As of Wednesday, October 20, the number of new cases of Covid-19 and the test positivity rate continue to fall sharply. The 7-Day New Case number was 1590 and the 7-Day Test Positivity Rate 6.83. Both of these are about where we were last February when we were halfway down from winter’s peaks, but still considerably above last summer’s nadirs of 142 cases and 1.79 percent of tests.
Hospital bed and ICU utilization (which track each other closely) are also clearly easing but not to the same extent as new cases. For example, ICU bed occupancy this week is nearly as high as the peaks of December and January. (One could speculate that this may be connected to the enhanced virulence of the Delta variant or perhaps even better reporting.) If we continue to see fewer new cases at the same rate since September 8, we could be below 500 daily by mid-November.
We should expect to see the number of deaths reported daily to begin to fall also– but we are not there yet. A substantial proportion of individuals still on respirators will not survive despite optimal treatment. It takes weeks or months to clear out a backlog of reported death certificates. It will take many months to arrive at an estimate of the number of “hidden” Covid deaths due to long-term systemic damage caused by Covid-19, or to delayed or absent care for unrelated illnesses.
Altogether, this week continues the decidedly good news we have been seeing for the past 4 weeks. This does not imply that we can back off of the public health measures that brought us to this point. The majority of Kentucky counties are still in the red in terms of high-risk case incidence rates. As is the Game of Thrones, “Winter is Coming” and with it a season of indoor activities and respiratory illnesses. The big-time holidays of November and December will soon be upon us.
Schools will be in session. Since August 18, the 7-Day average of new cases of Covid-19 in individuals 18 years old or younger has usually exceeded 25%. The good news is that vaccinations are currently available for children 12 and up and we are on the brink of having a vaccine approved for children as young as 5. The rate of vaccinations in these groups remains to be seen, but schoolrooms are obviously mixing bowls where students, teachers, staff, and their families are exposed to Covid-19 infection.
New daily cases of Covid-19 in Kentucky have been dropping sharply since mid-September in close parallel with the Test Positivity Rate. Hospital utilization is falling as well but remains high with ICU utilization even higher than it was last winter as measured by number of beds currently filled. Daily reported deaths (expected to lag new cases) have not yet begun to fall with a current 7-Day average of 35 deaths per day. A complete tally of Covid-19 deaths will require weeks to months to be compiled. This welcome turn-around in what was an even worse flair of the Kentucky epidemic is the result of more rigorous attention to the same proven public health measures that reversed our three previous ones and the increasing rates of effective vaccination. The fact that case and death rates match or exceed those of last mid-winter should be sobering as the pool of susceptible individuals of any age by virtue of vaccinated status has shrunken! Raw incidence rates of new cases show that all but two of Kentucky’s counties are still in the in the high or moderate range of risk. We need to remain humble and focused until we can reliably consider ourselves to be approaching “normal.”
There is no longer any doubt whatsoever that many fewer people are getting sick from Covid-19. Even though considerably volatility in daily case counts throughout each week remains, the counts for each of the seven individual weekdays are way down. The 7-Day average of new cases is falling much faster than that of the 14-Day average. Each of the last three full weeks has had dramatically fewer cases than the week before. The semi-log plot of new cases is also decidedly falling. However, the open question remains, “how low can we go” as we enter the indoor winter season with its sports and holidays and the delta variant still alive and breathing down our necks throughout the state and country. In retrospect, it is somewhat unnerving to see the relentless aggregate rise in both cases and deaths over the last twelve months. As reassuring as things seem now, we have been here before. In my thinking, our best public health measure is to both believe and act on our state motto: “United we stand, divided we fall.”
Here are some representative data visualizations. You can see the full interactive profiles on KHPI Tableau Public Website.
The following is a simple plot of aggregate cases and deaths from October 1, 2020 to the present. While we have has spurts and remissions since our epidemic began in earnest last Fall, the upward thrust has been relentless. This is what we must turn around!
Peter Hasselbacher, MD Emeritus Professor of Medicine, UofL Kentucky Health Policy Institute 12 October 2021
Hospital utilization in crisis state. Deaths rising as expected. Community struggling to find the right path forward.
