The Daily Digest, 30Nov2020
Georgia COVID-19 Updates
The World
Globally, the SARS-CoV-2 virus that causes COVID-19 disease has sickened > 62.8 million people (+4 million since last week) and killed at least 1,460,600 (+71,100 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 #15 in the world for average daily case rate per 100,000 people over the past 7 days (last week, 17th) with a rate of 48.8 compared to 51.6 last week. We should anticipate that some of this case rate drop is due to the Thanksgiving holiday. The top five countries for average daily case rate per 100,000 in the past week are Georgia, Serbia, Montenegro, Luxembourg, and Andorra.
For deaths, our average daily death rate per 100,000 over the past week is 0.4, less than last week (0.5), and we are ranked #37 in the world for this (last week we were ranked #33). Again, the Thanksgiving holiday may be a factor here. The top five countries for average daily death rate per 100,000 in the most recent week are Liechtenstein, Slovenia, Bulgaria, North Macedonia and Bosnia and Herzegovina.
The United States
As of this morning, there have been over 13.4 million cases (+1.1 million in the past week) and 266,758 deaths in the US (+10,003 in past week). Keep in mind that both of these numbers are probably an under-count of the situation in our country and the effect may be even worse this week due to Thanksgiving.
The top five states in the nation for average daily case rate in the past 7 days are North Dakota, South Dakota, Minnesota, Wyoming and New Mexico. The top five states in the nation for average daily death rate in the past 7 days are South Dakota, North Dakota, New Mexico, Wyoming and Illinois.
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 but was last updated on 23Nov2020, and I reported those numbers last week. So they are not shown in this week’s table.
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.
Georgia moved up a level, but remains in 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 20 counties in the red category, 87 in the orange category and 47 counties are in the yellow zone. There are 5 counties in the green category. However, I would advise against making any life-altering decisions based on this map just yet - it is impacted greatly by four days’ worth of holiday and weekend effect. I’ll provide an updated map on Friday.
For today, here are the net increases for each key metric for Georgia.
Testing: 11,521 new PCR tests (a really low number, even for a Monday), 11.9% were positive. 89.4% of today’s cases were identified through electronic laboratory reporting (ELR). The state does not provide data regarding the number of antigen tests performed.
Cases: 2047 cases were newly reported today (1532 by PCR, 515 by antigen test). The new statewide total is 471,563 (422,133 by PCR, 49,430 by antigen test). Of today’s cases, 39% came from nonrural counties outside of the Atlanta metro. Atlanta suburb counties were the second highest contributor, with 28% of cases.
Hospitalizations: 42 new COVID hospital admissions and 4 new ICU admissions. These are low numbers for Georgia, but the new admission number is high for a Monday. There are currently 2197 COVID patients hospitalized and this number is 290 additional patients compared to last Monday. In fact, we haven’t seen a number this high since 26Aug. We are effectively reversing the gains we made after the summer surge. Adult ventilators are being used at 31% of our state’s capacity as of today, and this is consistent over the past five days. But as you can see from the graph below, we are still at a level that we saw in early June, before the summer surge.
There are three hospital regions using >90% of their ICU bed capacity - regions C (91.9%), E (94.3%), and region N (93.6%).
Deaths: 0 newly reported confirmed deaths (net change), which is terrific. We haven’t had a zero deaths day since 15Nov and these are the only 2 days since 26Mar with zero 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. So it could be that we will see a bigger than usual number tomorrow. The statewide total remains 8778.
The School Aged Surveillance data report is usually released on Fridays but was posted today due to the holiday. Things are increasing, as they have been for weeks, but one of the most notable things I saw in the report this week was the impact of antigen tests on identifying cases. The graphs below show the cases among school aged children with the left side showing PCR cases only and the graph on the right showing PCR *and* antigen cases. First notice that the y-axis had to change in order to accommodate the increase in cases when antigen cases are included. Second, the most recent week’s total is now greater than the highest point we experienced during the summer surge. Compared to the peak we observed in July, the current height of our curve is driven mainly by increases among 11-17 year olds, with 5-10 year olds making up a much smaller portion of the cases. I think it’s noteworthy that these increases really took off shortly after Halloween. Children aged 11+ are those more likely to be unsupervised during trick or treating or to attend indoor Halloween parties and events with friends. It’s not possible to say with certainty that Halloween specifically contributed to these case increases based on the graphs below alone, but the timing puts Halloween in the realm of possibilities.
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 doesn’t agree at all with the red-yellow-green map inspired by the Harvard Global Health Institute but adding antigen cases. But, again, it’s a weird week with the Thanksgiving holiday. There is more emphasis on the southern half of the state and the Georgia coast. But also, a band of counties from Meriwether county to Elbert along the South Carolina border.
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®ion=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
Georgia COVID-19 Updates is a free newsletter that depends on reader support. If you wish to subscribe please click the link below. There are free and paid options available.
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.