The Daily Digest, 23Nov2020

Georgia COVID-19 Updates

During this week of Thanksgiving, it’s customary to reflect on things for which we are grateful. I know that 2020 has been a train wreck of a year and most of us would rather forget much of it. However, I want to take a moment to tell you about the things that inspire gratitude for me.

  • Our public health workers

  • Our healthcare workers

  • For all other city/county/state/federal administrators that are trying their best to navigate through challenging circumstances.

  • For the scientists who have been working around the clock to develop the vaccine and the therapeutic drugs that will save lives or ease the suffering of so many. The advent of these mRNA vaccines will have far reaching impacts on development of vaccines for so many other pathogens of concern.

  • For the everyday people who have worked to serve their communities - teachers, clergy, grocery store staff, food banks, etc.

  • For my readers and for all who have been willing to learn and adapt in the face of this challenge. I was commenting to someone today regarding how PROUD I am of our communities for gaining scientific literacy and using data to make their decisions. On January 1, 2020, I would bet most of you didn’t know what a 7-day moving average or 14 day window of uncertainty was. Or what PCR is. I bet you wouldn’t have been able to tell the difference between quarantine and isolation. But now you can. And as painful as this pandemic has been, I am hopeful that we have all learned some new things about the ways that viruses spread so that we can lead more healthy lives in the future, beyond the pandemic. And I hope that we all can go forward making data-driven decisions regarding a whole host of challenges.

This week as I’m writing more open records requests or emails to others working in this field, I am adding notes of thanks and appreciation. If you have time this week, I would encourage you to send a note of thanks to the people working at the Department of Public Health, your local hospital, etc. Morale is not great right now, and I think a message of thanks and solidarity would go a long way.


The World

Globally, the SARS-CoV-2 virus that causes COVID-19 disease has sickened > 58.8 million people (+4.2 million since last week) and killed at least 1,389,500 1,320,100 (+69,400 in the past week) as of this morning.

The US is ranked among the top color categories for hot spots. Things are similarly intense in parts of Europe, Jordan and Armenia. We are ranked #17 in the world for average daily case rate per 100,000 people over the past 7 days (last week, 23rd) with a rate of 51.6 compared to 45.3 last week. The top five countries for average daily case rate per 100,000 in the past week are Georgia, Luxembourg, Montenegro, Serbia, and Andorra.

For deaths, our average daily death rate per 100,000 over the past week is 0.5, higher than last week (0.3), and we are ranked #33 in the world for this (last week we were ranked #41). The top five countries for average daily death rate per 100,000 in the most recent week are Slovenia, Bosnia and Herzegovina, Bulgaria, Belgium, and North Macedonia.


The United States

As of this morning, there have been over 12.3 million cases (+1.2 million in the past week) and 256,755 deaths in the US (+10,672 in past week). Keep in mind that both of these numbers are probably an under-count of the situation in our country. The CDC recently added a county view to it’s COVID Data Tracker site. The best data are recent (i.e. in the past 14 days), local and adjusted for population. The CDC resource features all of those qualities. The problem I have is that it doesn’t allow you to see the entire continental US at the same time. So, for the time being, I’m still using the New York Times COVID data tracker to show you the maps of the world and the US.

The top five states in the nation for average daily case rate in the past 7 days are North Dakota, Wyoming, South Dakota, New Mexico and Minnesota. The top five states in the nation for average daily death rate in the past 7 days are South Dakota, North Dakota, Guam, New Mexico, and Montana.

The table below tells you where we are this week and how that compares to the previous week (in parentheses). The data for everything but the percent of inpatients with COVID-19 comes from the New York Times coronavirus tracker and is current as of this morning. The hospital data comes from the HHS Protect Public Data Hub and was last updated on 23Nov2020.

Here’s a look at how COVID-19 is contributing to hospital admissions. The map below shows how many inpatient beds in each state are occupied by COVID-19 patients.

From my perspective, checking this map weekly, it’s wild to see so much purple. We literally have never seen this much hospital demand for COVID-19 on such a widespread basis. This week the national proportion of hospital beds in use for COVID-19 is up 42%. And we haven’t even gotten to Thanksgiving and its effects yet.

