The Daily Digest, 08Jul2020

Georgia COVID-19 Updates

There are several troubling developments in the report today - the kind that made me close my laptop and go play with my kids out of shared grief and frustration. So I’m sorry that today’s report is going out later than usual.

We really have reached a point in many counties where we need as many people as possible to resume shelter in place if they’re financially able to do so. Hospitals are surging in COVID-19 patients, hospitals are running out of PPE again, and high school football teams are canceling workouts due to positive cases.


Testing

The Georgia Department of Public Health added a new area on their landing page area that helps to provide the new numbers for the public, rather than making us calculate them ourselves. I think it’s a positive development. But there is something weird going on with the PCR positive rate - the math doesn’t add up.

Below you can see a part of my spreadsheet where I track the testing numbers and you can see the data from today and yesterday. I calculate the “new PCR tests” by subtracting today’s data from yesterday’s data. We know how many new positives there were and you calculate the percent positive rate by dividing the total new positives by the total new PCR tests. So 3420 divided by 20957, which gives 16.3%. But the landing page above says that today’s % PCR Positive rate is 14.8%.

If you read the disclaimer below this section on the page they relate that this table is made of data from Electronic Laboratory Reporting (ELR) and doesn’t account for results from report submissions that were sent through more antiquated means. That’s important because the reason non-ELR submissions were not included in this chart a month ago and why none of us could get the numbers to add up to the current case total was because non-ELR subsmissions do not include negative test results, only positive ones. So I can’t explain why DPH is using a bigger denominator than what this chart provides to calculate % PCR Positive rate. But I know from their previous statements that it is NOT because of the non-ELR submissions. If is was because of the non-ELR submissions, they would factor into the numerator of the fraction since they only report positive results, not the denominator. As a consequence and the % PCR Positive rate would be higher than what I calculated. Instead, their rate is lower than what can be calculated from their own chart data. Hopefully this gets sorted out in the coming days.

Either way, we’re still well above the 5% threshold for PCR test positivity to be successful at containing the virus. You can see how the % positive rate has varied each day below.


Cases

There were 3420 new cases today. This was the second highest positive test day on record for Georgia, following the record set on July 2nd (3472). You can see how new cases reported each day have varied over time. The red dashed line is a 7-day moving average to allow us to see the trend through the noise.

The new statewide total is 103,890. There have been 81,742 cases since the governor reopened the state on 24Apr. For today’s 3420 cases, they were distributed as follows:

Atlanta: 291

Atlanta suburbs: 680

Nonrural: 1065

Rural: 713

Non-Georgia Residents: 714

Unknown declined by 57 as these cases were sorted into their correct county types.

Note that the non-Georgia residents category is comprised of a mix of people who can’t be classified into a county such as migrant workers, immigrant detainees, federal prisoners, Veterans Affairs nursing home residents, and military families living on a military installation. That will be important when we get to the deaths section in a moment.

Below you can see the 7-day increase in counties across the state. At present, there is one county with >75% increase, 17 counties with 50-74% increase and 47 counties with a 25-49% increase over the past 7 days. In short, there are 65 counties (or 40.9% of the state’s counties) experiencing significant growth in cases in the past week.

Depending on which school district you’re a part of and how they’re measuring low/medium/widespread transmission of disease, it would seem that a large portion of the state might not be meeting the transmission requirements for reopening schools. I’ve been getting a lot of questions about schools and tough decisions that parents are having to make. Remember that these are not normal times. We don’t normally go to school during pandemics. So there is no such thing as getting back to normal during a pandemic - instead we have glimpses of normal here and there until it is safe for us to resume life as it once was. The only thing that has changed since the time that every school district in Georgia closed this spring and now is that transmission in our communities has intensified.

Below are the counties of concern for today. To make my list, a county has to have >25% 7-day increase AND a >5% increase in the past 24 hours. However, I have a grace period for counties that dip below 5% for 24 hour increase in case they just had a low testing output day. I am especially concerned about Bibb county tonight with a 10.1% 24 hour increase and a 60.7% 7-day increase. I have no doubt that this information combined with local hospitalization data contributed to the Bibb County school board decision to postpone the first day of school to after Labor Day. I applaud them for applying data-driven decision making.

