On track to 5000 new cases per day by December 13. It’s even worse across the nation!
Kentucky is in the 260th day, 37th week, and 9th month of its Covid-19 plague. Hospitals here and nationally are getting slammed with more cases and fewer available clinical staff. With rates of new cases and deaths climbing more rapidly, Kentucky and many (but not all) states are instituting more stringent public health orders and recommendations. New vaccines with initially proven effectiveness but unknown long-term safety are coming before the FDA. These reveal some light at the end of the Covid tunnel. However, vaccines will not be widely available for much if not all of next year. Something had to be done to stall for more time. Kentucky’s new emergency orders and suggestions took effect last Friday evening, November 20. Enforcement is limited and the effect on cases will take some time to be seen. However, the number of new cases daily was accelerating too rapidly to ignore.
Summary Numbers: Kentucky has had 155,908 unique cases of Covid-19 since the first one on March 6th. In nine of the last 10 days through November 21, the number of new cases exceeded 3000. The time-to-double has fallen to 21 days, and at the current short-term rate, a trend line has Kentucky with a possible 5000 new daily cases by December 12. New cases per week jumped 20.0% from 16,476 to 19,771. With 8 days to go in November, we have already leapfrogged October’s record from 38,379 to 48,689 new cases. New cases are now emerging faster in rural and sparsely populated counties than in Jefferson, Fayette and more urban ones. Weekly deaths are following new cases having jumped 20% from 97 to a new record of 125 deaths. Deaths are certain to go much higher as the morbidity and mortality of current active cases reveals itself over the next weeks. Hospitals have never seen higher Covid-19 challenges.
At the end of this article is a selection of graphs that should be self-explanatory by now. The full portfolio of data visualizations can be viewed on KHPI’s Tableau Public website. The epidemic experiences of all 120 individual Kentucky Counties and be viewed here. Viewer-adjustable filters allow the epidemic experience of individual counties or ranges of dates to be explored. There are many interesting stories being told by the numbers. (Take a look at sparsely populated Lee County which has the highest aggregate number of cases per 1000 residents in the state!) On October 9th, I published an animated map of new cases as they appeared sequentially among the counties. The Governor’s office used such a similar display during one of last week’s presentations. A viewer can step through KHPIs visualization at their own pace. Free to explore some of the other Visualizations that address how and what Covid-19 data can show us. It has been an educational process for me.
I will dispense with additional editorial comment at this time. Suffice it to say that I fully support the justifiable efforts of Governor Beshear and his Public Health Department team. I correspondently condemn those who automatically for political purposes and without an offer of a rational alternative attempt to thwart at every step the application of standard public health measures. I blame them as well as the virus for the disastrous economic and medical places to which we have come and will enter further.
Peter Hasselbacher, MD Emeritus Professor Medicine, UofL 22 November 2020
Into this world we’re thrown, like a dog without a bone. The Doors, 1971
I never appreciated nor fully understood the lyrics of this iconic rock anthem. In today’s world, a different context made the words jump unbidden into my head. There is no need for me to launch into a lengthly end-of-week-review today. Everyone should already know that what is happening in Kentucky and in the nation broadly is nothing short of the disaster that defines pandemics plagues. Here and nationally new records are being set daily. I invite the reader to visit KHPI’s Public Tableau website to interactively explore an updated portfolio of data visualizations of Kentucky’s numbers.
In brief, virtually every Covid metric that KHPI has been following set a new record last week. Daily new cases now number greater than 3000. Weekly new cases jumped 32% from 12,442 to 16,476 for the week ending Saturday, Nov 14. The 7-Day rolling average of new cases is surging towards a straight-up direction faster than the 14-Day average indicating a rapidly expanding epidemic. Hospital and ICU utilization by Covid-19 patients is also setting new records records daily with hospitals making no attempt to hide their concerns about limited resources of space, inventory, or staff. The number of weekly Covid-19 deaths set a new record at 97, increasing from an average in the 80s for the preceding three weeks. It is inevitable, that despite better understanding of the disease and its treatment, the number of Covid-19 deaths will also accelerate. The number of total tests reported [not including many tests performed but not reported] remains more or less constant since early September at around 150,000 per day.
Below is a single graphic that encapsulates the dire situation we are facing. The people of Kentucky and their leaders, regardless of their political or social persuasions, are going to have to take responsibility for and to respond to this darkening storm.
