The Daily Digest, 26Oct2020

Georgia COVID-19 Updates

The World

Globally, the SARS-CoV-2 virus that causes COVID-19 disease has sickened > 43.1 million people (+5.5 million since last week) and killed 1,154,900 (+40,800 in the past week) as of this morning.

The US is ranked in the top color category for hot spots, where the dark red represents counties with >14 average daily case rate per 100,000 for the past week. Things continue to escalate in Europe. We are ranked 33rd in the world for weekly case rate over the past 7 days (last week, 36th). Our weekly case rate per 100,000 is 147 (up from 119). The top five countries for case rate per 100,000 in the past week are Andorra, Czech Republic, Belgium, Slovenia, and Armenia.

For deaths, our weekly death rate per 100,000 rose to 1.7 (last week, 1.5) and we are ranked #30 in the world for this (up from #32 last week). The top five countries for death rates per 100,000 in the most recent week are Andorra, Czech Republic, Argentina, Montenegro, and North Macedonia.


The United States

As hot spots go, they didn’t move that much this week but got more intense. They are mainly concentrated throughout the Midwest. Wisconsin is more filled in than last week. But the increases are also being seen in Utah and west Texas. As of this morning, there have been over 8.7 million cases and 225,158 deaths in the US. Keep in mind that both of these numbers are probably an under-count of the situation in our country. Georgia has cooled in the map above, relative to last week, but they do note increases in northwest Georgia and the rural counties of southeast Georgia. Note, the New York Times coronavirus tracker *IS* now including the antigen test-identified positives that Georgia DPH reports each Monday in the County Indicators Report.

Cases: Georgia is ranked #34 in the nation for 7-day case rate per 100,000, an increase from #36 last week. Our case rate is 109 per 100,000 in the past 7 days (up from 95 last week). Of the top 10 states for 7-day case rate per 100,000, none are in the South.

Georgia has no counties in the top 20 counties in the nation list for cases per 100,000 in the past week. We also don’t have any cities in the top 20 for case rate per population.

Testing: In the past week, Georgia increased slightly in the rankings from 41st in the nation (188 tests performed per 100,000 in the past 2 weeks) to 40th in the nation, with a testing rate of 198 tests per 100,000. The Harvard Global Health Institute, estimates that Georgia is performing at 46% of the ideal testing target (down slightly from 48% last week).

Hospitalizations: Georgia is now ranked #4 in the nation (up from #6 last week) for proportion of inpatient beds occupied by COVID patients at 9.8% (up from 8.9% last week). The top three states in the nation for this metric are North Dakota, South Dakota and Montana. These data come from the Health and Human Services dashboard which was last updated this morning (26Oct2020).

Deaths: We have slid down in the rankings for death rate per 100,000 in the past 7 days, from #15 in the nation last week to #33, with a death rate of 1.6. There is only one southern state in the top 10, Tennessee (ranked #10). It’s certainly good news to see our ranking decline, but our death rate itself didn’t really decline this week. So it’s a sign that things are much more intense in other states.

Influenza: Here’s the latest look at FluView, showing how influenza-like illness compares across states. The map below depicts how states compare when considering the average percent of outpatient (meaning, not warranting a hospital admission) visits for influenza-like illness for the current week compared to non-influenza season weeks.

Compared to last week, ILI activity decreased in Iowa, West Virginia and North Carolina. But we saw an increase for Connecticut. 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

Here is how the state of Georgia is looking based on the risk tool from the Harvard Global Health Institute. The color coding is explained below the map.

Note that the color categories for these counties are not comparable to the color categories in the White House Coronavirus Task Force reports. The former is concerned with average daily case rate per 100,000 in the past week. The latter is concerned with weekly case rate per 100,000.

There are some noticeable shifts this week. There’s more red along the border with Alabama, including Polk, Chattahoochee, Early, and Miller. There’s been some shifts in the southeast corner of Georgia. Clinch county has remained red, but the neighboring counties have decreased into the orange or yellow categories. There are three green counties which is the same as last week. Meanwhile, there are 49 yellow counties this week, compared to 61 last week. For yellow counties, there is community spread that might be manageable with adequate testing and contact tracing. These counties include some of our most populated ones such Gwinnett, but Gwinnett is right at the threshold for being colored orange. There are 107 counties have a daily average of >10 cases per 100,000 people which are color-coded orange and red (up from 95). So they remain counties of concern. There are some populated counties classified as red right now: Walton, Floyd, Whitfield, and Bartow.

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

  • Testing: 16,356 new tests (a low day for us, but typical for a Monday), 7.2% were positive. 124% of today’s cases were identified through electronic laboratory reporting (ELR), so there are a few duplicate results in today’s report. The state counts tests regardless of whether they come from the same person in their calculation of percent positive rate - it is all positive tests divided by all tests performed (positive and negative). However, multiple positive tests from the same person are de-duplicated when case counts are tallied. So the case count is where the correction is made for duplicates. Only 5% of the newly reported cases were backdated prior to the 14d window of uncertainty. So 95% of the cases reported today are recent.

  • Cases: 958 cases were newly reported today. Mondays are often low reporting days due to weekend effect, so today’s number is a bit high. For reference, last Monday the number was 752. The new statewide total is 351,881. Of today’s cases, 36% came from nonrural counties outside of the Atlanta metro. Atlanta suburb counties contributed 26% of cases.

  • Hospitalizations: 19 new COVID hospital admissions and 4 new ICU admissions (these are low numbers for Georgia, but higher than we saw last Monday). There are currently 1405 COVID patients hospitalized and this number is 109 additional patients compared to last Monday. 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 four hospital regions that are using over >90% ICU beds: region B (90.5%), E (91%), H (98%), and N (91%).

  • Deaths: 18 newly reported deaths. 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. Twelve of the deaths reported today came from outside of the Atlanta metro with rural counties leading with 8 newly reported deaths. The new statewide total is 7827. The case fatality rate is decreasing and is now at 2.22%. During the summer surge we saw the CFR decrease as deaths were diluted by large increases in cases. It’s too soon to know whether we’re seeing the same thing now, but that’s the trend we saw in the past.

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. In the most recent week, there were 2,337 antigen test-identified cases reported, 1,170 more than the week prior. This means that instead of the 10,365 weekly cases I reported yesterday, the total is more like 12,653. That puts us at a 7-day case rate of 127.4 per 100,000 (up from 103.9 last week), which means Georgia should be in the red zone by the White House Coronavirus Task Force definition, if they include antigen test data. Even without the antigen cases, we still surpass the 100 cases per 100,000 (red zone) threshold.

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 map is subdivided according to public health districts, not hospital regions. We can see that things have intensified in the Atlanta metro and the area around Athens to the border with South Carolina. Things seem to have calmed in some of the counties of northwest Georgia.

The White House Coronavirus Task Force reports are produced and released on Sundays but I usually don’t get a copy until Monday/Tuesday. So I’ll be back with that analysis on Wednesday.


References

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

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

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

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

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

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

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

https://dph.georgia.gov/epidemiology/influenza/flu-activity-georgia

https://dph.georgia.gov/county-indicator-reports


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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.