The Daily Digest, 22Mar2021
Georgia COVID-19 Updates
Vaccine Update
Nationally, 79.4% of the available doses have been administered, either as a first or second dose. Of the US adult population 31.5% has received at least one dose and 17.1% have been fully vaccinated. Among those 65+, 68.8% have received at least one dose and 41.8% are fully vaccinated. Across all 50 states, territories and other recipients, there are 32,253,143 doses on hand (9720 per 100,000 residents).
Georgia’s usage rate is below the national rate, at 70.5%, but the state has moved up in the rankings for this from #49 last week to #45 this week. There have been 4,553,155 doses delivered to the state of Georgia and 3,207,887 have been administered. It means that Georgia has 1,345,268 doses of the vaccine on hand, unused (or 12,670 per 100,000). This surplus is 30% higher than the national average. But considering how many people have had to cross state lines to get vaccinated, it is probably best to look at doses administered per 100k by state of residence. CDC doesn’t provide that number to us, unfortunately. But perhaps the workaround for this is to look at the percent of total Georgia population with at least one dose or fully vaccinated by state of residence. This takes the confusion out of where a person received a vaccine. Almost 19% of the state’s total population has received at least one dose of the vaccine (#50 in US) and 11% of the state’s total population is fully vaccinated (#48 in US).
According to the US Census Bureau, 23.6% of the Georgia population is children under the age of 18, most of whom are not authorized to get the vaccine. NOTE: teenagers 16+ are authorized to receive the Pfizer vaccine under emergency use authorization (EUA). We could approach herd immunity if every adult in Georgia took the vaccine. But that is unlikely at the moment considering issues of barriers to access and vaccine hesitancy. We will need a vaccine for kids in order to get to herd immunity in Georgia. For this reason, looking at total population is important. But it might also be helpful to look at how well the state is doing with the people who are currently authorized to receive a vaccine under EUA, or as close as we can come with CDC data - the people 18+. Among this group, 24.6% of the Georgia adult population has received at least one dose (#50 in US) and 14.2% are fully vaccinated (#48 in US). These numbers look better than the numbers for the total population and form a sort of “report card” for current strategy. But I think it’s important to keep the total population in mind too, given that herd immunity depends on the entire “herd.”
Let’s compare Georgia’s numbers to the leader, Alaska. In Alaska, 40.8% of the state’s adult population has received at least one dose and 26.2% of the adult population is fully vaccinated.
Governor Kemp is very proud of the state’s efforts to vaccinate the population that is 65+ and this is a bright spot in otherwise lackluster data for the state. According to CDC data, 45.2% of that age group is fully vaccinated in Georgia (national average is 41.2%). Georgia is ranked #18 for this metric, down from #10 last week. Note, the Community Profile Reports now provide a lot of vaccine data in the states tab.
Today AstraZeneca announced some preliminary data in its US trials and that they are preparing to apply for EUA with the US Food and Drug Administration. I think the earliest we will see the clinical trial data will be late April, if previous trends continue. But this vaccine works much the same way as the Johnson and Johnson vaccine but is a 2-dose series. It shows 79% efficacy against symptomatic COVID-19 infection and 100% efficacy against severe disease and hospitalization. It is a good, middle of the pack vaccine if these data are confirmed when we see the clinical trial data.
The World
According to the New York Times Coronavirus Tracker, the SARS-CoV-2 virus that causes COVID-19 disease has sickened >123.4 million people (+3.5 million since last week) and killed at least 2,718,200 (+64,300 in the past week) worldwide as of this morning. For both cases and deaths, the increases this week are greater than the increases during the previous week. So it seems that things are growing more intense.
The US is ranked #56 in the world for average daily case rate per 100,000 people over the past 7 days (last week #54) with a rate of 16 (last week, 17). The top five countries for average daily case rate per 100,000 in the past week are Estonia, San Marino, Czech Republic, Jordan and Montenegro.
For deaths, the US average daily death rate per 100,000 over the past week is 0.32 (previous week was 0.42), and we are ranked #40 in the world for this (last week we were ranked #28). The top five countries for average daily death rate per 100,000 in the most recent week are Czech Republic, Hungary, Montenegro, Bulgaria, and Bosnia and Herzegovina.
So while things may be growing more intense globally, they are not for the US…for now. But this is another reason why it is important to support global vaccination efforts. This pandemic showed us that a new disease is just one airplane ride or cruise ship away from our shores at all times. The more this virus has a chance to replicate unimpeded, the more chance it has to mutate into variants that may cause us additional harm.
