Plateaus do not last forever.
As we approach the end of this pre-Derby Week and a change of seasons, the best we can say about the status of Kentucky’s Covid-19 epidemic is that our rapid decline of new cases has ended and that our case and hospital utilization rates have “plateaued” –albeit at levels well above last Summer’s or before last Fall’s epidemiologic explosion. Of concern are early hints of renewed epidemiologic expansion. Daily new case numbers and Kentucky’s calculated Test Positivity Rate are both inching up. The 7-Day average new case number is beginning to peek above the 14-Day curve– another hint of epidemic expansion. With two reporting days left this week, we are on track to match the 4000-plus weekly case numbers of mid-March. Kentucky’s current situation largely mirrors the national situation, but we are in a better place than states and regions where the Covid-conflagration has reignited. Our vaccination programs are going well and from my person-on-the-street perspective, much self-imposed masking and social distancing practices can be seen. In my opinion however, we remain vulnerable to things we cannot control– or choose not to.
Kentucky still contains viral hotspots as judged by national criteria. New cases arise throughout the state ready to breakout again. The more contagious viral mutations roam freely among us. We are travelling and encouraging out-of-state visitors again. The fact that no vaccine or disease treatment is perfect, permanent, or risk free is likely to interrupt vaccine administration programs for those who would benefit most– and that indirectly includes all of us! We are all tired of the restrictions the virus has imposed on our lives which have impoverished us both emotionally and financially. Many of us are in denial or have given up trying to do what history and science tells us is effective to bring the current plague under acceptable control. We continue to have unacceptable differences in access to the healthcare and social support necessary to maintain social cohesion and justice necessary to maintain the health of the body politic.
Where we go from here is indeterminable. We will only know when we get there. When I was asked last week if I thought it was safe to run a proper Kentucky Derby, I did not have a supportable answer one way or the other. It was and remains my opinion that another disease “surge” is more likely than not. More to the point, we lack the tools or surveillance structure to demonstrate that a given large-scale event is “safe” or not. If cases flair again, how do we tell if it was a Derby, returning Spring vacationers, out-of-towners, new viral strains, or anything else? Certainly other large-scale events are still being postponed.
My belief is that we should continue on our present course and that it is very premature to let our full guard down. I agree with incremental steps. I could even support more mandatory vaccinations or other requirements for full participation in societal events such as school or employment. I cannot find fault with the recent CDC decision to take a close look at a rare complication of the Johnson & Johnson (Janssen) and AstraZeneca vaccines. Nothing we do in medicine, public health, or living together is absolutely risk free. It is only a matter of justice and social cohesion that we share that unavoidable risk of being alive.
I updated KHPI’s tracking data on the Tableau Public website as of April 15 for your inspection.
Peter Hasselbacher, MD
Kentucky Health Policy Institute
April 16, 2021