Although tonight’s list is pretty short, keep in mind that 65 counties are on the verge of making the list - they’re already above 25% increase for 7 days and are just one big testing day away from inclusion. We are not in a good place right now across many parts of the state.


Hospitalizations

Current hospitalizations continue to surge. Today there are 2215 currently hospitalized, which is 119 more than yesterday. As has been the case for the past week, this is a new record for state COVID-19 hospitalizations since Georgia Emergency Management Agency (GEMA) began providing the data to the public. Also noteworthy, with today’s increase my y-axis had to change to accommodate the new numbers, further indicating how big these changes are over time.

And unfortunately the surge isn’t just in hospitalizations and critical care bed use (currently at 82%), but also among adult ventilators. For months, the ventilator usage has hovered around 30%. Today we are at 36% and this has been part of a climbing trend of the past week. In the graph below you can see how ventilators in use (blue) have changed over time. The orange dotted line is the 7-day moving average to allow us to see the trend through the noise.

The concerning thing about these numbers combined with the reports coming from area hospitals and awareness that we are, once again, in a PPE shortage means that we are again putting heavy strain on our healthcare infrastructure. As a reminder, our healthcare workers are heroes, no doubt, but they are not superhuman. They are highly skilled but cannot manufacture beds, masks or respiratory therapists out of thin air.

At present, there is no policy among our communities apart from a county here or there implementing mandatory mask-wearing policies. So our communities are not doing anything to pump the brakes on this increase right now. It is therefore incumbent on us as individuals to really limit our exposures as much as we possibly can.


Deaths

This is the part where things get really hard. Today we had our second pediatric death, in a white 14-year old boy who is listed as a non-Georgia resident. As a reminder, the non-Georgia resident category is comprised of populations like migrant workers, immigrant detainees, federal prisoners, Veterans Affairs nursing home residents, and military families living on a military installation. A 14-year old boy isn’t likely in a federal prison or a resident of a VA nursing home. I’m making a big assumption here, but given his race, I doubt he was an immigrant detainee or a migrant worker. There is a chance this boy was a military kid. My family is a military family. My son is not much younger than this boy who died today (or, at least, we heard about it today). So this is what I meant in the introduction when I said that I had to walk away from the computer and play with my kids. It was too close for me. Regardless of this boy’s circumstances, this is hard news for parents across the state to cope with, especially with schools reopening in a few weeks. But let it be a reminder of the seriousness of this disease.

The 14-year old boy was one of 23 whose deaths were reported today (a low-medium day for us. He was one of two newly reported deaths in the non-Georgia resident category. The new statewide total is 2922.

The next worrying piece of information is what’s happening on the state’s death graph. As a reminder, this graph shows deaths by date of death, not date of report. So it also has a 14-day window of uncertainty, as cases do when they’re graphed by date of symptom onset. As a consequence, our most reliable data are at least 2 weeks old at all times and the deaths will almost always look like they’re decreasing in the 14-day window. But that’s an artifact of the graphing method and delays in reporting. For months now, gratefully, we’ve had declining death rates. However there are things over the three days right at the 14-day demarcation that might be the beginning of an increase.

On 22Jun there were 20 deaths. On 23Jun there were 17 deaths. Then on 24Jun there were 30 deaths. This could be an outlier and things will settle again, we’ll just have to see. The unfortunate thing is that when deaths start to climb, they might match our rate of increase for cases. I don’t mean to sound morbid, but once this increase starts even if we closed everything immediately, the people who are going to die within the next 3-4 weeks are already infected, or someone in their household is. By the time we recognize there’s a problem, it will be too late to make any sort of timely impact.


Media

Today I was interviewed by WUGA 91.7 FM out of Athens for their show, Athens News Matters, to discuss the latest trends on COVID-19. That program is scheduled to air this Friday at 1:00 pm if you’re interested in tuning in.


References

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

https://gema.georgia.gov/document/document/sitrep-78/download

News links are linked throughout today’s update.

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