The Daily Digest, 08Mar2021

Georgia COVID-19 Updates

Vaccine Update

Nationally, 77.6% of the available doses have been administered, either as a first or second dose. Georgia’s usage rate is below the national rate, at 68.8% (#48 in the US). There have been 3,437,635 doses delivered to the state of Georgia and 2,366,573 have been administered. It means that Georgia has 1,071,062 doses of the vaccine on hand, unused. Vaccine eligibility expanded today so perhaps the state was stockpiling doses to prepare for a big surge in demand today. But there is no need to hold stockpiles of the vaccines for second doses. The supply problem has been remedied with vaccines shipped increasing weekly and states getting a 3 week heads up on what is coming so they can plan. Furthermore, I hope we can get more insight as to why Georgia is so slow at this compared to other states. In the past, Governor Kemp has stated that there just isn’t enough vaccine to meet demand. But that doesn’t appear to be the case when the state has >1 million doses on hand. Eleven states plus the District of Columbia have administered at least one dose to >20% of their population. By comparison, Georgia is ranked #50 in the US for this, having administered at least one dose to 13.4% of its population.

I think we need to be asking where these doses are, why they’re being held in reserve, and what the plan is for correcting this problem. The challenges that Georgia is facing are challenges in all 50 states. What is unique to Georgia that explains its poor performance?

The Governor has done away with the phases of vaccine eligibility, citing confusion between what the state was doing compared to the the recommendations of the Advisory Committee on Immunization Practices. Instead, they’ll just make announcements about eligibility when they’re ready. This is problematic for a few reasons. First, I think we can all appreciate that we may need to wait our turn for a vaccine. But it’s harder to be patient for that wait when we don’t know our place in line. We need a roadmap of prioritization - what will be the sequence of eligibility going forward? Even if we don’t know exact dates when those people will be eligible it helps to tell us our place in line but also to ensure transparency in decision making. Right now, the governor is the sole gatekeeper for vaccine eligibility. With no public roadmap, we don’t have any assurance that future eligibility will be based on science or whether it will be impacted other priorities (including politics). I’m not saying that’s what the governor is doing, but the optics aren’t good. Being vague on this hurts public trust in the process at a time that we desperately need public buy-in. We are already having to combat disinformation and hesitancy on taking the vaccine in the first place. I think it is in the state’s interest and in the Governor’s interest to come up with a prioritization list and make it publicly available to ensure trust in the process.

CDC issued new guidance today on what the “new normal” looks like after vaccination. As predicted, they told us that fully vaccinated people can gather unmasked. But I would add that you should keep these gatherings small and grow slowly until we get community transmission down to a better level. But, hey! That’s a great incentive to get vaccinated and spend time with friends and family who are vaccinated too. The second piece of guidance that said that fully vaccinated people could gather with unvaccinated people from a single household unmasked if the unvaccinated people were at low risk of COVID-19 complications. NOTE: this is not a free pass to ignore pandemic precautions. It’s a “know your risk” sort of statement. I worry that this second piece of guidance is going to be misinterpreted and abused. To me, this second piece of advice sounds like continue to limit your interactions to your quarantine pod or bubble, but you’re safer now than before if some of you are vaccinated. Or perhaps you can expand your bubble to one additional family now that you’re vaccinated. But I’m not sure the public will read it that way. Especially with kids, it’s hard to predict who will have severe complications and seemingly healthy adults can end up with long haul COVID-19, even if they don’t require a hospital stay. CDC still recommends that vaccinated individuals continue to mask and observe social distancing when in public. I don’t think this masking and social distancing guidance will last forever, but until community transmission lowers to low-moderate levels throughout most of the region or country. In light of the new guidance, just remember that nothing we do here is risk free, given how much transmission we have going on in the community. However, your risk may be reduced the more you surround yourself with other vaccinated individuals.

To be considered fully vaccinated, you need to be 2 weeks past completing your immunization(s). For Pfizer and Moderna, that’s 2 weeks after the 2nd dose. Since the Johnson and Johnson vaccine is just one dose, it’s 2 weeks after receiving that dose.

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The World

According to the New York Times Coronavirus Tracker, the SARS-CoV-2 virus that causes COVID-19 disease has sickened >116.9 million people (+2.8 million since last week) and killed at least 2,593,500 (+61,500 in the past week) worldwide as of this morning.

The US is ranked #48 in the world for average daily case rate per 100,000 people over the past 7 days (last week #40) with a rate of 18 (last week, 20). The top five countries for average daily case rate per 100,000 in the past week are Czech Republic, Estonia, Montenegro, San Marino and Malta.

For deaths, the US average daily death rate per 100,000 over the past week is 0.52 (previous week was 0.62), and we are ranked #24 in the world for this (last week we were ranked #14). The top five countries for average daily death rate per 100,000 in the most recent week are Czech Republic, Slovakia, Montenegro, Hungary, Antigua and Barbuda.

