The Daily Digest, 28Dec2020
Georgia COVID-19 Updates
Vaccine Update
There’s another vaccine progressing toward emergency use authorization, from Oxford-AstraZeneca. This vaccine technology is different than the mRNA vaccines from Pfizer and Moderna. Instead, it uses an adenovirus that has been engineered to carry a copy of the SARS-CoV-2 spike protein gene. Adenoviruses are a family of viruses, many of which cause the common cold. In this situation, the adenovirus serves as a delivery vehicle to bring the spike protein gene to the place where it will be processed by the human cell - the nucleus. The adenovirus itself is not able to replicate inside of the human cell, so it will not cause an infection in vaccine recipients. It literally is a delivery vehicle. I thought the New York Times made a great visualization of how this vaccine works.
Interim analysis of AstraZeneca vaccine indicates it is an efficacy of 70.4% but recent comments by the CEO of AstraZeneca suggest that the efficacy might be higher. Remember, science doesn’t make decisions by taking CEOs at their word or based on press releases. Instead, science and health policy is based on peer-reviewed data. So we’ll see what comes of the FDA’s analysis of the vaccine as it continues through the process. You may recall that the Pfizer and Moderna vaccines have an efficacy of ~95%, meaning that they prevent illness in 95% of vaccine recipients. That the AstraZeneca one is potentially less efficacious is offset by a very important tradeoff - it is made of DNA, not RNA, so it is a much more stable molecule that can be stored at refrigerator temperature for up to 6 months. This will be a very important vaccine, indeed, for vaccinating the developing world and rural areas where (ultracold) freezers might not be widely available. The US has entered into a contract with AstraZeneca for 300 million doses of their vaccine as part of Operation Warp Speed.
A helpful reader made me aware of this link from the Georgia Department of Public Health for healthcare workers to make an appointment to receive a COVID-19 vaccine through their local health district office if they are not otherwise affiliated with an enrolled vaccine provider (i.e. hospital, pharmacy, etc). Long term care facility residents and staff vaccinations are evidently being administered by CVS and Walgreens who are going into these facilities to administer vaccines this week. The AJC article indicates that CVS will conduct these vaccination campaigns at 644 skilled nursing and assisted living facilities in Georgia this week alone. This is really, really good news.
Post-Christmas Reminders
If you gathered for Christmas, please assume that you were infected at your gathering and self-quarantine for 14 days following the event. You can seek out a test about 7 days after, so this coming Saturday. I hope you had a marvelous time at your gathering, really and truly. Self-quarantine is the consequence of that choice, however. For my readers who are >65 or who have underlying medical conditions, consider sheltering in place this week and next. The people who gather for Christmas and New Years, ignoring public health advice, will be infectious and in the community during these weeks. Be safe.
The data will be weird for probably the next two weeks due to back to back holiday closures and reporting delays.
The World
Globally, the SARS-CoV-2 virus that causes COVID-19 disease has sickened >81.1 million people (+4.2 million since last week) and killed at least 1,769,400 (+74,700 in the past week) as of this morning.
The US is ranked in the second highest color category for hot spots. We are ranked #9 in the world for average daily case rate per 100,000 people over the past 7 days (last week, 12th) with a rate of 55.7 compared to 65.1 last week. So our case rate is getting better. But case rate is improving even more dramatically for other nations, causing our ranking to climb up. The top five countries for average daily case rate per 100,000 in the past week are Gibraltar, Liechtenstein, Lithuania, Panama and Montenegro.
For deaths, the US average daily death rate per 100,000 over the past week is 0.7 (previous week was 0.8), and we are ranked #23 in the world for this (last week we were ranked #21). The top five countries for average daily death rate per 100,000 in the most recent week are Liechtenstein, Croatia, Slovenia, Bosnia and Herzegovina, and Hungary.
The United States
As of this morning, there have been over 19.2 million cases (+1.4 million in the past week) and 317,800 deaths in the US (+16,330 in past week). Keep in mind that both of these numbers are probably an under-count of the situation in our country.
