The Daily Digest, 31Mar2021

Georgia COVID-19 Updates

We have the latest White House state reports that were finalized last Friday but released to the public yesterday. I’ll talk about Georgia-specific data and trends in the following sections but I want to talk about national numbers first. In case you go look at them for yourself, I’ll point out that they changed some of the formatting this week. I suppose to keep on the sunny side of life, they’ve inverted the state rankings. So now states that perform well have the top rankings and states performing poorly have the lowest rankings.

For new case rate per 100,000

  • Best states: HI, CA, AZ, PR, AR

  • Worst states: NJ, NY, MI, RI, CT

  • 27 states + DC in the red zone (-1 compared to last week)

Test positivity

  • Best states: HI, CA, AR, NM, RI

  • Worst states: SD, NJ, MI, FL, NE

  • 1 state in the red zone (+1 compared to last week)

  • SC didn’t report data

COVID-19 hospital admission rates per 100 beds.

  • Best states: PR, HI, ME, WY, KS

  • Worst states: NJ, MI, KY, MD, GA

  • No states in the red zone (same as last week)

COVID-19 death rates per 100,000

  • Best states: ME, WY, CO, OR, AK

  • Worst states: KY, MA, CA, AZ, GA

  • 16 states in red zone (-2 compared to last week)

Vaccinations - as of last Friday, 27% Americans have received at least one dose of the vaccine (well done! Keep going!). As of today, the number is 28.9%.

  • Top 5: NM, AK, CT, SD, ME

  • Bottom 5: PR, GA, AL, MS, DC

The map and graph below show community transmission ratings. You want to be in the blue or yellow categories for this. The table on the bottom of the image below shows you how the state doing this week relative to last week. The graph on the right is sort of a pie chart that trends over time, showing you the percentage of counties that were red, orange, yellow or blue over time. You can clearly see where we emerged from the summer surge on the far left and the data dump of antigen cases that happened around 01Nov2020. You can also tell just how prolonged and intense the summer surge was for Georgia, impacting all 159 counties. But you can also see how much better things are now. In fact, there are fewer red counties now than there were in the fall between the summer and winter surges. All the same, the number of red counties is growing again and the number of blue counties is shrinking. We’ll have to see if this trend continues in the next week or so.


Vaccine Update

Pfizer-BioNTech announced some early data from their adolescent vaccine trials this morning in a press release. Of course, we’ll want to see the clinical trial data that is provided to the FDA before we get too excited. But here are the highlights from the press release:

  • It was a small study, 2260 adolescents between 12 - 15 years of age. Half of them received vaccine, half received placebo. Eighteen cases of COVID-19 were identified during the study, all of them in the placebo group and none of them in the vaccine group.

  • Neutralizing antibody production in the 12-15 year olds was even better than observed for 16-25 year olds. Having neutralizing antibodies is important because they bind up the viral particles before they have a chance to bind to their receptors on human cells.

  • The vaccines were well tolerated, with side effects similar to those observed in previous studies.

They also shared an update on their vaccine trials for children aged 6 months - 11 years old. The 5-11 year olds were dosed last week for the first time and children 2-5 years old will be given their first dose next week.

What we’ve seen happen in the past is that these press releases come out and the companies apply for Emergency Use Authorization (EUA) from the FDA. About 3-4 weeks later the vaccines and related biological products advisory committee (VRBPAC) reviews the data and decides whether to recommend the vaccine for EUA. Then about a week after EUA is granted, the Advisory Committee on Immunization Practices meets to discuss and give their recommendations on vaccinating the newly eligible group. So if past trends are repeated here, we could have a COVID-19 vaccine for adolescents as early as mid-May. This is really important for multiple reasons. First, if we look at recent weekly totals for confirmed COVID-19 cases in Georgia, we see that the 10 - 17 year group is the largest contributor to pediatric COVID-19 cases. Their case counts are similar to those observed in the 60 - 69 year group. Second, we are unlikely to reach herd immunity unless we also vaccinate children. And for me, the pandemic won’t be over until my children are safe. Perhaps other parents feel the same way. If we want to imagine a post-pandemic world, we get there with these vaccines. Third, what we’ve seen in Georgia is that the biggest surges happened during seasons when weather makes people more likely to gather indoors. So between summer heat approaching, more transmissible variants growing in number, and off-the-charts pandemic fatigue, there really is a sense of urgency to reach herd immunity as quickly as possible. Having a vaccine available for everyone 12 and up gets us that much closer.

In the meantime, we need to continue to be cautious. The more we let the virus spread, the more it has the opportunity to mutate into new variants. The vaccines are performing well, but we need to get them into arms faster. As the state continues work on that side of things, we still need to be wearing masks and do social distancing. Eventually we will get to a place where disease transmission is low enough through both of these efforts that the virus has fewer opportunities to cause infection and even those who haven’t been vaccinated have some protection through our collective effort. When we reach that sweet spot, then the need for masks and social distancing will diminish. But for now, disease transmission rates are still really high and we need to continue to work to bring them down. If you want to be done with masks and social distancing, then get vaccinated and help as many people around you to do so as well.

The two graphs below look at how well Georgia is doing at vaccinating its population (this is by state of residence, not administration) compared to the national trend for first doses full course administered to all adults. These data come from the White House State Report, I just graph them week to week. There’s good news here. If we look at the graph on the left, we can see that the gap has narrowed between Georgia and the US vaccination rates for first doses administered. I can’t help but think that expanded eligibility has helped with this. For the time being, the graph on the right shows that the gap is widening between Georgia and the US for full course of vaccine administered to adults (by state of residence). However, given the improvements in the graph on the left, we should expect to see some improvement for Georgia in the graph on the right in about 3-4 weeks when 2nd doses are administered. Of course, that assumes that the US continues on its current trajectory. If states accelerate their vaccination efforts and Georgia does not, then the gap will continue to exist and possibly widen further.