How bad can it possibly get? What tea leaves should be reading? Looking at what has or is happening in other states and countries informs us that it can get a lot worse than it correctly is in Kentucky. Kentuckians have been pushing back on the viral monster, but some of us feel like an actor out alone. We do not have data that is sufficiently current or standardized to take full advantage of what is happening in other states, or indeed even within our own counties. Left by Washington largely to our own resources for so long, we and others are left to look at what has already happened to us in the past, and on that basis attempt to predict what is to come– if nothing else changes. Of course, that latter clause is the unpredictable kicker.
There’s a killer on the road. When a sharply increasing epidemic curve such as those in the 7-Day and 14-Day average curves above seem to be going straight up, it is difficult to predict where they are headed. We intuitively recognize that when numbers are increasing at a faster and faster rate, that things can go from bad to worse in an correspondingly shorter time. To offer a mathematically rational way to tame exponential increases (think compound interest), KHPI has offered semi-log plots as a basis for calculating understandable trendlines. Of course, based on previous history alone there is a limit on how far into the future one can reasonably predict. However, the better the fit of data to a trendline or forecast, the more confident one can be that predictions are at least rational. In fact, earlier KHPI projections using this approach have turned out to be pretty good!
Below is a semi-log plot of the 14-Day average of new cases of Covid-19 in Kentucky based on daily Frankfort numbers from October 1 through November 14. As is anticipated when an exponentially rising curve is graphed with new cases on a logarithmic axis against linear time, the data points fit a straight line very well. Indeed, the statistical fit for Kentucky’s numbers is excellent. [For data-aware folks, R-Squared= 0.97 and p= 0.0001]. I forget the calculus I learned 50 years ago to offer an equation, but inspection of the trend-line on device screens or on paper allows one to estimate a doubling time of some 30 days. Based on new case numbers over the last month-and-a-half, we may be seeing as many as 5000 new cases per day by Christmas. By the end of January 10,000 cases per day are in the realm of possibility. Of course, this assumes that nothing will change– but surely it has to. [Disclaimer: As financial advisors always note, yields of the past do not necessarily predict profits for the future!] You can interactively change the data intervals Tableau Online uses to calculate trends and forecasts to see how they are becoming steeper. My take-away from these exercises is that we should have seen this coming for some time– at least since last summer.
It could be worse– and for the rest of the USA it is! There is no question that Kentuckians have been working hard to stay ahead of the curve. It has been difficult. Sacrifices have been made. Most of us have suffered financially and all of us injured someway in spirit. Thank goodness we have Mississippi or Indiana to compare ourselves to. We are definitely doing better than many other communities by a lot!
I downloaded Covid-19 historical data for all the US states and territories from the Covid Tracking Project and plotted the increase in daily positive tests (a proxy for new cases) in the same manner above that used Kentucky’s home-grown data. Nationally, new positives rose from 45,481 on Oct 1 to 170,333 on November 13. The trendline based on these dates indicates that positives have been doubling every 24 days. At this rate of accelerating growth, the US will hit 200,000 positives per day by November 28, and 500,000 by December 28. If only the surging data beginning November 1 are used (74,051 positives), the doubling time drops to 2 weeks, and we hit 500,000 positives by Dec 7.
Where do we go from here? I wish I knew. The Covid brand of Lysenkoism that evolved in our current American political climate has not been healthy for us. Lysenkoism is a political strategy that arose (or at least was named) under Stalin in Communist Russia. To quote Wikipedia, ” it has come to be identified as any deliberate distortion of scientific facts or theories for purposes that are deemed politically, religiously or socially desirable.”
When applied to agricultural practices in Russia and China, the making-up or denial of scientific facts to suit a tyrant government led to widespread famine and death. There was a terrible price paid for rejecting evolution and plant science. (The term is now used for areas other than agricultural science.) Although there have been elements of science-denial in previous American government institutions (and Americans), it is patently obvious that flagrant Lysenkoism has been a general guiding principal for the current White House, and specifically for dealing with Coronavirus. In Russia and in the Chinese Great Leap Forward, Lysenkoism sent scientists and other educated persons to gulags or otherwise to their deaths. To say that such things could never happen in America remains to be examined by history.
I would really like to be optimistic and say that we will all buckle down and minimize the damage to both our psyches and pocketbooks. However, with a Kentucky Republican legislature, an Attorney General, some judges, and a large segment of Kentucky’s population content to let them try their darndest to reverse a Democratic Governor’s application of proven public health measures, I believe we have not yet seen our darkest days.
