem pushing testing and vaccinations down to the local level, but won’t allow local leaders any power to limit the damage to their communities.

And I’d be curious to know if frontline healthcare workers would describe their current situation as “managing?” You do have to wonder if perhaps that’s one reason why no one from the Georgia Department of Public Health was at the press conference about something that is squarely in their lane.

Grant Blankenship, a journalist for Georgia Public Broadcasting, made this tool for identifying your public health district and their website for more information about vaccinations, including appointment systems. Beware that not all websites have their appointment systems ready to go, and at least one district’s website is down completely. But these, and possibly the health district social media pages, will be the best sources of information regarding vaccines available in your area.


Testing

Today was a HUGE day for cases, but only 30% of the state’s PCR-identified cases were reported through Electronic Laboratory Reporting. So it’s strange that we had an on time daily status report from DPH when earlier this week they were several hours late with 50% of a much smaller case total reported through ELR. Separately, is something wrong with ELR? There were a total of 10,379 new PCR cases reported today (net increase) and only 3134 were reported through ELR. In fact the total test output reported today was 14,381 due to the problems in ELR, and that number is only just above our combined case total today.

Of today’s tests reported through ELR, 21,8% were positive, but this is only telling us about 30% of the data. As we all learned from watching election results, it’s hard to tell what’s happening when you’re only looking at a small portion of the available data. So it’s possible that today’s reported percent positive rate is not an accurate estimate of today’s actual positive rate.

Now that we’ve closed the month of December, I’ve been able to calculate the total test output and percent positivity for the different county types in Georgia. First, let’s look at the percent positive rate over time in the graph below. The statewide average is represented by the black line. The goal is to be at or below 5%, as an indication that you’re testing widely enough to identify most cases.

We can see that Atlanta (blue line) actually was below the 5% goal line for September and October. It has risen since then, but hasn’t yet surpassed Atlanta’s peak set in July. By comparison, every other county type in Georgia has surpassed their peaks, set in July.

When we look at tests performed per 100,000 residents, it’s really easy to tell why Atlanta is doing so well. They are doing a MUCH better job of testing their population than any other county type. Despite this, the last graph showed that Atlanta’s positivity rate is increasing. So even though they are testing a higher proportion of their population, they need to be doing more. Rural counties have the worst test rate per 100,000.


Cases

Today was a record setting day for cases, with 10,379 identified by PCR and 2917 identified by antigen test. The combined total is 13,296 compared to yesterday’s totals. The previous record was 11,709, set on 31Dec2020. Thirty two percent of the cases came from nonrural counties outside of the Atlanta metro, another 30% came from the Atlanta suburbs. Twenty one percent of cases came from rural counties and 14% came from the Atlanta counties of Fulton and DeKalb.

The 7-day case rate per 100,000 for each of these county types over time is shown below. You can see that there’s tight agreement between the state average and the case rates of rural, nonrural and Atlanta suburb counties. Comparatively, Atlanta is doing better, but still much higher than their peak that they saw in the summer. Currently the 7-day case rate per 100,000 for the state is 128% higher than the summer peak.

All but three counties in the state are in the red zone by the Brown School of Public Health tool, Echols, Long and Marion counties.

The map below is formatted in the same way as the DPH 14-day case rate map, but it includes the antigen cases, whereas DPH’s map does not. The DPH map gives a misleading impression that the disease rate is not that bad for many counties. Including the antigen cases provides a more comprehensive look at disease intensity. Using PCR + Antigen cases, there are 99 counties in the top color tier. Using only PCR cases (as DPH does), there are only 21 counties in the top color tier. You can click on the map below to see the live image where you can click/hover of the counties to find your county’s number.

For the past couple of weeks, there have been more 14-17 year olds (high schoolers) infected with COVID-19 than all children infected during the height of the summer surge. You can explore this graph and other findings in the School Aged Data Surveillance report, issued today.


Hospitalizations

Next, let’s see how hospitals are “managing” with COVID-19 today (extremely frustrated by the Governor’s choice of words). Today, there were 391 patients newly admitted to the hospital for COVID-19 and 48 patients were newly admitted to the ICU. The number of patients currently in the hospital for COVID-19 treatment is 5515, a new record, and this is 72% higher than the height of the summer surge.

The percentage of COVID-19 patients in the hospital compared to all admitted patients is 32.2% for the state. But that varies by region (see right column below). Every hospital region is now classified in the dark red zone, using the US Department of Health and Human Services criteria. Seven of the 14 hospital regions have a percentage of 40% or higher.

For ICU beds, 91.4% of the state’s beds are in use and the HHS Community Profile Report for 07Jan2021 tells us that 45% of the state’s ICU beds are in use by COVID-19 patients, so about half of them. The same report tells us that 41% of the state’s adult ventilators are in use and 16% of the ventilators are in use by a COVID-19 patient. There are 3 hospital regions that are operating at an overage, using all of their ICU beds and then some (E, G and K). Nine of the 14 hospital regions are using >90% of their beds.

Emergency room visits among school-aged children and adults for COVID-19 syndrome continues to surge upward, with no signs of slowing for those 0-4 and those 14 - 22 (high school and college age).


Deaths

There was a net increase of 80 confirmed deaths today from COVID-19. This is higher than usual but not a record. Forty four percent of today’s newly reported deaths came from rural counties and 26% came from nonrural counties outside of the Atlanta metro. At least 10,180 Georgians have died from this disease.

The graph below shows how the 7-day death rate per 100,000 has varied over time for each county type. There’s an increase for all county types today over the past few days, most dramatically for rural counties.

Looking at all confirmed deaths from COVID-19 so far, the death rate per 100,000 residents is more than twice as high in rural counties than in the Atlanta metro.

Hopefully things improve drastically with the vaccine effort and soon. In the meantime, we have a really serious surge of disease going on right now that is overwhelming our hospitals. In the absence of any effort by the Governor to limit disease transmission, we need every Georgian to willingly take steps to limit exposure and transmission on their own. Georgia is on fire right now with COVID-19 and every Georgian needs to grab a bucket of water.


References

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

https://dph.georgia.gov/school-aged-covid-19-surveillance-data

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

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

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.