The United States
The map above comes from the CDC COVID-19 Tracker on the Community tab, county view. 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. Things are better in the western half of the country, but we see fewer blue counties in the west this week. The eastern half of the US remains intense. In the South, things have gotten better for Mississippi and Georgia, but worse for Alabama. Much of the East coast in particular is more intense this week.
As of this morning, the New York Times coronavirus tracker indicates there have been over 29.8 million cases (+400,000 in the past week) and 542,587 deaths in the US (+17,550 in past week).
According to data from the 21Mar2021 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 Jersey, Rhode Island, New York, Michigan and Delaware. The top five states in the nation for new death rate per 100,000 in the past 7 days are Kentucky, West Virginia, Massachusetts, Georgia, and Texas.
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 21Mar2021.
In the previous week, all of the metrics in this table dropped for Georgia. But this week we saw case rate plateau and deaths increased slightly. The rankings, other than death rate, are largely similar to what they were last week.
Georgia remains in the top 10 for percent of hospitalized patients who are being treated for COVID-19 and new death rate. Chattahoochee county is back in the top 20 counties in the US, ranked #5 for new case rate.
There’s something I want to point out in the national trends which is that test positivity is starting to tick upward for the US. If we look at regions of the country, we can see increases for the West (orange line) and the Midwest (purple line). For the Northeast, it’s plateaued but is not yet increasing or increasing only slightly. The line is obscured by the national trend, so it’s hard to tell. For the South (green line), test positivity has plateaued and might be increasing slightly. Of note, there’s a 14-day window of uncertainty on this graph, so things may change, but it’s something to keep an eye on.
We can also see some interesting trends when we look at testing by age groups. Test positivity is increasing and sharply among 12-17 year olds and 25 - 64 year olds. They are also increasing, but to a smaller degree among 5-11 year olds.
The community profile reports from HHS now provide these age group test positivity data by age group for each state too. I’ve shown you the section for this in the graphic below, with Georgia highlighted. Statewide, the HHS tracks Georgia’s test positivity rate at 5.3%, but there is a big difference when you look at school-aged children with 7.1% test positivity among 5-11 year olds and 10.8% positivity among 12-17 year olds. This indicates that we are missing more cases among these age groups than we are for other age groups at or near 5%. Looking at some of the other states, Georgia doesn’t appear to be unique in this observation. But it’s a good reminder that there might be more disease in children than we currently realize. So continue to encourage good mask wearing and social distancing among kids.
Georgia
We can zoom in on a current view of Georgia using the CDC community transmission criteria. Last week, there were 4 counties in the blue category and 39 counties in the yellow category, with 73% of Georgia’s counties in the substantial or high transmission categories. This week, there are 8 blue counties and 45 counties in the yellow category. That leaves 67% of the state’s counties in the substantial or high transmission categories. So on a county to county level, things got better in the most recent week.
Let’s discuss today’s numbers for Georgia.
Testing: a low day for both PCR and antigen testing. For PCR testing, there were 11,228 new PCR results reported, 4.3% of which were positive. There were 2835 new antigen tests reported today and 9.7% were positive. The graph below shows how PCR and antigen test positivity have compared during that time. It seems that there is more day to day variation in antigen test percent positivity.
It’s interesting that we’re seeing test positivity increase over the past few days for antigen testing, because that’s the test from which a lot of our case increase in the past week has originated. Both graphs below come from the Georgia Department of Public Health. The graph on the left looks only at PCR cases. The graph on the right looks only at antigen cases.
Cases: cases are often lower on Mondays due to weekend effect. Today there was a net increase of 744 newly reported cases (534 by PCR, 210 by antigen test). The 7-day case rate remains 46% above the pre-winter surge baseline.
Hospitalizations: Usually we see small numbers for the weekend that show up on Sunday and Monday. There were 29 new hospital admissions for COVID-19 today (last week, 22) and 3 admissions to the ICU.
According to the HHS Community Profile Report, the Georgia counties with the highest percentage of COVID-19 patients are Paulding, Douglas, Greene, Wilkes and Newton counties.
Deaths: there were 26 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, 42% came from nonrural counties outside of the Atlanta metro and 31% came from rural counties. The state 7-day death rate per 100,000 residents is 50% above the pre-winter surge baseline.
References
https://covid.cdc.gov/covid-data-tracker/#vaccinations
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/2020/us/coronavirus-us-cases.html
https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/operation-strategy.html
https://covid.cdc.gov/covid-data-tracker/#county-view
https://dph.georgia.gov/school-aged-covid-19-surveillance-data
https://www.astrazeneca.com/media-centre/press-releases/2021/astrazeneca-us-vaccine-trial-met-primary-endpoint.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.