Hope? One glimmer of distant hope may remain. Given the emerging multistate explosions of Covid-19 cases around the country, even previously hands-off governors and governments are issuing new restrictions that Kentucky has been using for some time. One can only pretend for so long that there is nothing that can be done to mitigate this disaster. Hopefully any holdouts will listen to Ohio Governor Mike DeWine who was quoted last week in the WSJ about protecting both the economy and beating the virus: “We made a mistake when we talk about these two things separately” as he imposed stricter mask wearing requirements. “Customers confidence that they can go out and be safe is entirely related to how bad the virus is in their community.” Perhaps it will no longer be acceptable in any form to stand by and let bad things happen without a defendable plan to mitigate the damage. A combination of leadership, education, and a judicious modicum of enforcement is in order.
“Girl, ya gotta love your man Take him by the hand Make him understand The world on you depends Our life will never end”
Peter Hasselbacher, MD Emeritus Professor of Medicine, UofL 15 November 2020
Sadly, and disappointedly, there has been no change in the trajectory of Kentucky’s Coronavirus epidemic since last week’s summary report. The number of new cases continues to set new records daily or almost every other day, now doubling every 4 to 5 weeks. Weekly cases have been relentlessly setting new records since early September. Fourteen-day rolling averages since early September closely follow a trajectory that could generate some 5000 new cases per day by the end of December and 10,000 by the end of next January if the trend continues unabated. It is no consolation that the Country as a whole is doing even worse. Surely it cannot go on like this– it must not!
If nothing changes could hit 5000 new cases per day by the end of December based on trend since October 1.
It may not make too much sense to update the Kentucky Covid-19 epidemic in midweek because it takes the remainder of the week for statewide reporting to catch up from the slow or absent reporting of Sundays and Mondays. I make an exception today even before Wednesday’s reporting because things have been so bad here, nationwide, and in most other countries that have the infrastructure necessary to count cases at all. I am also moved by considerations that our hospital and their preexisting ICU beds are now truly threatened by sequential record-breaking days since reliable accounting began in May.
Brief Review with Charts:
Below is my customary histogram of new cases showing the dramatic peaks and troughs of daily counts, with nadirs on Sundays that render anything other than 7- or 14-day rolling averages unsatisfactory to predict very far into the future.
A weekly consolidation of cases proves the sharp and sustained explosion (dare I use that word?) of cases since the end of the summer. We have 4 days worth of counts left to add to the most recent week! (Tableau’s internal calendar starts every new week on a Sunday by default, and therefore so do I.)
I asked my statistics package (Tableau) to plot a forecast on what will happen to new cases in the near future based on numbers since October 1. I do not know how the software calculates these forecasts or their confidence levels, but I want to emphasize the point that even a 7-Day rolling average has a much wider range of unconvincing predictability than the 14-Day one. Even at that, the 14-Day average puts us at an average of 2000 cases per day or higher by the end of the week.
I have been using another way to estimate the rate of growth of Kentucky’s epidemic that I think I understand better. The following figure plots the 7-Day rolling average of new cases on a semi-logarithmic axis that allows both small and large numbers to be placed in the same view. An added feature is that an exponential trend line (as opposed to a linear one) is a straight line allowing a rate of exponential growth to be calculated or determined by inspection. In this case, if nothing else happens, and based changes on the daily numbers from October 1 to November 3, the average number of new cases can easily hit 2000 by the end of this week, and even reach 5000 per day by the end of December. Those numbers are based only on historical collected data but should make us sit up and take notice. I suggest that it is healthy to be somewhat apprehensive right now. (If I really wanted to scare my readers, I would illegitimately project the trend line further to suggest that at the present rate of growth, we would hit 500,000 new cases daily by the end of next July! Such is the power of compound interest. Of course, our hospitals would have been closing long before those dates and such an end-of the-world prediction would be irresponsible– right?)
I will close this article off shorter than usual. I will update the Tableau Public portfolio of on-line data visualizations after this evening’s report without further commentary. In the week ahead, I will trim down the number of individual visualizations in that file to focus on what I believe are the most useful. What should I keep, and what should I omit? For that matter, what new would you like to see?
Peter Hasselbacher, MD Emeritus Professor of Medicine, UofL 3 November 2020