Cases of New Covid-19 Infection in Kentucky Soar to New Daily Records.

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.)

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Can We Detect Local COVID-19 Surges in Time Do Anything About It?

What happens in Myrtle Beach does not stay in Myrtle Beach!

When I last wrote in these pages on June 8, Memorial Day was two weeks behind us, and retail stores and other public venues in Kentucky had recently taken an intermediate step opening up to the general public. Parking lots, roads, and sidewalks were noticeably more populated. Masks appeared to be optional. Perhaps and probably not coincidently, by June 6 both new daily-reported cases (310) and 7-Day rolling average of new cases (226) hit all-time highs for Kentucky’s part of the epidemic! This change was large enough that the New York Times included Kentucky in its daily tally of states in which the numbers of new cases were increasing fastest. Over the next 2 weeks or so, our state was regrouped by the Times with states whose numbers were decreasing, and then back into the group with “mostly the same” number of new cases. Yesterday we were back in the “increasing” cohort along with 31 other states. In only 6 states or territories were cases decreasing. This considerable volatility in case reports does not inspire confidence that our system of timely epidemiological monitoring or control is adequate. New cases are exploding across the nation. Current Kentucky numbers are rising as well. The following graphic tracks the 7-Day rolling average of new cases in Kentucky and an estimate of the Basic Reproductive Rate as of June 27, 2020. An assortment of other visualizations are presented at the end of this article. Interactive online versions of the complete portfolio of visualizations are available at the KHPI Public Tableau website.

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New Covid-19 Cases on the Rise in Kentucky: Not Completely Unexpected.

How many tent revivals does it take to alter the trajectory of an epidemic?

When Kentuckians did the hard things necessary as we entered the great unknown of a new viral disease, we altered the course of the Covid-19 pandemic in our Commonwealth. If we had remained on the initial exponential curve we were experiencing, the entire state would have been infected in a matter of weeks. We have met and passed that challenge– for now. Governor Beshear, Public Health Commissioner Stack, I, and all the rest of the hopeful Kentuckians would like to have believed that the number of new cases would steady, if not decrease altogether. Looking at the reported data and given what I understand to be the definitions of the individual data elements, I believe that the number of new cases is on the rise again. Saturday’s new cases numbered 310, the highest since May 5 when an institutional outbreak was recognized and reported all at once. Indeed the 7-Day rolling average of new cases daily has never been higher than it is now. Reported deaths or hospitalizations have not been rising substantially, but those numbers take longer to show up in reports. Other states are also reporting upticks in their case counts as society opens up.

Are rising cases the simple result of more testing?
The reporting of tests done daily remains erratic. Even though “Tests” now include both viral RNA and patient antibodies, the 7-Day average of Kentucky tests reported daily has actually been decreasing since the first of June. (See below.) The Basic Reproductive Rate (the average number of people that a given case will infect in turn) has been rising. The percent of daily tests that are positive has not changed much. Based on publicly available numbers, I cannot agree yet that the increase in cases is explainable by more testing.

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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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