New cases of Covid-19 infection in Kentucky are rising dramatically and there is no way to explain away the reasons as anything less than a demonization of medical science, and a destructive politicization of public health policy. I fear that after 4 months of difficult sacrifice, we are going to have to start all over again.
The total number of new of new Kentucky Covid-19 infections jumped by 570 and 454 over the last two days. Today’s report will be available soon. The seven highest daily reports of the epidemic have occurred since July 1. Although there were 577 cases reported on Tuesday, May 5, this obviously aberrant number included a large cache of previously uncounted cases in a prison, and from several long-term care facilities. That day’s report also included catch-up cases from the immediately preceding Sunday and Monday– intrinsic low reporting days. We are in new territory.
When did the current surge begin?
Because of our multiple catch-as-catch-can reporting systems nationally and in Kentucky, it is hard to tell. Because it was marked in my mind with a rapid change in public behaviors when retail stores and restaurants opened, I believe our local expansion began with May 25 Memorial Day weekend. After all, national and some local political leaders were telling us it was safe to do more. Indeed, some political and other leaders were telling us to frankly ignore what actual public health experts were advising. (There is still a lot of that going around.)
I have mused a good bit in these pages that, for a variety of reasons, the data collection systems we had available have baked-in delays. If for no other reason, we had a 7-Day virus being cataloged over a 5-day work-week. Here and nationally, counts of cases and deaths have been much lower on Sundays and Mondays and correspondingly higher on Tuesdays and Fridays. This zig-zag pattern shows up in Kentucky and national data. It is for this reason that most updates now use 7-Day or even 14-Day rolling averages to smooth out the numbers. Of course, this bakes-in additional delays in interpretation and time to respond.
My calculation of our 7-Day average.
In the chart just below, the 7-Day average for any given day is defined as the sum of that day’s new cases and the total counts of the previous 6 days, divided by 7. Thus, the aberrant spike of May 5th gets smoothed out over the next week and is followed by a tantalizing decline. After the Memorial Day weekend, the average begins to rise again and never returns to the averages of April. It should be noted we have never had a significant interval when new cases fell in a sustained manner.
Plotting case data by calendar weeks makes the same points. The week beginning July 5 marked a major jump in new cases. The week labeled July 12 includes cases only up through Wednesday July 15. It will almost certainly go higher over the next three days.
If it quacks like a duck...
The rise in cases cannot be explained by increased testing.
Our national testing capability has never been enough and is faltering again. Kentucky’s daily testing numbers as reported have not been rising very much over the last two months. To my understanding, our ability to capture the number of new daily tests, or for that matter the number of cases in Kentucky’s hospitals and ICUs, is currently unreliable. My requests for access to Kentucky’s epidemiologic data base have not been responded to. The CDC has been bullied into relative submission and there are reports and concerns of data suppression or manipulation in other jurisdictions. Based on the daily Kentucky reports that are available on the “Data” tab of KHPI’s Tableau Public portfolio of data visualizations, I have no confidence that we can currently calculate a positive test rate. In the aggregate, our percent of tests that are positive has been hovering around 4% since the end of May.
It’s not just us.
Graphic portrayals of Kentucky’s case history look like the rest of the nation’s which is currently spinning out of control in globally unprecedented numbers. We have squandered our early successes. There is no reason to believe Kentucky was or is immune from the same practices and pressures that have exacerbated the epidemic elsewhere. In the face of a lack of coherent national policy and an inadequate system of data collection and sharing it has been a reasonable to ask the difficult question: how long do we wait before we decide to roll back, or at least enforce the public health measures we have already adopted? Some states with currently choked-up hospitals and with no places to store the bodies are now essentially going back to square one. We are not there yet, but I would argue that we have likely been spinning up our share of the epidemic for at least the last month. I think we have waited long enough!
Turning this epidemic around is like steering an ocean liner: the captain has to turn the steering wheel well before the point of impact with the iceberg to avoid sinking. I applaud the judgement of Governor Beshear and Commissioner Stack. I am bewildered and even angry at the opposition of our attorney general, a few judges, and other public officials who for reasons of flat-earth science, and for political electoral advantage seem to fight the Governor at every opportunity. “Every man or woman for themself” is not an effective way to deal with a plague.
More than a pity, I judge it a criminal abdication the part of the White House to shift its responsibility to a fragmented and under-funded patchwork of states to deal with the worst epidemic we have faced in at least the last century. The final story has yet to written. Much will never be– and must not be the same for us again. Those who have defended Washington’s hyper-politicized rejection of sound public health policy and medical practice share fully in the blame. Washington is fiddling while the nation burns.
Where do we go from here?
It is too late to pretend that nothing bad is happening. No matter what we do in our state, cases will go up in the near future. So will deaths– they are already inching up. I estimate that based on daily increases in cases since June 30, that the number of new cases will double every 10 or 11 days. I would love to be wrong.
I have written earlier about my thinking of how our preparedness was inadequate. We did not have data gathering and reporting systems in place to see what was happening among us. We lacked the essential supplies necessary to cope with a highly infections illness. We are facing a disease that is for all practical purposes new and for which we have not yet found any intervention other than marginally helpful for treatment let alone for prevention. Dying on a ventilator does not fully catalog all the bad long-term effects of Covid-19 infection in either adults or children. We have no way currently in place to test the hypothesis that it is safe or not to open a major soccer stadium or similar large-scale event. We asked people to do difficult things but gave much of the necessary financial and other social support to many who did not need it, with correspondingly little or nothing to those whose needs were great. The belittling of science and the rational was a retreat to medieval ignorance. We paid a heavy price for our early effective success, but the cracks in our fraying social system tore us apart. We will not be easily reassembled into a fair sustainable whole that we never really were. The Covid-19 epidemic proves my guiding postulate that we are never as a society any healthier than the sickest individual among us. Unless we emerge from this in a different place than when we went in, we will be sitting ducks for the next plague that will certainly come to test us. Indeed, we have yet to emerge from the current one intact.
Enough of this for now. Let us cross our fingers and look out for each other. Isn’t that the Golden Public Health Rule?
Peter Hasselbacher, MD
Kentucky Health Policy Institute
July 15, 2020
[Addendum July 18, 5:00 pm: The 7-Day average of new case counts for Thursday, July 16 and Friday continue to track upwards at the same rate. Friday’s count adds 522 new cases to the total. Saturday has usually been a day of high counts as the week wraps up. I have been updating the graphic. ]