Plague:” A disastrous evil or affliction.”
New cases soaring.
It is clear that Kentucky’s allotment of the Covid-19 pandemic is not under control. In Jefferson County, our largest, it is currently described as a “wildfire still burning” by a senior county public health officer and where the mayor has extended his order declaring a state of emergency through September 30. New cases are exploding in smaller and more rural counties where previous total cases had been sparse. At 608 cases per day, the current 7-Day average of new cases statewide continues to gyrate widely depending on day of the week but is hovering at three times what it was through May and June. Even if this represents a “plateau” in the number of daily new cases, at the current rate of expansion we remain on-track to double the aggregate number of total cases every month. The 4352 new state-wide cases last week fell short by only a little the highest weekly total ever.
Deaths following.
The 12 deaths reported yesterday represent the highest daily reported count since May 30th. The 7-Day average number of deaths reported daily at 6.7 is currently the highest since June 5th. This number is expected to rise as deaths catch up with cases. In Kentucky, currently 2.1% of all reported cases have died. The true number is certainly higher than this due to unrecognized Covid-19 cases and the collateral damage resulting from unmet medical needs in disrupted medical and social systems. Covid-19 patients currently reported as being in the Hospital or ICU– even if not overwhelming for any given hospital– remain higher than at any time since the epidemic began.
What does “recovered” actually tell us?
Of the 40,299 reported Covid-19 cases, only 22.9% are categorized to be recovered. I do not know what “recovered” really tells us here. In classical epidemiologic modeling, recovered individuals are kept track of because those individuals are considered no longer to be at risk for acquiring the given disease therefore diminishing the risk of adding to new cases. This brand-new disease caused by Covid-19 is revealing itself to be a multisystem disorder that damages more than just the lungs. It attacks small blood vessels and other cells throughout the body and is already known to cause longer term damage to other organ systems. Just because an individual of any age survives the initial manifestation of the disease does not mean that they got off scott-free. We will only learn the true impact of Covid-19 on morbidity and mortality in the years to come. There are more than enough reasons not to let it spread unchecked today.
Do we really need a Kentucky Derby?
I would like to paint a more rosy picture but I cannot. I am personally troubled by the disconnect between the numerical facts on the ground and an inconsistency in public health standards being applied– at least in my home county of Jefferson. In my opinion and as I have previously asked, is it wise to host a Kentucky Derby that will bring individuals to Kentucky from states to which we as Kentuckians are not allowed to travel without a self-imposed quarantine on return. We have already documented that Kentuckians returning from vacations in other states have been a major factor in our surging epidemic. We are still being told to stay at home for our vacations. We canceled public attendance at this year’s State Fair because of the risk of centralizing Covid-19 carriers from the four corners of Kentucky. How do we then justify importing the virus from an unlimited number of states, some with failing control of their epidemic?
The Derby is a signature event for Louisville and Kentucky. Pressure to open the gates is intense from influential quarters. It will assuredly be a challenge to host this year even with stands containing a limited number of privileged spectators (the cheap seats have been taken away). This may be the first year in recorded history that, even if you can obtain a ticket, that you can find a hotel room or a fancy restaurant. Naturally, masks will be required at the track –unless you are eating or drinking or in your private spaces. (The few times a few decades ago I was able to attend Derby or Oaks, I did a great deal of eating and drinking. In-between that and trips to a crowded restroom I intermittently shouted at the top of my lungs the patented phrase “down the stretch they come!”) This morning’s Courier-Journal describes the difficulties restaurants and hotels see themselves facing. All of this is occuring at a time when Louisville is facing what is probably unprecedented social distress, a center-city that is largely boarded up, and where armed patrols are promised. This has been a terrible 6 months for restaurants, bars and their employees. It has proven hard and even impossible to make a profit at reduced capacities. Restaurant plans for Derby were highlighted in this mornings Courier-Journal, but at least one restaurateur thinks that “having that many people come into Louisville for an event is insane.” I have to agree. Why, for who, and for what reason more important than maintaining our school systems are we doing this? By all means run the Derby– but with stands empty of general spectators as is so frequently becoming the norm for other major sporting events.
How about soccer?
