The Daily Digest, 19Aug2020

Georgia COVID-19 Updates

Good afternoon! In this week’s episode of Public Health for the People I answered kid questions about COVID-19. In it, I cited two resources. One is a fantastic comic book for kids that explains how infections and the immune system collide in the human body. I cannot recommend this book highly enough - I have purchased it for every child I know. I do not know the author nor do I make any money from recommending the book. I’m just a really big fan.

The other resource I mentioned is the New York Times Coronavirus vaccine tracker that keeps us updated on the progress of different vaccine trials.


We have a new state report from the White House Coronavirus Task Force.

First, I’ve included the charts from the most recent report, dated 08/16/2020 (left side) and the chart from the previous report, dated 08/09/2020 (right side). You can see that our testing per 100,000 has doubled in size since last week. Take note that they are using test data from 08-14Aug to make this determination, so the dates and numbers do not align with my report from the Week in Review, which indicated a 40,000 decrease in tests last week. That drop should be reflected in the next White House Coronavirus Task Force report. With the increase in testing noted in this report, there was an associated decrease in the percent positivity rate, a very good thing.

That’s the good news. Let’s move on to the other metrics. For cases, our new case rate per 100,000 increased slightly and remains about twice the national average (216 compared to 112 for the nation). Despite our decline in percent positive test rate, it is still about 4% higher than the national average and twice as high as it should be to contain the virus. So we’re making progress, but we haven’t reached that goal yet. Unfortunately, with a record-setting week for deaths last week, that is reflected in our death rate, with a 27.1% increase in our death rate per 100,000 residents compared to last week. The death rate is also twice the national average (4 compared to 2 per 100,000). Finally, we are moving in the wrong direction for keeping the virus out of skilled nursing facilities (abbreviated as SNFs in the chart) with a 5% increase in cases there this week compared to last week. And our rate of SNFs with at least one case is 2.3 times the national average.

There’s something else that seems hopeful initially but ultimately is not good news in the summary statements (see below). Above the blue line is the summary statement on hospitalizations for the most recent report and the same section is provided below the blue line for the previous report. We’ve seen a reduction in the most recent report of 548 new daily hospital admissions compared to 661 last week. On its face, that seems like really, really hopeful news. However, there’s a sharp reduction in the number of hospitals who are reporting data to the federal government, 65% this week compared to 81% last week. So the hopeful downturn to 548 new admissions per day is most likely a serious undercount of the situation.

There are five fewer metro areas in the red zone this week compared to last week’s report, but the number of counties in the red zone remains the same at 109 of Georgia’s 159 counties. An additional 39 counties are in the yellow zone. In summary, 148 of Georgia’s 159 counties are in either a yellow or red zone (neither is a good place to be). The Task Force’s recommendations for the state from this week’s report are provided below.

They now provide a firm number to guide which counties should consider a mask mandate - it is any county with 50 or more active cases. Hopefully this metric proves valuable to local mayors and county commissions who are having to weigh mask mandate ordinances.

The task force also recommends limiting social gatherings to 10 or fewer people, even among family, with significant cases coming from within the same household. I think that means the Task Force would also not support school settings where classes have more than 10 people.

Lastly, the task force goes on to identify our serious shortcomings in testing infrastructure, even despite our recent gains. They specifically mention the need to shorten turnaround times and again are recommending that the state commandeer university research laboratories to perform testing to support education populations (K-12, community college and university communities).

This is how the Governor responded to the White House Coronavirus Task Force report.

Unfortunately, the numbers he cites are not referenced and they are directly refuted by the White House report. But as has happened before when confronted with bad news, his statements just aren’t supported by data. Citing the 7-day average of new cases being down 26%, I imagine this is based on date of report, which is really a graph that shows us testing output. So he’s actually acknowledging a 26% decrease in testing output - which is supported by his statement that testing capacity is being underutilized. The positive test rate is declining (a good thing) but we aren’t to the goal yet and the federal government still classifies us in the red zone. Hospitalizations do appear to be down about 17% according to the White House report, but the Governor neglects to mention the problem with hospitals not reporting data, giving an undercount of reality. He indicates that our transmission rate is 0.85 but doesn’t mention his reference. In the past, he’s relied on the Rt estimate from the founders of Instagram (Rt.live). I’ve talked about some of the problems with the Rt model before and strongly encourage you to use the model from the Harvard Chan School of Public Health. But even using Rt.live, the transmission rate as of today is 0.95. The Governor is citing 0.85 but there isn’t data to support that. Most of all, however, it is disappointing that he is resorting to partisan attacks now when our deaths are climbing. Coronavirus doesn’t discriminate political affiliation. These are both Republicans and Democrats (as well as Independents and others) who are dying.

