Kentucky’s Covid-19 Epidemic Expanded Relentlessly During Past Two Months.

This week we will reach a milestone of 800,000 reported new cases of Covid-19 in Kentucky. All public health experts agree that this is a substantial undercount. Despite that there were 5 days of undercounting new cases over the Thanksgiving holiday weekend, and that a rolling average is by definition always hostage to its earliest days, the 7-Day average of new reported KY cases has been rising in an unrelenting fashion since November 5th.

However, our epidemic expansion began weeks before that. For each given weekday (i.e. a Wednesday) the most recent daily count for that day of the week has been higher than the that of the previous 7 to 9 weeks. Last week’s total new case count exceeded by far that of the previous 8 weeks reaching 52% of the highest weekly count of any week during the 628 days since Covid-19 was recognized in Kentucky. The most recent upward trajectory of new each new daily case count has been steep.

Other indicators of epidemic expansion are consistent with this increase in daily new case counts. The number of new cases tracks very closely with the Covid Test Positivity Rate (TPR) whether calculated daily, or using the KY Department of Public Health’s indicator of the 7-Day average of percent of tests reported electronically that are positive. The current “official” positivity rate has been above 9% for the past few days. (The maximum reported rate of 14.2% occurred as recently as last September 8th.) The TPR has been rising sharply. The 7-Day new case rate is surging past that of the 14-Day rate also indicating rapid expansion. The current gap between the two of 463 cases is the highest so far in the course of Kentucky’s epidemic. Cases plotted semi-logarithmically reveal our current expansion of both cases and the TPR to be formally exponential, albeit at a doubling rate of around 4 weeks.

Impact on hospitals.
With the expected few days of delay, current hospital census attributed to Covid-19 has been rising progressively since November 8. The number of patients hospitalized with Covid-19 that require Intensive Care Unit or ventilator support both tracked overall hospital census closely for the duration of our epidemic and are doing so now.

Accurate and timely counts of death due to Covid-19 are not available due to the structure of our healthcare system. There is however, no doubt that daily reported deaths are rising at a trajectory not that different than observed during the surges of last winter and fall. To the best of my ability to assemble such data, the current death rate in Kentucky from Covid-19 exceeds that of all types of cancer combined!

What, Me Worry? (Mad Magazine, 1952-2018)

The “sky is falling down” approach to informing the public about risk is generally considered to be less than maximally effective if not objectively undesirable. However bad things sometimes do fall out of the sky. The current iteration of SARS-CoV-2 is such a bad thing. It will join the historical list of the worst pandemics of all time. Just as the plagues of 14th Century altered the structure of society, so will things unpredictably never be the same again for us.

Why did the previosus surges in cases go down?
We in Kentucky and in our nation weathered and partially reversed 3 or 4 earlier epidemic expansions of Covid-19. I would argue that our effectiveness in climbing down from these mountains of cases and deaths cannot be attributed primarily to better medical treatments, or from the restrictions enforced in myriad ways by political or public health authorities. Rather, our temporary successes were due to a reality that citizens like you and me recognized and believed that something bad was happening to us. We were motivated to more carefully protect ourselves, those we care about, or even the communities we live in. We listened to what we thought was the best advice available to us (sometimes even if it was bad advice). The sum of all the big and little things we did– even or especially if they were hard to do or sustain– made a difference.

“Fear is the mind killer” is a favorite trope from Frank Herbert’s novel and Dune movies. There is however a difference between fear and concern. I believe there is sufficient evidence that we need to be concerned and to act accordingly.

I may add a chart or two to this entry at a later time. The entire portfolio of updated data visualizations is available on KHPI’s Public Tableau website where you can interactively query the data behind this series of articles.

Peter Hasselbacher, MD
Emeritus Professor of Medicine, UofL
7 December 2021