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The United States

The map above comes from the 07Mar2021 Community Profile Report (executive summary, PDF). I’ve changed to this kind of map because it still provides county level data for Iowa, whereas New York Times has stopped reporting county-level data for that state. As of this morning, the New York Times coronavirus tracker indicates there have been over 29 million cases (+400,000 in the past week) and 524,652 deaths in the US (+11,673 in past week). Keep in mind that both of these numbers are probably an under-count of the situation in our country.

According to data from the 07Mar2021 HHS Community Profile Report (the source document for the White House Coronavirus Task Force reports), the top five states in the nation for new case rate per 100,000 residents are New York, New Jersey, Rhode Island, Arkansas and Florida. Georgia is ranked #7. The top five states in the nation for new death rate per 100,000 in the past 7 days are Virginia, Oklahoma, Georgia, Texas and California.

The table below tells you where we are this week and how that compares to the previous week (in parentheses). The data for everything comes from the HHS Community Profile Report from 07Mar2021.

Georgia remains in the top 10 for case rate, death rate and percent of hospitalized patients who are being treated for COVID-19. That’s despite decreases for case rate and percent of inpatients with COVID-19 within the state. That means that even though things are getting better for Georgia, they are getting better to greater degrees for other states. Test output rose 16% for Georgia while it held steady for the nation. Georgia is 40th in the nation for tests per 100,000.

Test positivity is trending down across the nation, but it is highest in the South.

CDC recently gave us new guidelines on what it considers to be high, substantial, moderate and low levels of community transmission to inform school reopening decisions. But those thresholds can inform us how our communities are doing even outside of the school decision making. The map below looks at the combined community transmission indicators that looks at both case rate and test positivity. Red and orange are considered the danger zone, yellow is safer and blue is safest. So even though things are a LOT better than they were, I want you to see and realize that we remain at a very high rate of community transmission. It reminds me of the frog in boiling water story. Briefly, if you put a frog in boiling water, it will immediately jump out to save itself. But if you put a frog in a pot and bring it slowly to a boil, the frog might not realize it is in danger. Given how red and orange much of the country is, we might be just below a boil and not sense it.

However, things ARE getting better. The graph below shows how the number of counties in each of these categories has changed over time since August. Clearly the winter surge was massive, affecting just about every county in the US. But we can see that counties are emerging from that high community transmission level. We haven’t seen counties return to pre-winter surge baseline. But this graph makes me hopeful.

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Georgia

The Brown University School of Public Health tool now appears to include antigen cases but removes non-Georgia resident cases in its calculations. And that makes sense when you’re looking at county-level risk. This is just another way to grade a county’s risk or level of community transmission but it is exclusively based on case rate. Unlike the map and graph shown in the section above, it does not factor in test positivity. Last week there are 71 counties in the red category, 77 in the orange category, 9 in the yellow category and 2 in the green category. This week there are 33 counties in red, 85 counties in orange, 38 counties in yellow and 3 counties in the green category. So there have been some shifts and generally all in a good direction.

Let’s discuss today’s numbers for Georgia.

• Testing: a really low day for PCR testing, lower than most Mondays we’ve had recently. There were 13,948 new PCR results reported, 6% of which were positive. There were 6409 new antigen tests reported today and 15.1% were positive. We only started to get antigen test output over time a couple of weeks ago to allow us to track percent positivity. But the graph below shows how PCR and antigen data have compared during that time. It seems that there is more day to day variation in antigen test percent positivity.

• Cases: cases are often lower on Mondays due to weekend effect. Today there was a net increase of 1444 newly reported cases (741 by PCR, 703 by antigen test). So when about half of the cases were identified by antigen test, the antigen test positivity rate starts to matter a lot more.

• Hospitalizations: Usually we see small numbers for the weekend that show up on Sunday and Monday. There were 39 new hospital admissions for COVID-19 today (last week, 50) and 6 admissions to the ICU (same as last Monday).

  Some happy news to share is that there is not a single hospital region in Georgia today that is using >90% of their ICU beds. This happened last Monday too. Only region N is in the red zone for COVID-19 patient census.

  

• According to the HHS Community Profile Report, the Georgia counties with the highest confirmed COVID-19 admission rate per 100 beds are Evans, Irwin, Camden, Troup and Paulding counties.

• Deaths: there were 42 newly reported confirmed deaths compared to yesterday’s total and 0 probable deaths. Death reporting on Mondays is typically low due to weekend effect. For today’s deaths, 40% came from nonrural counties outside of the Atlanta metro and 21% came from rural counties. The state 7-day death rate per 100,000 residents is 165% above the pre-winter surge baseline.

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References

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

https://www.npr.org/sections/health-shots/2021/01/28/960901166/how-is-the-covid-19-vaccination-campaign-going-in-your-state

https://beta.healthdata.gov/download/gqxm-d9w9/application%2Fpdf

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

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

https://www.nytimes.com/interactive/2021/us/college-covid-tracker.html

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html

https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/operation-strategy.html

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

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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.