The Daily Digest, 25Jan2021

Georgia COVID-19 Updates

Vaccine Update

Here's a link for healthcare workers to register for an appointment to get their vaccine if they are not part of a larger hospital system that is providing them (https://dph.georgia.gov/provider-vaccine-registration-ph-district-list).

This week, vaccination eligibility has expanded to first responders and people >65 years of age although the rollout is not without problems. DPH has provided this vaccine locator so that you can find the enrolled vaccine providers in your area and make appointments, if vaccine is available.

We can see how the US (and Georgia) is doing with respect to the vaccine administration effort using the CDC’s COVID-19 Data Tracker. Nationally, 53% of the available doses have been used to initiate a person’s 2-dose vaccine series (last week it was 34%). Of those who have started the vaccine series, 14.7% have had their second dose. In long term care facilities (LTCFs), there have been 2.57 million doses administered (of the 41.4 million administered overall so far). Vaccine administration in LTCFs is one area where Georgia is doing rather well. The CDC COVID-19 Vaccine Tracker does not give us LTCF administration adjusted for population, but in terms of people in LTCFs with at least one dose of the vaccine, Georgia is ranked the #10 state in the nation.

The CDC COVID-19 Vaccine Tracker provides a map of the US for how many people have received at least one dose of the vaccine, adjusted for population. Using this method of looking at vaccine data, Georgia’s vaccination rate has increased 161% in the past week, which is really, really good news. For the state, 534,161 people have initiated the two-dose series. 59,965 people have completed the 2-dose series in Georgia. It is great to see that upward momentum. Georgia is still ranked in the bottom half of the US, but moved up from #50 to #32 in the nation this week, with a vaccination rate that is 5031 per 100,000 residents. The top three states for doses administered per 100,000 residents are Alaska (10652), West Virginia (9140), and New Mexico (7756). The bottom three states are Missouri (3958), Idaho (4053), and Nevada (4195). This week, Georgia has administered 1+ doses per 100,000 at a rate that is 53% less than the leader (Alaska). But last week the leader’s rate was 3x higher. So we’re improving.


Public Health Advocacy

Last week, I made an argument that we needed to contact our elected representatives in the Georgia legislature to advocate for increased funding for the Department of Public Health. This was after the Governor’s budget proposal indicated that public health wasn’t a priority for the state with only a negligible increase in funding proposed (during a pandemic!). I wanted to bring up some talking points for those who may be new to political advocacy.

Contact information

You can find out who your Georgia House and Senate members are here. In addition, we also need to be contacting the members of the Georgia House and Senate appropriations subcommittees that will determine the budget allocation for the DPH. Non-committee representatives and senators then get to vote up or down on what the committee recommends. So, really, the subcommittee is vitally important. The members of the House Health Subcommittee on Appropriations are Debbie Buckner, Matt Dollar, Lee Hawkins, Carolyn Hugley, Butch Parrish (Chairman of the subcommittee), Jesse Petrea, Ron Stephens, and Darlene Taylor (Vice-Chairman of the subcommittee). For the Senate subcommittee on appropriations for human development and public health, the members are Dean Burke, Emanuel Jones, Kay Kirkpatrick, Butch Miller, Nan Orrock, Lindsey Tippins, and Ben Watson.

Each of those links will take you to their profile page with contact information. Phone calls are typically more impactful than emails. But you can do either *or* both. When you contact these individuals, understand the “game” you’re playing: you are a number being counted. When their staff runs through the number of constituent contacts regarding a certain issue, we want public health to be a top issue that they’re hearing about. So you can count just once via email. Or you can count 2-3 times if you email, call their capitol office and their district office. You can count on multiple days, too. It reminds them that public health is important to their constituents and to the state as a whole (if you’re contacting the subcommittee). When you call, remember that you are most likely going to be speaking to a staffer, not the elected official themselves. They are there to take a message and you are unlikely to face an argument, just someone writing down your concern. So please be polite and respectful. The same is true for email.

What to say

I know from experience that this part can be intimidating. But I promise you that it’s not as scary as it seems. Go into it with a plan (i.e. a script) and you’ll get better with practice. Here’s what I recommend for the subcommittee members. These are the people you need to contact most right now. Feel free to modify the script, especially if you have had personal impacts from COVID-19 or other public health concerns.