One of the justifications offered by Derby officials to hold the races is that opening the new soccer stadium to the public was done safely. I maintain that there is no way that statement can be confirmed. That said, I confess to being a fan. I enjoyed taking my grandsons to the games in the old stadium last year. The level of play was high. Daytime games were attended by many children, reflecting the popularity of boy’s and girl’s soccer in our schools. I enjoy eating the food and drinking the beer and drinking the beer again! However, the constant booming of drums and horns and other loud noise made it almost impossible to talk to the person next to me– certainly not without shouting in their faces. The smoke from the frequent celebratory flairs was enough to make one cough. Perhaps things are different now, but if I wanted to amplify the infectiousness of a respiratory disease, I cannot think of a better way. Perhaps things are different this year. I hope so. I have not yet been to a game this year. Nonetheless, the opening of the soccer stadium was followed by the July surge in our local cases. What is the evidence that the soccer season lended no contribution to our case surges? Demonstrating safety would require knowledge of what happened to spectators after they went home. This is impossible without robust and timely community testing or reporting of viral infection, and effective case finding and contact tracking. It is my understanding that we are not there yet. If I am wrong in this, I trust that if someone on-the-ground within Kentucky’s public health system will correct me by confirming that opening the public soccer season was demonstrably safe.
College (and other) football.
As far as I am aware, the University of Louisville still plans to go ahead with its Fall football schedule. Other major college football and NCAA conferences have read the tealeaves and cancelled or postponed their 2020 schedules. Some have tried and failed. We are still holding out. I can only wonder what pressures might be being applied to fill the home stands with spectators! Financial pressures are the hardest to ignore. Other schools or teams attempting to play their usual schedules ran smack into the (inevitable) emergence of new infections in the players and their general student populations. It will be hard enough for universities, colleges, or for that matter our public schools to open effectively in person this Fall. College and other school sports are the least important problem to be solved, and in emerging fact can predictably make matters worse. How much should it count if playing is “cleared” by team or school doctors? As a physician myself, I am concerned that the recommendations of a team or school doctor with close connection to the schools may not reflect the best overall interests of the community. After all, was not a cage-fighter who was killed in a match a few years ago in Louisville “cleared” to fight by an event or team doctor?
I was frankly disappointed at the reasons offered to go ahead with a Fall schedule by Louisville’s football coach recently. The thrust of his logic as I understood it, was that because the school and the ACC Conference had a plan to attempt a safe playing season, it would be a failure of leadership to abandon it. In my opinion, not to adapt to major changes in what is happening in the real world would be an actual failure of leadership. As a former board member of the UofL Athletic Association and physician, I would recommend to UofL President Bendapudi that she overrule her coach and withdraw from Fall play in front of live spectators. It is going to be hard enough to keep the University itself open and that is where the higher priority should lie. This is obviously a painful situation for all involved, not the least the players themselves. I feel for them. It is appropriate and commendable to attempt to protect the players. There is another obligation to protect the community. I believe this latter obligation is being left out of the equation. In Kentucky, private groups of a few tens of people are currently restricted. Public schools are closed to in-person education until the end of September. How then can we rationally justify public meetings of tens of thousands under conditions similar if not more intense than those faced at a track or a soccer stadium?
Here is the data.
The above statements and opinions are based on KHPI’s accumulated numbers reported daily by Frankfort since the epidemic began here on March 6. They are not lightly offered. Our numbers–which have always excluded duplicate cases– track reasonably well with the tallies of major national data aggregators which draw their numbers directly from similar public health sources. Interactive data visualizations can be examined at KHPI’s Public Tableau website. Plots of daily cases in user-selectable Kentucky counties can be also be explored in a separate panel on that website. KHPI’s database on which the latter county-specific visualizations of case (and death) are based is available in the attached Excel file which I abstracted from the New York Times covid database. It is up to date as of August 18, 2020. I hope that individuals familiar with the situation in counties other than Jefferson will look at those experiences and share potential correlations of spikes (or reductions) in case incidence with the rest of us. We need those lessons to help the state navigate this current version of an 11th plague.
Peter Hasselbacher, MD
Kentucky Health Policy Institute.
Emeritus Professor of Medicine, UofL
August 19, 2020
[Addendum:August 20, 2020: Yesterday’s (Aug.19) reported Covid-tracking numbers from Frankfort continue the trends detailed above as the total number of new cases increased by 627. The number of cases reported daily still jumps around wildly such that even the 7-Day average curve is not very smooth. The big jump of 1152 cases on August 12 that followed two low-report days threw a monkey wrench into attempts to discern a trend. (A 14-Day rolling average, currently at 585 cases, is arithmetically less erratic and for the last week has been somewhat smaller than the 7-Day average indicating rising daily case numbers.) Deaths increased by another twelve and are clearly in a rising phase. Hospital utilization remains very high and ICU utilization is at a newer high since mid-May. KHPI’s Public Tableau panel of visualizations has been updated.]