This week we see things have gotten better for much of the Midwest, the Pacific Northwest, upper plains states and the Rocky Mountain states of Colorado, Wyoming and Montana. There is still a swath of more intense disease rate from Illinois to Pennsylvania. And, of course, things continue to be intense along the southern half of the United States. We should remember that some of this improvement may be an artifact of delayed reporting over the holiday. The top five states in the nation for average daily case rate in the past 7 days are California, Tennessee, Arizona, Alabama, and West Virginia. There are three southern states in the top 10 - Tennessee, Alabama and South Carolina. So Georgia is almost surrounded by top 10 states. The top five states in the nation for average daily death rate in the past 7 days are South Dakota, New Mexico, Pennsylvania, Arkansas and Rhode Island. There are two Southern states in the top 10 for the metric - Mississippi (#8) and Tennessee (#10).
There’s a new data resource available to us now from the federal government, called the COVID-19 Community Profile Report and it is a TREASURE TROVE of data for counties and cities. It is formatted in much the same way as the White House Coronavirus Task Force reports but with one key difference - this resource DOES include Georgia’s antigen cases in their total whereas the WHCTF does not. So this resource is the best head to head comparison we have for how Georgia is faring relative to other states. There is both a PDF and an excel file (this is the gold mine of data) of the report at the link above that you can download and review. They break the US into FEMA regions and you can find how your state is classified here. My Georgia readers are in region 4. Kansas readers are in region 7. The first map I want to bring up from the Community Profile Report from 26Dec2020 is this one that shows how case rate per 100,000 is increasing or decreasing across the country. Look at Georgia and see if you notice anything interesting.
Whereas the states around us are showing decreases in disease rate (green or yellow), much of Georgia is continuing to increase in disease rate (pink or red). Remember, this was data leading into the Christmas holiday, so there was a LOT of momentum for the disease in Georgia communities when those holiday gatherings took place last week.
Next let’s look at the map below of rapid riser counties. What you’ll notice is that the middle of the country is largely blank here. The upper Midwest and northern Plains states are relatively quiet, things are holding steady or decreasing. Instead, the counties of concern are the coastal states and sunbelt. Things seem to be getting better for Tennessee (thank goodness) but there are several pink or red counties in Georgia (not good).
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 Community Profile Report from 26Dec2020. Keep in mind that some states did not report data over the holiday, so the rankings might not be accurate assessments of how states compare this week.
In spite of the holiday data reporting delays, Georgia has seen some dramatic increases in their rankings for case rate per 100,000 and the percentage of hospital inpatients with COVID-19. The latter jumped 26.5% in the past week and we are now ranked #5 in the nation for this metric.
Next, let’s look at how seasonal influenza is impacting different states across the US. 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. The maps below show last year’s map for the 51st week of the year (left side) and this year’s map for the same week on the right side.
The entire country remains in the minimal zone for influenza. Compare that to where we were a year ago for week 51 in the map on the left. The things we’re doing to limit the transmission of COVID-19 are also interrupting the transmission of influenza. Of course, COVID-19 is more transmissible than influenza so we aren’t seeing the same impact for COVID-19. But it’s a pretty great way to see what is possible through collective effort. Imagine a map that looked like this for COVID-19 if we could get more people to wear a mask. Remember, it’s not too late to get your flu shot. Please do so, if you haven’t already.
Georgia
The map below is calculated and formatted the same way as the Harvard Global Health Institute tool, but includes Georgia’s antigen cases. The HGHI tool relies on the data Georgia DPH supplies to USAFacts.org and Georgia only provides PCR case data to this data repository. You can click on the image below to see the live map where you can click or hover over your county of interest to see its number.
This week there is improvement along the South Carolina border to the Georgia coast. There are 119 counties in the red category, 35 in the orange category, and 5 counties in the yellow category.
For today, here are the net increases for each key metric for Georgia.
Testing: 15,065 new PCR tests (a low number, not unexpected for a Monday), 20.7% were positive. The state does not provide data regarding the number of antigen tests performed.