Testing

For each of these sections, you’re going to see a graphic similar to what’s provided below. The map comes directly from the White House state report and gives us a look at where we are now. The graphs on the right are related to that same metric, but show us how Georgia and the US have trended weekly over time (where we’ve been). The graphic below all relates to testing. Georgia is ranked #38 in the nation for test positivity (with #52 being worst) and in the yellow zone.

For the map, you want to be in the green categories as much as possible. And the state is doing pretty well here. In the lower right, we can see how Georgia (blue line) has compared to the US (red line) for tests performed per 100,000 residents. Here too, you will see that Georgia has always underperformed relative to the national average. The lines tend to move in parallel, but right now testing is increasing nationally whereas it remains flat over the past couple weeks for Georgia. I think it’s easy to appreciate that it’s harder to find disease if you’re not looking for it.

Test positivity is shown over time in the graph on the upper right. The gray dashed line shows the WHO goal line (5%). The US is now below that goal line and Georgia is just above it (5.3%). Georgia has never dropped below 5% since the White House/HHS has been compiling this information. We’re closer than we’ve ever been to breaching that goal line, but Georgia’s test positivity is stubbornly above 5%. Test positivity is often considered alongside case rate to gauge how much the case rate might be an undercount of present disease burden. Seeing a test positivity rate at or below 5% means we are unlikely to be missing very many cases with the current level of testing. It doesn’t mean the pandemic is over. It means that case rate numbers are more accurately capturing disease burden.

Today, Georgia reported 15,681 PCR test results and 13,528 antigen tests. This is a low number for PCR tests, especially during the middle of the week. Of today’s PCR tests, 5.5% were positive. Of the antigen tests, 6.2% were positive. PCR testing identified 60% of today’s newly reported cases.


Cases

Case rate per 100,000 is improving a lot compared to where Georgia has been in the recent past. For the map, it’s best to be in the yellow or green categories and we see a about a dozen yellow counties. There are still red zone counties and a lot of them are clustered around the Atlanta metro and on state borders. The two dark red counties are Chattahoochee and Bacon counties. Georgia is ranked #24 for case rate (with #1 being best and #52 being worst) and in the orange zone.

If we look at where we’ve been (on the right), we can see that Georgia’s case rate has hit a second plateau in its descent from the winter surge. Georgia’s weekly case rate has almost reached pre-winter surge levels. Nationally, case rate has been pretty flat for the past month or so.

Today, Georgia reported a net increase of 1089 newly reported PCR cases and 718 antigen cases, for a combined total of 1807. I noticed something in the hospitalization data for Georgia today that made me look a little more closely at the counties in Region A (northwest corner of the state). There are three counties with increases in total cases in their 14-day window of uncertainty (blue dots in graph below) - Dade, Fannin and Walker counties. We can see a lot of variation in these curves from day to day so ordinarily I wouldn’t stress about this too much. But there’s a really big jump in the COVID-19 patient census and ICU bed usage for Region A that made me look at the counties a little more closely. Region A is especially an important region to pay attention to, because that’s where the winter surge seemed to begin, spreading down throughout the state. More on this in a second when we get to the hospitalization data.


Hospitalizations

The map below shows how regions compare for COVID-19 hospital admission rate. You’ll notice that the dates for this map cut off on 24Mar. If we look at the trends over time (right) then we can see that hospital admission rates for COVID-19 have sort of leveled off over the past three weeks for Georgia and the same is true for the US. This week, Georgia is ranked #48 in the US (with 52 being the worst) for COVID-19 hospital admission rate.

Today Georgia reported a net increase of 150 new hospital admissions and 26 admissions to the ICU. 77% of the state’s ICU beds are in use and the HHS Community Profile Report tells us that 12% of those ICU beds are being used by COVID-19 patients (#6 state in the US). As I discussed in the cases section, there’s something that caught my attention about hospital region A in the northwest corner of the state. Their ICU bed usage shot up from 63% to 98% in the past 2 days. Alone, that could be explained by a bad car accident or other non-COVID things.

But there was also a big jump in their COVID-19 patient census over the past week for region A, from 9% on 25Mar to 14.5% today. The region has been in the yellow zone for COVID-19 inpatient bed usage for almost the whole month (4Mar - 30Mar). The graph below compares COVID-19 patient census over time for region A and its neighboring regions. Something may be happening in region A for us to monitor. Patient census is also trending upward for Region N (northwest Atlanta suburbs).


Deaths

The map on the left shows how Georgia counties are doing with respect to new death rate per 100,000. I should note that delayed reporting impacts deaths even more than for cases, so some of these deaths are not recent and likely happened during the winter surge. All the same, this week’s map looks worse than the previous week in terms of how many red and dark red counties there are. That makes sense when you look at the graph on the right where an increase in death rate was noted for the state.

The death rate for Georgia has been above the national average since late January. The state’s death rate remains 55% above the national rate. Georgia is ranked #48 (with 52 being the worst) in the US for new death rate.

Georgia reported a net increase of 74 newly reported confirmed deaths and -6 probable deaths (data correction?). Death rate popped up a few days ago but is beginning to decrease again. At this point, the 7-day death rate for the state is 67% above the pre-winter surge baseline. Death rate is highest for rural counties and lowest for Atlanta suburb counties at this time.


References

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

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

https://beta.healthdata.gov/browse?tags=covid-19-spr

https://covid.cdc.gov/covid-data-tracker/#vaccinations

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

https://www.pfizer.com/news/press-release/press-release-detail/pfizer-biontech-announce-positive-topline-results-pivotal

https://www.nytimes.com/2021/03/29/opinion/covid-vaccines-kids.html


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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.