The Week in Review, 04 - 10Jan2021

Georgia COVID-19 Updates

Combined Data

In the graph below, you’re looking at the trends for three of our big metrics for evaluating the state of the pandemic - cases, hospitalization and deaths - over time. The cases are represented by the blue line and correspond to the left y-axis. The hospitalizations (gray) and deaths (red) correspond to the right y-axis. I graph them together here so we can see temporal associations.

This week we are seeing continued increases in cases and hospitalizations, both of which have now set state records. This week we also saw a dramatic jump in deaths.


Testing

Today, Georgia reported 39,819 new PCR test results through Electronic Laboratory Reporting (ELR). Of those, 18.8% were positive.

For the week, Georgia reported 210,049 PCR test results, a big drop from the previous week. However, we had two days this week with 49% and 30% of PCR cases reported through ELR. The remaining PCR cases and the negatives that accompany them from labs that couldn’t report through ELR, could have provided a big boost to the weekly testing total. So I’m not alarmed by the drop in tests reported. However, we know that public health departments that are already stretched thin are having to divert resources from testing to vaccinations. The bulk of testing in Georgia is performed by commercial laboratories, not public health departments. But still, those public health testing sites are the easiest way for the uninsured to be tested. With so many Georgians losing work (and health insurance) since the pandemic began, we’ll want to keep an eye on what happens with test output and test positivity over the coming weeks. The percent positive rate decreased slightly this week, from 19.3% to 18.8%. You can see how test output (blue line, left y-axis) and test positivity (red line, right y-axis) have trended over time in the graph below.

The Georgia Department of Public Health does not provide antigen test data in terms of tests performed or a test positivity rate. It also doesn’t provide any demographic data (you’ll notice this in the sections that follow) for the antigen cases, nor does it include antigen case data in any of their website’s maps or graphs. This is despite the fact that DPH investigates each antigen case the same way that they investigate PCR cases and despite the fact that Dr. Toomey has previously said that she looks at the data using both PCR and antigen cases. In the meantime, I can tell you that antigen testing identified 25% of this week’s cases. So it’s not an insignificant amount of data that we’re missing in terms of demographics.


Cases

The number of combined new cases (by date of report) is as follows:
- 24 hours: 7169 by PCR + 1024 by antigen = 8193 (+1.1%)
- 7 days: 49,297 by PCR + 16,848 by antigen = 66,145 (+9.6%)
- 4 weeks: 160,329 by PCR + 53,878 by antigen = 214,207 (+39.5%)

The new statewide total is 757,045, combining PCR and antigen-test identified cases. In the past two weeks, we have recorded 124,746 cases which is roughly equal to our statewide total on 14Jul. The two week case total is also more cases than the Atlanta counties of Fulton and DeKalb have recorded since the start of the pandemic (106,919). Our case growth really is breathtaking to see. Bear in mind that as large as these case totals are, they are likely an under count of our actual case count - it’s a problem that plagues public health for multiple diseases and especially so when a disease has so many asymptomatic cases, as COVID-19 does. But also because we know that our percent positive rate is high. Our number of cases have grown nearly 40% in the past month and of all the cases that have been recorded in Georgia to date, 28.3% were reported in the past 4 weeks. In other words, more than one in four of the cases we’ve had so far were in the last month, even as we are in the 11th month of this pandemic. In the graph below, I show the Georgia cases by date of report for both PCR and antigen cases for each county type. Ignore the big bump around 11Oct - that was a data dump of antigen cases. You’ll notice that we are well above the previous summer surge now. In fact, our 7-day rolling average is now 168% higher than our previous peak. But the Atlanta counties (Fulton and DeKalb, blue line) are faring better than other county types in the state. Atlanta suburb counties have the highest 7-day case rate in the state.

The top ten counties for 14-day case rate per 100,000 residents are Madison, Upson, Johnson, Turner, Treutlen, Pike, Toombs, Whitfield, Ben Hill and Jackson. All of them are rural except Whitfield and Jackson. The highest ranking Atlanta Suburb county is Cherokee, at #18. I made a chart that you can visit to see the entire county list and their 14-day case rates.

The DPH does not provide demographic data for antigen cases. So the graphs to follow only include the data for PCR cases. First, the graph below shows the weekly case totals for each age group, as 8-week timelines side by side.