I think there is a desire among all Georgians to rally behind progress in this pandemic. We all want to go back to normal life. But the people dying aren’t expendable and shouldn’t be considered that way. Let me be clear that these are *preventable* deaths. They are not the price we should be willing to pay to be able to eat a hamburger in a restaurant. And I think many of us don’t care who has the good ideas - we’re willing to try them, regardless of what their political background is. But we need to let the science lead us out of this scientific problem. The experiment of reopening after just 3 weeks of shelter in place was a bold move, and perhaps worth a try, but unfortunately it just isn’t working as the Governor had hoped. We have been a hot spot for months and now we have the highest daily case rate per 100,000 residents in the nation.

The current strategy just isn’t working. We can’t just wish for things to get better. We need a change. To be very clear, I *want* to rally behind the Governor. I want to rally behind Georgia. As soon as we start making science-driven decisions, I look forward to being the state’s biggest cheerleader.


Today’s update on Georgia

Today there have been some technical challenges for the Department of Public Health daily report. The report didn’t post until about 30 minutes after it usually does and the county by county data was not updated for cases, deaths and hospitalizations in the table or in the downloadable CSV files. Big thanks to DPH for recognizing the problem and quickly resolving it. I know it is a lot of data to compile each day.

Statewide, it was a low testing output day, with 15,378 new results reported. That’s half of the total from yesterday. Of today’s tests, 10.4% were positive - an increase over the past two days. Interestingly, only 70% of today’s new cases came through electronic laboratory reporting when usually it’s around 90%, so it’s possible that we are undercounting the total tests performed as well as the percent positive.

There’s a net increase of 2305 newly reported cases today and 547 of them (or 23.7%) were backdated prior to the 14-day window of uncertainty. The new statewide total is 243,982. To put that number in perspective, the second largest city in Georgia is Augusta-Richmond County with a 2019 population estimate of 197,888 according to the US Census Bureau. The next highest city is Atlanta at just over 500,000. So we’re running out of cities in Georgia with which to compare the case total. Of course, not all of these people are sick at the same time, but sometimes it is hard for people to wrap their minds around these big numbers. When looking at cases per 100,000 by county type in Georgia, the case rate in rural Georgia (2428) is 7.7% higher than the next highest category (nonrural) and it is 43.8% higher than the national average.

There’s a net increase of 235 new hospital admissions today and 26 ICU admissions, compared to yesterday’s numbers.

There was a net increase of 55 deaths today compared to yesterday and unfortunately that is a medium-low day for us now. The new statewide total for deaths is 4849. The updated case fatality rate (CFR) is 1.99%, shown in the gray line and using the left y-axis in the graph below. You can see that as cases began to surge in late June, they diluted the deaths and caused the CFR to fall. Now that our deaths have begun to climb as well, the CFR has plateaued. Let’s hope that continued increases in deaths do not cause the CFR to climb once again.

Of today’s deaths, 28 of them (51%) came from nonrural counties outside of the Atlanta metro. Another 16 came from rural counties. Below we can see how deaths per 100,000 compare across county types and to the national average. Again, rural counties are most heavily impacted when adjusted for population. Their death rate is 41% higher than the next highest category (nonrural counties) and it is 22% higher than the national average.

Again, death from COVID-19 does not discriminate political affiliations. Fighting this pandemic shouldn’t be a political issue. People are dying. In fact, more people have died in Georgia from COVID-19 than who died in the terrorist attacks on September 11th - a day of such loss that it transformed so many of our lives. That these Georgia COVID-19 deaths have been spread out across five months rather than one day does not make them less tragic. Rather, it makes them more tragic. Because we didn’t have the ability to respond quickly to 9/11 to prevent the deaths that happened that day. But we do have the ability to respond quickly to prevent the deaths that are continuing to accumulate in our state and we haven’t. We need the kind of unity and leadership that we experienced after 9/11 to combat an enormous challenge like this pandemic. We need to take this seriously like we took 9/11 too, as ordinary citizens. We grumble about taking our shoes off for airport security, but we do it. Is wearing a mask really that different?


Media

I will be featured on Univision this evening at 6:00 pm and 11:00 pm to talk about the White House Coronavirus Task Force’s report on Georgia.


References

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

White House Coronavirus Task Force report: https://www.ajc.com/news/white-house-says-georgia-now-leads-nation-in-rate-of-new-virus-cases/GXLTMDVSWJGO3EVVFAR7EJT7CA/

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

https://amberschmidtkephd.substack.com/p/the-sunday-week-in-review-10-16aug2020

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

Harvard Chan School of Public Health Rt model: http://metrics.covid19-analysis.org/

NYT Vaccine Tracker: https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html?name=styln-coronavirus-national&region=TOP_BANNER&variant=undefined&block=storyline_menu_recirc&action=click&pgtype=Interactive&impression_id=d7ef0d73-e151-11ea-99f7-7b9f26bf625e

This week’s episode of Public Health for the People


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