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?
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?
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..
It has been 46 days since the first case of Covid-19 infection was reported in Kentucky and 36 days since the first death– not as long as it seems for those of us riding out the storm at home or still on the job.! Nonetheless, we are hearing increasingly broad demands to walk away from the non-medical public health approaches we are using to mitigate the impact of this highly infectious agent. However, given the very limited availability of viral testing, of what is at best a decrease in the exponential growth rate of new cases, and continuing sporadic jumps in the number of new deaths daily; it is not at all clear that we have broken the back of Kentucky’s part of this pandemic. It does appear that our personal and other community sacrifices have awarded us success compared to other states! We have avoided a disabling flood of very sick Covid-19 patients on the capacity of our hospitals– one of our most important goals. However, in my opinion and as based on the raw numbers available to me, we do not have the evidence in-hand to declare that we have reached the plateau needed to justify anything more than thoughtful planning for progressive gradual stand-downs. The lack of a fully functioning viral testing and reporting system has not reached anyone’s minimal expectations. We are flying blind. Governor Beshear’s reports over the weekend through Tuesday evening show continuing substantial volatility in the counts.