The Week in Review, 05-11Oct2020
Georgia COVID-19 Updates
Let’s talk about what happened in Georgia this week. As you can see below, cases, hospitalizations and deaths have all decreased compared to last week. Note that cases (blue) correspond to the left y-axis whereas hospitalizations and deaths (gray and red lines, respectively) correspond to the right y-axis.
This week we saw a modest increase in both cases and deaths. For cases, we have seen variation in the descent since the summer surge, where a week may show an increase that is quickly reversed the following week. But this is the first time we have seen two weeks in a row where the cases have leveled off in their descent. Hopefully we see that blue line continue downward next week. Meanwhile, hospitalizations continue to decline.
Testing
For testing, both the new test count and the percent positive rate have decreased. In total, 132,421 PCR tests were performed this week, roughly equivalent to what we did last week. This week’s percent positive rate is 5.5% compared to 7.2% last week. Note that the testing output (blue line) corresponds to the left y-axis whereas the percent positive and WHO goal correspond to the right y-axis.
Cases
The number of new cases (by date of report) is as follows:
- 24 hours: 1140 (+0.4%)
- 7 days: 8,484 (+2.6%)
- 4 weeks: 37,095 (+12.6%)
The new statewide total is 331,409 which means that of all the cases that have been recorded, 11.2% were reported in the past 4 weeks. That is a reduction compared to last week (12.3%). Bear in mind that these case totals 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. And these cases are those confirmed by the diagnostic PCR test. It does not include those who screen positive through other testing methods such as the rapid antigen test. Below you can see how the cases have been distributed across different county types in Georgia, adjusted for population. The solid black line is the statewide average.
I’ve noticed something for the last few days and didn’t say anything, thinking it might just be variation in the data. But there is something concerning in the 7-day case rate per 100,000. Every county type is showing an increase and it started with the Atlanta counties earlier this week. I often caution people against making judgments based on one day’s worth of data, but the trend is consistent across multiple days now. The last time we saw this kind of agreement between all four county types was during the summer surge. It’s too early to know if this concurrent increase in the case rate among county types is the beginning of a new surge. Since this graph is based on date of report, rather than symptom onset, then it could be the result of old data being added to the totals. Because of recent adjustments to the way that data are coded by DPH, a tool we have to see how cases are backdated is no longer functioning. Mr. Shaver is the person who created and supports the backdating tool. Prior to this change in the way data are coded, we only had 11-16% of the cases being backdated prior to the 14-day window so far this week. But we don’t have such a number for the past 4 days.
Please, please be vigilant, in case this is the beginning of a new surge. Please keep doing the things that public health experts have been recommending including wearing a mask, maintaining a 6 foot distance, avoiding indoor gatherings, etc. If this is the beginning of a new surge, then we are starting at a disease rate that is 98% higher than prior to the summer surge.
Next, let’s look at how cases have been distributed across age, for the past 8 weeks. These data are based on date of report. There are other graphs much like this to follow. Keep in mind that each bar represents a week’s worth of information and that the timeline starts over when you get to the next age group. It allows us to see the timelines side by side for each age group.
You can see that for the most part it’s been a good week, showing declines for many age groups. However, cases increased this week for those 1-29 years of age. Similarly, there were decreases across all races this week with the exception of American Indian / Alaska Native. Remember, the unknown category is a holding spot until contact trace investigation can sort cases correctly. Seeing a negative number in this category is a good thing - it means contact tracers are able to clear through some of the backlog.
Hospitalizations
Current hospitalizations are at 1222 today, which is a decrease of 51 patients compared to a week ago. There were 24 people newly admitted for COVID-19 and three new admissions to the ICU. We usually see low numbers for this over the weekend. Adult ventilators in use has decreased to 28%. Prior to the summer surge, use of adult ventilators consistently hovered around 30%. So we’re actually below that pre-summer surge level now.
Next, let’s look at how hospitalizations have been distributed across age for the past 8 weeks.
There were increases this week for those 60-79. And hospitalizations remain steady among 10-29 year olds.
The Department of Public Health has expanded the data offered in their “download the data” section of their daily report. In it, we now have access to demographic data for hospitalizations and ICU admissions. DPH considers ICU stay as a comorbidity, and that is odd since it’s more of a consequence of severe infection than a condition that may have led to more severe COVID disease. Either way, we have the data. I’ve graphed the proportion of total COVID hospitalizations and ICU admission for each race in the pandemic to date and compared that to each race’s proportion of the overall population (2018 census estimates).
What we can see is that Black / African-American populations are hospitalized and admitted to ICUs at a percent that exceeds their makeup of the Georgia population. That means they’re being disproportionately impacted. Keep in mind that these are percentages on the y-axis. So the number of hospital and ICU admissions is not relatively equal in total counts among Black / African-American populations, but the percentage is roughly equal. Meanwhile, White and Native Hawaiian / Pacific Islander populations are hospitalized and admitted to ICU at a rate that is less than their proportion of the total Georgia population. As of yesterday, there have been 5508 ICU admissions for COVID-19 to date, out of 29,611 total hospital admissions. In other words, 18.6% of the patients hospitalized for COVID-19 end up needing an ICU. Unfortunately, there have been 2066 deaths among patients admitted to the ICU for COVID-19, for a fatality rate of 37.5%.
Deaths
The number of new deaths (by date of report) is as follows:
- 24 hours: 23 (+0.3%)
- 7 days: 254 (+3.5%)
- 4 weeks: 1083 (+17.1%)
This week we saw an increase in the weekly total from 216 last week to 254 this week. The current statewide total is 7416 and of those, 14.6% were reported in the last 4 weeks alone. The case fatality rate is 2.24%, the highest it has been since 19Jul. Below you can see how the deaths have been distributed across county type, using a 7-day moving average and adjusted for population. The black line is the statewide average.
You probably noticed that the rural counties have the highest death rate in the state and it is over twice the statewide average. This tells us that rural Georgia is being impacted disproportionately. The statewide average is trending up, both due to what is happening in rural Georgia, but there are also increases in Atlanta and Atlanta suburb counties.
Next, let’s turn to how deaths have been distributed across age groups for the past 8 weeks.
Unfortunately, we are seeing increases in deaths among those aged 30 - 79 this week.
There were increases in deaths this week for every race other than Native Hawaiian / Pacific Islander and Other (which includes the majority of people who identify as Hispanic / Latinx).
To summarize, after a relatively mild week two weeks ago, this most recent week is showing some concerning trends. Case rate has leveled off at a rate that is about twice as high as where we were prior to the summer surge and is showing signs of growth among all county types. Even if this doesn’t materialize in a surge, we definitely don’t want to be stalled at this higher disease rate as we head into influenza season and the winter months.
References
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.