New Cases and Deaths in Kentucky Declining but Availability of Testing is an Issue.

The number of new cases of corona virus announced by the Governor last evening was not as high as was feared. There was concern that changes in data collection techniques would cause an artifactual “catch-up” spike. The aggregate numbers of both cases and deaths is still rising but not as strongly exponential as before.  The daily count of new cases may be leveling off, but the number of viral tests performed daily is also declining.  Current case mortality is hovering at 5% of identified cases. The percent of viral tests that are positive has been slowly rising– currently 8.2%. Both of these latter two statistics reflect the fact that sicker and high-risk individuals are still being preferentially tested.  As long as we are hamstrung by lack of testing capacity and timely reporting, Kentucky is in no position to open up its economy by relaxing the fundamental epidemiological principles necessary to control this extraordinarily infectious agent.

This morning I simplified and updated the data visualizations currently on the Tableau Public pages of KHPI.  I include some of the semi-log plots that I discussed yesterday, but as it happens, the aggregate numbers of cases and deaths are falling off even this trend line.  Visual inspection confirms that the plots are rising less steeply especially for the number of aggregate cases. (Aggregate deaths might be expected to lag new case discovery.)  Muddying the water however, is the fact that rather than increasing, the number of tests performed (and reported publicly) is actually declining!  What is not looked for is rarely found.  We are still largely flying in twilight– if not the dark.

Cases and Deaths.
The graph below gives an overview of the aggregate numbers of new cases and deaths. The recent points are falling away from the exponential trend line. This has to be a positive sign.

Aggregate Number of Tests.
It is not a positive sign that the rate of performing new tests (as reported publicly) is not increasing as it must. We want to see exponential growth in the number of test done!

New cases and tests.
The daily number of new cases lacks the higher spikes of the week before but remains volatile. The daily number of tests reported is demonstrably declining. It is reasonable to wonder if any appreciable decline in cases may be related to a decrease in testing. I pause here to ask a question that perhaps can be answered by someone in Frankfort. Are all “Cases” defined by a positive viral lab test, or is a clinical diagnosis of Covid-19 infection without a positive test enough of a ticket to make it to the New Case list? It surely is a given that many Kentuckians are infected or killed by Covid-19 than are included in the data available publicly!

What is the problem with testing?
The Governor and Commissioner were obviously disappointed if not frustrated.  I do not blame them.  I am not the first nor the last to point fingers at our Federal Government’s role in deemphasizing or even delaying our national response to the threat of a pandemic. What happened to our scientific and medical leadership that smaller and less wealthy countries had strong testing capacity while we staggered with faulty tests that were worse than nothing?  That story will eventually be told in full, but the current paradoxes are indeed frustrating.  Governor Beshear pointed out the availability of having 15 of the Abbot Company’s rapid-testing machines, but only 20 of the testing kits containing the chemicals needed to actually perform individual tests.  Who has these machines? Are we paying to have them sit unused?  Who is responsible for providing the specimen collection kits and testing reagent kits.  Are they even available anywhere?  The Governor also made a point that while some labs were turning out and reporting results in 24 hours, that others were taking 10 days.  Naturally it takes time to set up any new test and insure that it is working properly.  What entity has arguably failed us– the free market, or the public health agencies of our nation?  I suggest that devolving some public functions to the free market has actually been dysfunctional.

Is it safe to open up?
The suggested  guidelines and thresholds announced by the White House yesterday about how to proceed in the days ahead are at first blush surprisingly reasonable.  If they are actually supported remains to be seen.  I have not had an opportunity to study them myself.  An emphasis is on gradual stepwise changes.  I suspect that most of the critical metrics and capabilities that will justify initial changes are dependent on knowing who is a virus carrier, where they are, and where they have been.  Sadly, it appears that we are far from that capability now. Will we be ready in 12 days till May?  Of course not!  Yes we need to get on to our new normal.  I will be listening to Drs. Fauci and Stack, and Governor Beshear.  Who would you trust your lives to?

Peter Hasselbacher, MD
Emeritus Professor of Medicine, KHPI
President, KHPI
April 18, 2020

Comment: The visualizations on the Tableau Public website are generally updated daily and will differ from the figures included in this article.