[Addendum Sept 25, 2021: Data on Tableau Public updated as of Friday. New cases and Test Positivity Rates clearly going down. Deaths not yet showing meaningful declines. Hospital, ICU and Ventilator utilization still at record highs. New cases for ages 18-and-under averaging 27% but declining from high of 31% on September 1. See additional notes at the bottom.]
Since the last article in this Covid-19 tracking series, I have been waiting to get through the low reporting-days of a weekend to allow time for the necessary 7-Day and 14-Day averages to reveal a reliable direction of our Kentucky epidemic of Covid-19. A number of indicators show new daily cases to be holding at a steady state with indications of a possible decline. The concern is that the 14-Day average of some 4000 daily case is still higher than any time since March 2020. With three reporting cases left this week, this September will have given us the largest monthly number so far, probably outstripping even the dark months of last December and January.
On a positive note, case-counts for specific weekdays have been trending down every day for over a week. You can click through the individual days on KHPI’s Public Tableau portfolio of data visualizations. Semi-log plots of New Cases also show a stable accumulation of new cases –but not yet a definite decrease. The Kentucky Department of Public Health Test Positivity Rate has taken a sharp turn downwards since September 8th.
Deaths. It is clear though that the Coronavirus is still having its way with us. Deaths will continue to increase for a while as new cases work their way through their individual clinical courses. The sporadic reporting of deaths illustrates the delay in time built into our clinical and death certificate reporting systems.
Hospitals and ICUs. Many if not most Covid-19 deaths occur in hospital facilities. The need to be placed on a ventilator is a strong predictor of a future Covid-related death. One has to be still hiding in their Groundhog-Day hole not to be aware that our Kentucky hospitals are over-whelmed with Covid-19 patients and under-whelmed with a healthy staff to take care of them. The number of patients in the hospital, in ICU beds, and on ventilators are at the highest levels we have ever seen. The fact that inspection of the shape of a curve graphic might be said to be “flattening” is not a good sign when the number of beds is limited!
This is where we are today. It remains to be seen where we are going. We were in a similar place last December but got a lot worse in January. I would like to assume that the seeming temporary stabilization of new reported cases is a result of the good sense and commitment of Kentuckians to their communities. So far there are not enough of us.
Peter Hasselbacher, MD Emeritus Professor of Medicine, UofL Kentucky Health Policy Institute Thursday Morning, 23 September, 2021
[Additional comments to addendum, 9-25-21: September has been a tough month for Kentucky’s epidemic of Covid-19. So far, even as of only September 24, this month has already had the highest number of new cases (96,964 added to the total number confirmed). The number of cases 18 years old and under has never been higher based on data available to me. The consequences of this flair in deaths, long-term morbidity, and hospital utilization have yet to play out.
There is however some good news in case numbers as Kentuckians take the bit of disease prevention and mitigation between their teeth. (I could not resist using a Kentucky motif.) The number of weekly cases will likely be down somewhat when Saturday’s new case number becomes available on Monday. Better news is that the 7-Day average of new cases is racing the 14 day average downwards as is expected when the virus is (at least temporally) fading. The 7-Day average of the test positivity rate is sharply declining following the same path downwards in its correlation with new cases as it did when were in the home stretch of recovery from last winter’s earlier meet with the virus. The semi-log plots of new cases agains time switched from a rising epidemic trend to a flat steady-state one beginning late August 22. More recently the trend has shifted to a modestly downward slope indicating reversal of the epidemic’s expansion. I take these numbers to suggest our community efforts are advancing us as we make the final turn, but the home stretch lies ahead and we are still far from the finish line. We need to continue to work with our trainers, track authorities, and the real veterinarians to the human animal. P.H.]
It has been more than two weeks since I posted a full update of Kentucky’s Covid-19 epidemic status. As I commented on the article in following days, data collection volatility, exacerbated by the Labor Day weekend, did not give me the confidence to opine one way or the other the direction of epidemic status. Available numbers as of the evening of Thursday, September 16 are compatible with the number of new cases entering an interval of steady-state, albeit hovering between 4000 and 4500 news cases per day which exceeds the rate of the darkness of last winter. That is not a good place to be.
[Addendum: Friday evening’s new numbers do not really alter the state of affairs or conclusions outlined in the following paragraphs and graphs. Specific detail is added at the end of this article.]