Next, let’s look at how seasonal influenza is impacting different states across the US. This week Iowa jumped from Moderate to Very High. Things also ticked upward for North Dakota, Idaho, New Mexico and Oklahoma. Things are steady among the other states in the US this week. You can consult FluView any time you’d like to see this map and other data visualizations.

Georgia remains in the most minimal of the minimal section. Keep in mind that influenza is not a mandatory notifiable disease for public health departments like COVID-19 is. But there is a robust surveillance network for tracking trends. So we aren’t likely to see case counts and death counts like we do for COVID-19 because we are seeing estimates for influenza rather than actual numbers. Both diseases feature a wide spectrum of disease severity that can make it hard to identify all cases. You can read the weekly report from Georgia Department of Public Health here.


Georgia

Normally I would provide the Harvard Global Health Institute tool for assessing disease trends at a county level in Georgia. But they are only using PCR-based cases to compare counties because they rely on the same data source as the White House Coronavirus Task Force - USA Facts which is a repository of the data that each state wishes to share. Georgia only shares their PCR-based cases to this repository. So, using the same calculation method and color coding, here’s what the Harvard map would look like if antigen cases are included (as CDC, Johns Hopkins University, and New York Times do). Click on the map to be routed to a live image where you can click or hover over your county of interest.

There are 84 counties in the red category, 57 in the orange category and 15 counties are in the yellow zone. There are 3 counties in the green category.

For today, here are the net increases for each key metric for Georgia.

  • Testing: 26,729 new PCR tests (a high number for a Monday), 7.5% were positive. 111% of today’s cases were identified through electronic laboratory reporting (ELR). Remember, the state de-duplicates those who are tested positive more than once. The state does not provide data regarding the number of antigen tests performed.

  • Cases: 1924 cases were newly reported today (1809 by PCR, 115 by antigen test). Mondays are often low reporting days due to weekend effect, but today’s Monday case number is 54% higher than last Monday. So we are seeing an escalation over time even on our low reporting days. The new statewide total is 451,056 (406,220 by PCR, 44,836 by antigen test). Of today’s cases, 36% came from nonrural counties outside of the Atlanta metro. Atlanta suburb counties were the second highest contributor, with 23% of cases.

  • Hospitalizations: 26 new COVID hospital admissions and 4 new ICU admissions. These are low numbers for Georgia, but not unusual for a Monday. There are currently 1907 COVID patients hospitalized and this number is 210 additional patients compared to last Monday. In fact, we haven’t seen a number this high since 01Sep. We are effectively reversing the gains we made after the summer surge. Adult ventilators are being used at 28% of our state’s capacity as of today, and this is consistent with where we’ve been recently and where levels were prior to the summer surge.

    There are five hospital regions using >90% of their ICU bed capacity - regions C (90.7%), E (94.3%), G (94.9%), L (300% <- I suspect this is a typo) and region N (95.3%).

  • Deaths: 17 newly reported confirmed deaths, a low day for us but high for a Monday. It should be noted that nursing homes typically do not report over the weekends, and Mondays tend to be low count days for this reason. Fifteen of the deaths reported today came from outside of the Atlanta metro with nonrural counties leading with 10 newly reported deaths. The new statewide total is 8644.

The Georgia Department of Public Health County Indicators report is released on Mondays. This report provides a lot of county level data, including testing, confirmed and probable cases (i.e. those identified through the rapid antigen test) and the counties of concern as far as DPH is concerned.

Here’s a comparison of where the emerging counties are (this is code for “counties of concern”) last week compared to this week, on the right.

The new map agrees in large part with the red-yellow-green map inspired by the Harvard Global Health Institute but adding antigen cases. Wee see a lot of counties filling in in the northern half of the state. But the state map shows concern along the Georgia coast.

That’s it for today. See you on Wednesday!


References

https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html

https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html?name=styln-coronavirus&region=TOP_BANNER&block=storyline_menu_recirc&action=click&pgtype=Interactive&impression_id=97ba8610-2dbb-11eb-a0bf-4f82d045d121&variant=1_Show

https://countyindicatororeport.s3.amazonaws.com/county_indicator_report_20201123.html#emerging-counties

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

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

https://www.cdc.gov/flu/weekly/fluviewinteractive.htm

https://protect-public.hhs.gov/pages/hospital-capacity


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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.