Every age group saw an increase this week except infants <1 year old. Cases totals remain highest among 18-29 year olds. But the increases have been felt similarly for most age groups. Unlike the summer surge where we saw a jump first in the 18-29 year olds that later fanned out to the older populations, this time they all started to increase at about the same time. Be advised, the low case counts among children may be due in part to the fact that we don’t test them very widely. They have the highest percent positive rate of all age groups across the US (see green line in the graph below).

Next, let’s look at the weekly case totals by race. The past week saw increases for all races other than American Indian / Alaska Native. But the case surge has been dramatic for White and “Other” population (this includes the majority of those who identify as Hispanic). We also see a really big increase in the number of people in the “unknown” category. This is a holding zone for cases as contact trace investigators are gathering more information. When we see the cases grow in the unknown category, it’s a good sign that contact tracers are overwhelmed by the current case burden. With 66,145 newly reported cases this week alone, it’s not hard to imagine that a workforce of about 1500 - 1600 would be swamped, considering they have had a steady buildup over the past two months.


Hospitalizations

The number of new hospital admissions and ICU admissions (by date of report) is as follows:
- 24 hours: 125 admissions, 15 to the ICU
- 7 days: 2152 admissions, 285 to the ICU
- 4 weeks: 6998 admissions, 888 to the ICU

The state doesn’t provide age group data for ICU admissions but we can see them for race. Admissions are climbing elevated for most races except Native Hawaiian / Pacific Islander and American Indian / Alaska Native. ICU admissions have risen 18% in the past 8 weeks for Black / African-American populations. But they have risen 80% for White populations.

In the past week, the number of COVID-19 patients currently hospitalized has risen 13.6%. We’re starting to see some leveling of the data. But it’s too soon to know whether this is an artifact of reduced reporting over the weekends. Notice that we see these “shoulders” in the data at regular intervals, those are weekends. In addition, our cases continue to climb and cases fuel hospitalizations. We should expect to see cases level off before hospitalizations do. Trust me, I want to talk about positive signs in the data. But I also don’t want to give a false sense of hope yet.

Here are the latest numbers for the COVID-19 burden for hospitals. Ninety one percent of the state’s ICU beds are occupied, and 47% of them are occupied by a COVID-19 patient (HHS Community Profile Report, 09Jan21). That’s more than half of ICU beds in use. There are two regions using all or more of their ICU beds, regions A and E.

The HHS reports now include hospital data for Census Bureau Statistical Areas (CBSAs) in their 09Jan21 report. So now we can look at COVID-19 ICU bed demand and patient census (how many hospitalized patients are there for COVID-19) down to a city or metro area, which is more local data than Georgia provides. The table below is sorted high to low by the third column.

The best data are those that are recent, local and adjusted for population. So seeing more local data is terrific. These reports are provided daily except for federal holidays.


Deaths

The number of new confirmed deaths (by date of report) is as follows. The percentage in parentheses indicates how the increase compares to Georgia’s cumulative total at the start of each window of time.
- 24 hours: 2 (+0.02%), death reporting is always low on the weekends.
- 7 days: 389 (+3.9%)
- 4 weeks: 1077 (+11.7%)

This week the number of deaths increased 117% compared to the previous week. However, it’s unclear how much of this might be due to delays in reporting with back to back holidays. The current statewide total of confirmed deaths is 10,282 and of those, 10.4% were reported in the last 4 weeks alone. Of this week’s 389 newly reported deaths, 36% came from nonrural counties outside of the Atlanta metro and 33% came from rural counties. Another 19% came from Atlanta suburb counties and 9% came from the Atlanta counties of Fulton and DeKalb.

In the graph below, we can see how this week’s big death increase was distributed by age group. Again, you’re looking at 8 week timelines side by side.

Many of the deaths were among those 70+. But we saw increases for every adult age group.

To sign off today, I just want to thank everyone who is doing the hard work of limiting transmission in this surge. Goodness, I know we are all so tired of waiting for this thing to end and we’d all like to go back to normal life. But the sacrifices you are making are saving lives. The situation would very likely be even worse without your efforts. I’ll be back tomorrow to discuss how Georgia fits into the national context. Until then, be safe and be well!


References

14-day case rate table: https://datawrapper.dwcdn.net/ypNPQ/1/

Age-based positivity rates: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html

Estimates of contact tracing workforce: https://www.npr.org/sections/health-shots/2020/10/14/923468159/covid-19-contact-tracing-workforce-barely-inching-up-as-cases-surge

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

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

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


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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.