Hi, my name is (____) and I am a registered voter who lives at (____). I’m contacting you today to ask you to consider increased funding for the Georgia Department of Public Health, above the Governor’s budget request, since you’re a member of the (House/Senate) appropriations subcommittee that oversees DPH. This pandemic has highlighted the need for us to shore up public health infrastructure from top to bottom so that we can combat not just COVID-19 but many other areas where Georgia lags behind other states. Thank you for your time and your service to the state.

When it comes to state representative or state senator that represents your district, we still need to contact them, even though they’re not deciding the actual dollar amount given to DPH. They’ll just vote to approve or deny the subcommittee’s recommended budget. That’s because their staffers will also let them know how many constituents have contacted them about public health and then the elected person will contact the appropriations subcommittee to let them know also. So now the subcommittee is hearing not just a request for additional funding, but a resounding demand for more funding, from all across the state including their own office. Here’s what I suggest you say:

Hi, my name is (____) and I am a registered voter who lives at (____). I’m contacting you because I’m very concerned about the state of public health in Georgia. This pandemic has highlighted the need for us to shore up public health infrastructure from top to bottom so that we can combat not just COVID-19 but many other areas where Georgia lags behind other states. I’ve been in touch with members of the House and Senate appropriations subcommittees that determine the budget for the Georgia Department of Public Health and asked that they increase funding for public health. Please do all within your power to support increased funding for the DPH as well. Thank you for your time and your service to the state.

Guess what? Knowing that their constituent has taken the time to look up who their representation is and the members of an obscure appropriations committee is going to make your Representative and/or Senator take notice. It signals that you’re serious not just about public health, but about voting. Again, be respectful. You are already making a serious point just by contacting them. You don’t need to shout or argue. I’ve done the hard part of looking up the subcommittee members. You just need to contact them (and the representative/senator who represents your district). Hopefully our collective efforts work. When that time comes, we’ll do this again, but to thank the members for their support of public health. We need that support not just for this year but the years to come.


The World

According to the New York Times Coronavirus Tracker, the SARS-CoV-2 virus that causes COVID-19 disease has sickened >99.4 million people (+4.3 million since last week) and killed at least 2,134,000 (+102,300 in the past week) worldwide as of this morning.

Things have improved this week for the US and Canada in terms of average daily cases per 100,000. We are ranked #13 in the world for average daily case rate per 100,000 people over the past 7 days (last week, #11) with a rate of 51 compared to 66 last week. So our case rate has improved. The top five countries for average daily case rate per 100,000 in the past week are Gibraltar, Portugal, Andorra, Israel and Spain.

For deaths, the US average daily death rate per 100,000 over the past week is 0.93 (previous week was 1.0), and we are ranked #17 in the world for this (last week we were ranked #15). The top five countries for average daily death rate per 100,000 in the most recent week are Gibraltar, Portugal, United Kingdom, Slovakia and Czech Republic.


The United States

The map above comes from the New York Times Coronavirus Tracker. As of this morning, there have been over 23.9 million cases (+1.2 million in the past week) and 397,612 deaths in the US (+21,595 in past week). Keep in mind that both of these numbers are probably an under-count of the situation in our country.

This week things are a lot better for many areas. It’s most noticeable in California, Utah, Wyoming, Kansas and Oklahoma. According to data from the 24Jan21 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 Arizona, South Carolina, Rhode Island, Georgia and New York. It is the first time since the summer surge that Georgia has been in the top 5. South Carolina and Georgia are the only Southern states in the top 10. The top five states in the nation for average daily death rate in the past 7 days are Arizona, Alabama, Pennsylvania, New Mexico, and Georgia. In addition to Alabama (#2) and Georgia (#5), Louisiana and Mississippi are also in the top 10, at number #7 and #10, respectively. Two weeks ago, Georgia was ranked #37, so we’ve ascended quite a long way in a short period of time.

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 24Jan2021.

Georgia has seen a continued increase in its ranking for death rate per 100,000. Georgia currently has one county (Chattahoochee) in the list of the top 20 counties for disease rate in the nation and it is ranked #4.

