The Daily Digest, 30Dec2020

Georgia COVID-19 Updates

I’ve had this song, “A Long December” by Counting Crows, stuck in my head for the last few days as we close down the month of December in a difficult year. I sort of marvel at how relevant this song is now, 24 years after it was released.

The smell of hospitals in winter
And the feeling that it's all a lot of oysters, but no pearls
All at once you look across a crowded room
To see the way that light attaches to a girl

Drove up to Hillside Manor sometime after two a.m.
And talked a little while about the year
I guess the winter makes you laugh a little slower,
Makes you talk a little lower about the things you could not show her

And it's been a long December and there's reason to believe
Maybe this year will be better than the last
I can't remember all the times I tried to tell my myself
To hold on to these moments as they pass

And it's one more day up in the canyon
And it's one more night in Hollywood
It's been so long since I've seen the ocean I guess I should

Anyway, as we close a year that has brought so much upheaval, sickness and death, I want to point out that not everything has been bad. I hope that you are able to gain perspective on the things that went well this year, even as we eagerly look forward to 2021. Being mindful of these good things has been helpful to me. For me, I have really benefitted from the ways the pandemic has made me slow down and prioritize my health and wellbeing. It also helped to re-calibrate the importance of family time. While I certainly hope that we are back to “normal” sooner rather than later, I hope to keep some of the habits I’ve developed this year in the post-pandemic future.


We have the latest White House Coronavirus Task Force report for Georgia. We’ll go through it along with the rest of the latest numbers. Georgia is ranked #11 for new cases per 100,000, #17 for test positivity, #7 for new hospital admissions per 100 beds, and #40 for new deaths per 100,000.

The WHCTF “alerts” for us are provided below. They warn that data will be weird due to delayed reporting over the holidays. They say that things *seem* to be getting better in parts of the country, but that momentum can shift very quickly bringing about a new surge. They tell us that “no unmasked public gatherings are safe and no indoor private gatherings are safe without all members fully masked, unless all members are actively taking the same precautions and regularly test negative.” This latter part means the people in your bubble are okay. But if you don’t live together and aren’t following the same precautions, then it is unsafe to be together while unmasked.

“Georgia continues to deteriorate.” They want us to increase testing, but provide no funds to support an expanded testing effort. Lastly, the want us to prioritize vaccinating LTCF residents, frontline workers and Georgians by age in categories 1b and 1c to save the most lives.

Here’s the summary table from the WHCTF report.

Today we’re going to deep dive a bit more on testing and hospitalizations. The other metrics are important, of course, but this is where I’d like to focus today.


Testing

Georgia has once again overtaken the US average for PCR percent positive rate. The Georgia rate is now 14.2% while the national rate is 11.3%. Consistently being at or below 5% is the goal.

And while the state isn’t doing as much testing as the rest of the nation, it is doing better and we are narrowing the gap.

One area where we really are falling behind though is timely reporting of test results - to the state, and presumably to the patient as well. That makes it hard to do efficient contact tracing and isolation of infected individuals. The data used to produce the map below come from the 26Dec2020 HHS Community Profile Report, and it indicates that Georgia has the second worst rate of RT-PCR tests reported within 3 days, just behind Mississippi. The majority of COVID-19 tests are performed by commercial laboratories, not public health laboratories. So why Georgia (and the rest of the South) are doing comparatively worse is not clear. You can view a live image of the map if you click on it in order to hover over a state of interest and see its number.

Today Georgia reported a net increase of 23,511 new PCR test results, 19.9% of which were positive. Of today’s newly reported tests, 85% were reported through Electronic Laboratory Reporting (ELR) and this is within normal limits. Only 10.4% of today’s newly reported PCR cases were reported prior to the 14-day window of uncertainty. So the vast majority of today’s newly reported cases are recent. It will be important to keep an eye on this given Georgia’s difficulty with timely test reporting as shown above. As the case surge intensifies, we might see further delays in reporting as we experienced during the summer surge.

The state of Georgia does not provide numbers on the total antigen tests performed nor how many of them were positive. However, 40% of today’s newly reported cases were identified by antigen test. So it’s not an insignificant number.


Cases

Today there was a net increase of 5465 newly reported PCR cases and 3588 cases identified by antigen test for a combined total of 9053. The updated statewide total is 654,743 cases since the start of the pandemic. Thirty seven percent of today’s newly reported cases came from nonrural counties outside of the Atlanta metro, 27% came from rural counties and 25% came from Atlanta suburb counties. You can check to see how your county is classified here.

The top five counties for 14 day case rate per 100,000 (PCR + Antigen) are Madison (1982), Whitfield (1665), Rabun (1535), Jackson (1531), and Wilcox (1529). Three of these counties are rural and two are nonrural (Whitfield and Jackson). All but one of them (Wilcox) are in the northern half of the state.

