We have not yet reached the peak of either cases or deaths!
It has been my tenant, that as a society “We are no more healthy than the sickest among us.” In recent months, I restate as a corollary that, “We are no more healthy than the person standing right next to us!”
When I started this, I was actually surprised to see that I have not written for these pages for a full year. Ironically, the last article I wrote dealt with Kentucky’s major epidemic of Hepatitis-A. Fortunately, after more than 5000 cases, 2400 hospitalizations, and 62 deaths, that viral epidemic has simmered back down into its always-threatening background rate. Sadly, the non-medical societal determinants and public health support that permitted and accelerated that outbreak are still with us. It was just a matter of time that another life-threatening epidemic would come calling in the United States and to our Kentucky Home. This global pandemic, Coronavirus (Covid-19), is a particularly nasty one for which the world was ill-prepared. Reams of paper and terabytes of postings have been published attempting to explain why and how things got so bad so quickly, or whether we are overreacting. I expect to add something to those discussions, but not in this first effort. For now: it is what it is– bad! We will have to deal with it.
My readers know I like to play with numbers. I have been trying to assemble data about the number of cases of Coronavirus in the Commonwealth of Kentucky. It has not been easy, and I cast no blame. Despite the fact that the virus has been ping-ponging around the world causing death and devastation along the way, we in the United States were not prepared to test for the illness, to trace contacts, or even to take care of large numbers of very sick people. For now, I have been scraping numbers from Governor Andy Beshear’s daily reports to the state about the status of the epidemic and the state’s plans to deal with it. Governor Beshear has drawn national praise for the way he and his administration are managing with this maximally challenging problem and for communicating with the public. I echo that praise. I do not believe we are over-reacting.
Testing in Kentucky only began in early March. The first instance of a positive blood test in Kentucky was reported on March 6, rising by March 10th to about 50 tests of which 8 were positive. The first death was reported to the public on March 16. As of last evening, despite ongoing issues of availability and delays in reporting test results, the number of known infections in Kentucky rose to 770 with 31 known deaths attributed to Coronavirus. In the last two days alone, the number of deaths increased by 50%. Surely these numbers are low because of the inability to test individuals with less severe disease. Below are the details of what I found so far. [An interactive graphic with updated data and alternative visualizations can be accessed here.] Click on graphic to enlarge.
The main point of this figure is that both the number of positive blood tests (which represent viral infection) and the number of deaths are rocketing upwards in what looks like an exponential manner. This is serious stuff. We have by no means reached the peak of this plague! It is for this reason that hospitals, public health entities, and governments are worried if we can handle an oncoming “surge” of cases. We should all be concerned and do our part in getting through this as a community. It will not be easy, but we can save lives and get ourselves back on our economic feet sooner.
How deadly is this virus?
I don’t know. Others with more training than I in epidemiology are making very different estimates. It is clear to me that this is something worse than the flu or chickenpox. No one had any justification to claim otherwise from the moment this illness emerged on the other side of the world. This Coronavirus is very infectious– that is to say it passes easily from one person to another even without physical contact. It can make people very sick and is quicckly draining our healthcare system of resources and personnel. It makes patients out of our neighbors and healthcare personnel alike.
In the data visualizations I offer, I made what is for now a back-of-the-envelope calculation of Observed Mortality Rate. This is the percent of patients known to have been infected with the virus at a given point in time divided by the number of deaths. As of today, 4.0% of the 770 Kentuckians known to have been infected so far in Kentucky have died. This is on the high side of the estimates of others. I assume that this number is artifactually high since we have only been testing the sicker and sickest of people with symptoms. Undoubtedly many individuals who have no or less severe symptoms may never come to medical attention and are not tested. Furthermore, it takes a while for the symptoms to occur after exposure, and even more time to get really sick. I expect with more information that the mortality curve will level off at a less labile number. There are about 4.5 million people living in Kentucky. If only one quarter of us get the virus and 3% of the infected die, that adds up to almost 34,000 Kentuckians. The eventual numbers cannot be predicted with any confidence at this time.
A Stealth Attack!
I believe that for some time now that many early Coronavirus patients were being diagnosed as “Flu-Like Disease.” Indeed, the CDC is reporting on its national website that we have had an extended influenza season this year with a second “peak” just when Coronavirus began to flourish. Many of these cases are classified as “Influenza-Like Illness” with absent or negative lab tests for the influenza virus itself. Kentucky’s news media were also reporting on an especially bad flu season so far this year. I have no doubt that many of there presumed influenza cases were actually Coronavirus which has been with us for some time now, both nationally and here in our Kentucky Home. The time to nip this disease in the bud has passed. We are now in the mitigation phase of dealing with this epidemic. Our present goal is to minimize the damage and make it possible for our healthcare system to take care of more sick people than it was used to or designed for. The effort will not be easy but we must believe it is worthwhile.
I plan to expand this offering a little and to add my 4-cents in future articles. I will be updating the graph and on-line visualization. I expect we will learn more together. If I have made errors of fact, or math, or interpretation, please help me. If our state motto is anything more than a feel-good slogan, we must all work together and come out at the same time in the end.
Peter Hasselbacher, MD
Emeritus Professor of Medicine, UofL
3 April 2020