Is the Covid-19 Epidemic Still Expanding in Kentucky and Its Neighborhood?

Kentucky and many other states are backing away from public health measures of varying strictness that were adopted in March or April during the exponential expansion phase of the Covid-19 pandemic in the United States. It is appropriate and even necessary to begin this process, but it needs to be done with an acceptable degree of safety. There is no doubt that measures taken so far have at least “bent” the curve, slowing down if not ultimately decreasing the mortality and morbidity of this overtly infectious disease. I believe Kentucky has benefited greatly from our collective efforts despite opposition on several fronts including armed protest. The expectation and promise is that we and the nation will be able to detect “surges” of the epidemic in a timely way and to be able to reinstate restrictions on public interactions that have proven effective. I wish I could be more confident that we can be successful in either instance.

It‘s not over yet.
In the nation as a whole, albeit to a lesser degree in Kentucky, both the number of aggregate cases and deaths continue to increase. Our ability both as a nation and Commonwealth to test for, identify, and report the presence of Covid-19 in the community and to trace exposed persons is still far behind what is needed to detect and respond to localized outbreaks before they show up two or three weeks later as increases in hospitalizations and deaths. It is from such localized hotspots that epidemic expansion can be continuously fueled. More troublesome is a background of resistance from individuals and groups which, for a variety of ideological, religious, political, or business reasons, hold the nation hostage by refusing to follow evidence-based public health initiatives that are effective only when done collectively. Unfortunately, we face these problems with a weakened and fragmented public health system and an inequitably distributed healthcare system overall.

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What Can We Learn from Mini-Coronavirus Updates?

Some weeks ago, when public health experts were still visible in Washington, a reasonable-sounding set of guidelines for opening up the national economy was offered. Sadly, the White House seems now to place all responsibility on the individual states with minimal if any major Federal help. It is walking away from, if not contradicting, the advice of the best public health scientists the nation has to offer. I fear that things are going to get interesting quickly and that we will land in an uncharted place somewhere between good and disastrous.

With individual states beginning to open up their economies in different ways and to different degrees, it is apparent that our ability to identify new cases of Covid-19 infection early, to do so in unexpected places, and to be willing and able to do something about it will be critical.

What is a “Mini-Update?”
The Wall Street Journal and other publications often offer a “Coronavirus Daily Update” sidebar with a simple list of Total Cases, Total Deaths, and Recoveries for both the United States and globally. When applied to a given geographic area, these three totals are important elements for predictive epidemiologic models. The fact that the numerous models offered today differ widely (or even turn out to be wildly wrong) confirms the truism that any model is no better than the assumptions it makes and the data available to it. By themselves, these high-altitude aggregate numbers are not fine-grained enough to help us predict the future for Kentucky. I do suggest there are some insights to be gained by examining them. In any event, the numbers are sobering.

What might we learn?
Readers of these articles may notice that I have been educating myself (and I hope some of you) about how we can best use the limited and imperfect epidemiologic data available to us to monitor the opening our economy. Are we are on the right path– or are we falling off the wagon? This is today the major healthcare challenge facing us as a nation. What might we learn from countries where the epidemic started earlier? How are we similar or dissimilar?

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How Can We Tell If Our Covid-19 Epidemic Status is Under Control?

What would a recurrent surge of infections look like?

As fifty states with varying intensity of public health approaches to decrease the impact of this highly contagious disease begin to loosen their restrictions, how will we be able to recognize the very real threat of a “second-peak” surge of infections?

Most real experts agree that aggressive testing, new-case finding, and tracking of contacts (backwards and forwards) will be important– indeed critically essential. Small local micro-outbreaks need to be identified quickly and dealt with aggressively. This is going to be a challenge for a number of reasons!

We have become accustomed to seeing a variety of graphs and tables in our public media used to show the status of the epidemic and the hoped-for success in dealing with it. Such macro-presentations will continue– including by me! The problem is that by the time the significance of a given graph becomes evident, the horse may already be out of the barn and running. Nonetheless, what we can’t count, we can’t control. One important metric thought to justify a loosening of restrictions is a sustained two-week decrease in the number of new cases in a given locality. What would this look like in the different possible data visualizations?

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Reopening Kentucky’s Economy in the Current Covid-19 Epidemic.

How will we know if we are still ahead?

It had to start sometime, but pressure from partisan and a variety of other assemblies have surely advanced the nation-wide schedule for lifting restrictions of non-medicinal management of the Covid-19 epidemic. It is happening in Kentucky too. While there are state differences in degree, the number of new cases identified continues to increase overall. We are “bending the curve.” Because availability of viral testing continues to be limited, as more testing done more cases will be found. How best should we monitor our populations to detect, localize, and quantitate any significant second peak in the curve of disease incidence? I cannot say that I know!

Kentucky has been fortunate to have acted early and aggressively to deal with our rising number of cases. Despite relative success compared to other states, the number of known cases in Kentucky is rising and will continue to do so while our still-modest ability to test for the virus increases. A 7-Day rolling average of daily new cases remains high. Timely identification of new cases will be essential to deal with the brushfire outbreaks that are certain to occur in the months ahead– whatever we do. Depending on the day of the week, the number of tests done, and reporting from new hot-spots, the number of new cases per day varies widely, making predictions uncertain..

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