We are seeing a downturn in case rate right now due to the holiday/weekend effect from Christmas. It is very similar to what we saw after Thanksgiving. For now, the 7-day case rate per 100,000 residents is 59% above our previous peak that we reached during the summer surge.

Georgia now has a higher case rate per 100,000 than the rest of the nation, even despite the holiday/weekend effect.


Hospitalizations

According to the WHCTF report, Georgia averaged 810 new COVID-19 admissions per day last week, at a rate of 29 admissions per 100 beds. The graph below shows how Georgia has done compared to the national trend for this metric.

The WHCTF report also indicates that 15% of Georgia hospitals are experiencing supply shortages and 31% are experiencing staffing shortages.

Today Georgia reported 375 new hospital admissions and 53 new admissions to the ICU for COVID-19. There are currently 4560 COVID-19 patients hospitalized in the state and this is a new record. They make up 27.4% of all hospitalized patients in the state. However certain regions are feeling this impact more acutely than others. The COVID-19 patient census is highest for regions M, B, C, and H. The US Department of Health and Human Services considers anything above 16% to be in the red zone.

Eight of Georgia’s 14 hospital regions are using >90% of their ICU beds and four regions (A, B, G, and H) are completely maxed out. Eighty nine percent of the state’s ICUs are in use as of today, for all medical conditions. How many of those are being used by COVID-19 patients? According to the HHS Community Profile report from 29Dec2020, 38% of Georgia’s ICU beds are occupied by COVID-19 patients. Thirty nine percent of adult ventilators are in use across the state as of today. According to the HHS Community Profile report, 13% of the state’s adult ventilators are being used by COVID-19 patients.

In fact, ICU usage has grown so much in recent weeks that the Georgia Geospatial Information Office had to adjust their y-axis on the ICU bed usage graph. We now have more ICU beds in use than at any other time during the pandemic.

When multiple areas are out of ICU beds (and the staff that support them) it means that the beds that are available might be a long distance away. It might mean less than ideal care for those who are critically ill.

Keep in mind that all of these numbers do not yet account for the after effects of Christmas gatherings. New Years Eve gatherings will add on top of that.

The other thing to note from the WHCTF report is that 46% of skilled nursing facilities (SNFs) report at least one new COVID-19 case among their staff. The national rate is 51%. For many SNFs, these critically important staff members are among the few people who cross from the clinical setting to the community and back. If roughly half of all SNFs have staff cases who could potentially be working while asymptomatic, it certainly increases the risk for outbreaks in those settings where many of our most vulnerable people live and cannot get away from the disease.


Deaths

There were 49 newly reported confirmed COVID-19 deaths today, bringing the statewide total to 9808. Fifty one percent of today’s newly reported deaths came from nonrural counties outside of the Atlanta metro and 22% came from rural counties. In other words, 73% of the deaths came from outside of the Atlanta metro.

If we look at how the deaths have been distributed across the state since the start of the pandemic, we can see that both nonrural and rural counties outside of the Atlanta metro have much higher death rates. In fact, for rural counties, the death rate is roughly double the death rate in the Atlanta metro.


Vaccines

I reached out to a colleague at DPH regarding some of your questions for the COVID-19 vaccines. Keep in mind, this is probably not the official position of the DPH, just some insights. Here are some answers to your FAQs:

There have already been news reports of scams with people advertising the COVID-19 vaccines for anyone who wants them, regardless of eligibility, for a price. The DPH does not probably have resources to police this sort of activity. I am not sure where to tell you to report such activity other than the Governor’s office and/or your local news media.

The DPH vaccine page will have the most up to date information regarding when we are moving to next phases of the vaccine distribution plan. They are following the ACIP recommendations for phased vaccinations.

The DPH is trying to develop data visualizations (i.e. maps and graphs) to help us see how vaccination efforts are progressing over time. Currently, their website just gives a year to date snapshot as of the most recent update. For example, the image below is from their most recent update. But there is no estimate on when those visualizations will be available.

In the meantime, another colleague has developed a Georgia Vaccinations Trend graph for us to follow, using the DPH numbers as they are updated. It meets the need of seeing how the vaccine data are trending over time. One note, the “percent of goal” bar at the top is telling you how many people have been vaccinated according to statements made by the federal government (20 million doses by the end of 2020). That’s not the herd immunity goal line, FYI.

I do plan to write on Friday (New Year’s Day), so I’ll be back then. Let’s hope 2021 is better than 2020.


References

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

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

https://dph.georgia.gov/covid-vaccine

https://www.covidmappingproject.com/dashboards/georgia-vaccination-trends

https://amberschmidtkephd.substack.com/p/pcr-percent-positive-rate-by-county

https://drive.google.com/file/d/1RAT0MSr2ib9vydQ_n22RkYI0f0hXEo9b/view?usp=sharing

https://beta.healthdata.gov/National/COVID-19-Community-Profile-Report/gqxm-d9w9


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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.