Cases. The 7-Day average of new cases is playing leapfrog with the 14-Day average. When the 7-Day average is higher than the 14-Day, epidemic expansion is occurring. The numbers obviously vary greatly from day-to-day, inserting a large degree of uncertainty into predictability.
Case counts by day of the week for Thursdays, which are weekdays with reliably higher daily counts. Stable or not?
I like to rely on semi-log plots of exponentially rising counts as a way to estimate the rate and direction of epidemic expansion. Since the end of August, the plot of daily new cases is trending to a horizontal line representing a steady-state of the numbers of new cases– even if they are bouncing up against 5000 or more a day! If we had continued at the rate of the previous few weeks, we would have been at 10,000 new cases a day. Surely such a possibility demanded effective interventions, even if unpopular.
School-age people. As summer activities for children and young adults blossomed and students went back to school, the proportion of new cases 18 years old or younger reported each evening by the Kentucky Department of Public Health rose from a 7-Day average of 18% to over 30% in early September– a greater than 80% increase. This rise occurred in the midst of intense controversy about masking and vaccination of students, teachers, and school staff. Hmm.
Hospitalizations, ICUs or worse. As would be expected, the number of deaths of cases emerging since July 1( as depicted in the first graph of this series above) is entering a more rapid expansion. It will take a while for a full accounting of those deaths to be finalized. The consensus of reports from hospital and other entities is that this newest expansion of hospitalizations and deaths (and in particular ICU and ventilator use) is occurring almost entirely in unvaccinated individuals and is related to the increased virulence of the current universally present Delta variant of the virus.
We expect Covid-19 deaths and hospitalizations to move in the same direction– albeit out of phase with each other. The sequence begins when individuals are exposed and get infected. Some get symptomatically ill. A smaller proportion of these require hospitalization and an even smaller number require ventilatory support. The odds of surviving being put on a ventilator vary considerably by reporting entity, but they are not what anyone would consider good. Against this context, achieving a “plateau” of hospital, ICU, or ventilator use is not a favorable sign if those facilities are already fully in use. This is happening in many places around the country including Kentucky. Some localities are operating under a formal “crisis status” in which the most difficult life or death triage decisions must be made. (I do not ever want to hear a politician utter the words “death panel” again to scare people into not supporting reform of our non-functional healthcare system!)
To conclude. I believe Kentucky, indeed the nation, is poised at one of a sequence of tipping points in terms of the future of our Covid-19 epidemic and its consequent effects on our healthcare, social, and financial futures. I am unwilling to concede that we are doing OK. It troubles me that coordinated and informed responses to the virus do not yet exist. Our political system that should be looking our for our health and welfare interests has abandoned that responsibility to business and the private sector. I want very much to believe we can expect a rapid turn-around, but in all honesty I see things getting worse first.
Peter Hasselbacher, MD Emeritus Professor of Medicine, UofL Kentucky Health Policy Institute 17 September 2021
[Addendum 9-18-21: A new set of Kentucky Covid update numbers was reported Friday evening. Numbers for Saturday, Sunday and Monday will not be available to me until Monday evening.
New cases increased from Thursday to 5133, one of three times in the last 14 days in which counts exceeded 5000 of which twice occured in the last three daily reports. The 7- and 14-Day averages did not change appreciably. The 7-Day average still exceeds the 14-Day average compatible with epidemic expansion. The number for a Friday has been about the same for the last three weeks. A count for the past week will not be available to me until next Monday but is high. The semi-log plot of new cases remains horizontal describing a steady state of new cases. The 7-Day average of the proportion of new cases in individuals 18 and under remains high at 28.1%.
Testing: The 7-Day number of new tests reported which began rising significantly only in early August is 39,253. In June and until mid-July, daily test counts only occasionally exceeded 10,000. Friday’s 7-Day average of electronically reported tests was 12.9, down from a high of 14.6 on September 8. (There is a complicated but significant correlation of both the Test Positive Rate and number of new cases with the number of tests performed and even hospital census that deserves further consideration.)
Hospital, ICU, and ventilator utilzation for Covid-19 remain at the same high levels as they were last week.
Deaths are clearly on the rise with an additional 45 reported yesterday. This rising trend will surely continue for a while.