Influenza-like illness in almost all of the US remains minimal, but Tennessee is in the “low” category (next level above minimal). You can consult FluView any time you’d like to see this map and other data visualizations. You can read the weekly report from Georgia Department of Public Health here.


Georgia

Normally, in this part of the newsletter I would give you an updated risk map for Georgia, calculated and formatted in the same way as the Brown University School of Public Health but including Georgia’s antigen cases (which DPH does not for any of their graphs or maps). However, the map isn’t particularly interesting this week since most of the state is in the red category, or 155 of 159 Georgia counties. The four counties in the orange zone are Marion, Schley, Wheeler, and Wilcox.

Let’s discuss today’s numbers for Georgia.

  • Testing: a lower day for PCR testing, not unusual considering it is a Monday. There were 26,036 new PCR results reported, 15.2% of which were positive. Antigen testing identified 9.9% of today’s cases.

  • Cases: cases are often lower on Mondays due to weekend effect. Today there was a net increase of 3917 newly reported cases (3530 by PCR, 387 by antigen test). Of today’s newly reported cases, 32.4% came from Atlanta suburb counties followed by 31.5% coming from nonrural counties outside of the Atlanta metro.

  • The top five counties for 14 day case rate are Madison (2706), Chattahoochee (2310), Jackson (1645), Wilkes (1636) and Taliaferro (1627). Other than Jackson county (nonrural), these are all rural counties.

  • Hospitalizations: there are 4879 patients currently hospitalized for COVID-19. This is a decrease of 12% compared to a week ago. According to the HHS Community Profile Report, the top 5 counties for percentage of inpatient beds occupied by a COVID-19 patient are Dodge, Crisp, Greene, Peach and Grady.

    COVID-19 patients represent 29.6% (-11% since last week) of all patients currently hospitalized in Georgia and this varies by hospital region. In 2 (last week 6) of the 14 hospital regions in Georgia, COVID-19 patients represent >40% of all patients currently hospitalized. Georgia is #3 in the nation for this metric behind California and Arizona.

  • Just under 90% of the ICU beds in the state are full. According to HHS, 47% of Georgia’s ICU beds are occupied by COVID-19 patients. Three regions are coping with an overage, regions A, E, and G. Eight regions (of 14) are using >90% of their ICU beds. Last week, it was twelve regions. So there are several signs of improvement here.

    There were 113 new hospital admissions for COVID-19 today and 4 admissions to the ICU. We typically see lower numbers on Mondays. But if we look at how new COVID-19 admissions have varied over time, we can see that the trend is similar to the summer surge. But we are seeing less weekend effect this time around - notice that the bottoms of the purple line are a lot higher this time than during the summer. It’s unclear if this is due to more disease over the weekends or better data reporting from hospitals over the weekend. I tend to favor the latter, since the virus doesn’t take weekends off.

  • Deaths: there were 53 newly reported confirmed deaths compared to yesterday’s total. Death reporting on Mondays is typically low due to weekend effect. For today’s deaths, 35.8% came from nonrural counties outside of the Atlanta metro and 30.2% came from rural counties. Twenty-two percent of today’s deaths came from the Atlanta suburbs and 9% came from the Atlanta counties of Fulton and DeKalb. The state 7-day death rate per 100,000 residents is 25% higher than the summer peak.

The 21Jan2021 School Aged COVID-19 surveillance data report came out today from DPH. We’ll go over two of the graphs today, but I encourage you to look at the report’s other figures if you have time. First, the graph below shows us how case rate per 100,000 (using PCR and antigen tests) have trended over time for different school-aged populations.

The rate remains very, very high for college aged adults, but it has decreased slightly. However, cases have not yet declined for children 0 - 17. The next graph shows how test positivity is trending for each of these age groups over time. There was a time in November when at least the 0-4 year olds were at or near the 5% goal. But apart from that span of time, no school-aged group has been tested widely enough to ensure we aren’t missing cases. In fact, the test positivity rate is highest for those 5-17 years of age. In other words, we aren’t testing nearly enough K-12 aged students and our rate of missing cases is growing, not decreasing.


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://dph.georgia.gov/school-aged-covid-19-surveillance-data


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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.