Cases: 3941 cases were newly reported today (3152 by PCR, 789 by antigen test). The new statewide total is 636,240. Of today’s cases, 35% came from the Atlanta suburbs and this is the first time in recent memory that the Atlanta suburbs had more cases than nonrural counties outside of the Atlanta metro. Nonrural counties were the second highest contributor, with 31% of cases.
Hospitalizations: 165 new COVID hospital admissions and 11 new ICU admissions. Both of these numbers are much higher than we saw last Monday. There are currently 4342 COVID patients hospitalized and this number is 826 additional patients compared to last Monday. Our current patient census (see graph below) is 36% higher than the previous record set during the summer surge. Adult ventilators are being used at 40% of our state’s capacity as of today. According to the HHS Community Profile Report from 26Dec2020, last week’s average was 37% of Georgia’s ventilators in use. And 11% of all ventilators in use in the state were being used by a COVID-19 patient, an increase of 28% compared to the week prior.
There are eight of Georgia’s 14 hospital regions using >90% of their ICU bed capacity - regions B (94%), C (92%), E (94%), G (92%), H (100%), I (91%), L (93%) and region N (97%). There is no hospital region using less than 80% of their ICU beds. Across the state, only 13% of the ICU beds are empty. And all of this before the impacts of Christmas gatherings are felt.
Deaths: 5 newly reported confirmed deaths (net change), which is a low day for us, but not uncommon for a Monday. Nursing homes typically do not report over the weekends, and Mondays tend to be low count days for this reason. The statewide total of confirmed deaths is 9719.
The image below shows the Georgia Department of Public Health’s website and dashboard for the COVID-19 vaccine including answers to frequently asked questions, resources to learn more about the vaccines and the DPH plan for distributing the vaccine. Compared to last Monday, the state has enrolled 168 additional providers, 325 additional Pfizer doses have been allocated and the state has received all of its Pfizer allocation. Last Monday, the Moderna numbers all read “zero” so we now have 174,000 doses of that vaccine on the way, 158,500 of which have already arrived. In a week’s time (a holiday week, mind you) 24,752 Georgians initiated their two-dose vaccine series. Only 9.1% of the state’s supply of doses have been administered as of this update. Georgia has at least 258,265 doses on hand.
A reminder, Operation Warp Speed only covered the development, manufacture and shipment of the vaccines to the states. The “last mile” of transforming a vaccine into vaccinations is the responsibility of the state. And Georgia, like many states, has a budget that has dramatically cut public health funding for the past decade. There likely isn’t the funding nor the infrastructure to support a statewide vaccination roll out at the speed that any of us would see as reasonable. The coronavirus relief bill that was signed into law late last night includes 8 billion dollars for vaccine distribution, but we don’t yet know how that money will be allocated to the states. So if you are growing impatient about the speed with which the vaccine is being distributed, perhaps get in touch with your state senators and representatives as well as your representatives and senators in Congress to ask for better funding for public health. Nothing in this country happens for free.
There are 10.6 million residents in Georgia, so we have a long way to go. In the meantime, the nonpharmaceutical interventions such as wearing a mask, social distancing and good hand and cough hygiene are going to be the best protection we have against the virus. So keep doing those things. Help is coming, but it is slow.
References
https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html
https://dph.georgia.gov/covid-19-daily-status-report
https://covid-gagio.hub.arcgis.com/
https://www.cdc.gov/flu/weekly/fluviewinteractive.htm
https://beta.healthdata.gov/National/COVID-19-Community-Profile-Report/gqxm-d9w9
https://www.fema.gov/about/organization/regions
https://dph.georgia.gov/covid-vaccine
https://www.nytimes.com/interactive/2020/health/oxford-astrazeneca-covid-19-vaccine.html
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32661-1/fulltext
https://www.hhs.gov/coronavirus/explaining-operation-warp-speed/index.html
https://www.ajc.com/news/cvs-walgreens-to-start-vaccinations-at-georgia-care-homes/GBDIZQ5KEZGEDOWPZHOEUKYHCY/
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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.