A seeming stabilization of case counts this past week at a new high level teased us into thinking we had gotten over the hump of the July surge of new Covid-19 cases. That seems not yet to be the case. The aggregate number of cases increased today by 782 new ones. There were 8 new deaths. The number of patients in ICUs remains at the highest level ever. As we approach the opening of public schools, colleges and universities, college and professional sports, the Kentucky Derby, and other public postponed or Fall activities; it cannot be said that we have our share of the pandemic under adequate control.
Our communities need now to make some hard decisions about where their highest priorities lie– and act as though we believe it! Seems to me that opening public schools physically would rank high on any list if feasible, but there is zero doubt that new cases would emerge in both students and staff that will undermine if not crush the advantages of doing so. (We will still need other than schoolhouse-based ways to provide for the learning and non-pedagogical needs of children and students.) Businesses and their jobs must remain available to the extent they can do so with acceptable safety. There is no zero-risk to anything we do or do not. In my opinion, sporting events and similar large-scale public or non-public events, no matter how much fun to play or attend, do not rise to the same level of necessity to our communities, and in fact are already demonstrating an ability to make things worse. Assuming that all of us as individuals will make the best decisions in the interest of public good is folly.
Below is a bar chart of new cases since March to August 8. The complete series of interactive data visualizations is available on the KHPI Tableau Public website.
It may or not be coincidence that the great leap upwards beginning in July followed the opening of bars, expansion of restaurant service, and a series of home games for the Louisville City FC soccer team. Although additional analysis is needed, the biggest jumps in cases appear to have been in Jefferson County. Adjacent Oldham County had spikes of cases on July 18 and 19 but this may have resulted from cases in the correctional facility there just as the previous highest spike on May 5th contained a cohort of cases from the Green River Correctional facility.
Below is a graphic of the Covid-19 history of Jeffereson County current to August 4th extracted from the New York Times database. A sharp increase in the rate of new cases occurs in early July. Whether this same rate of increase is shared by other counties with large populations remains to be shown, but that data is now available to us and I am learning how to use it..
Weekly cases.
When looked at as cases per calendar week, this past one remains near the top with over 3800 cases. (The week beginning Sunday, July 12 had more, but I understand it included some correctional facility cases.) A look at the individual county case numbers may help clarify where these cases came from, We were recently told that county assignment may represent the location of the hospital rather than the residence of the patient. This needs clarification.
Hospitals are definitely seeing more patients. I have no information about whether ICUs are reaching capacity, but surely some of the counties with smaller hospitals or no ICUs may be feeling squeezed. I confess that I do not yet have great confidence in how the hospital numbers are collected, but I assume the trend displayed is reasonably correct. (I am still not sure if the number of ICU beds is included in, or in addition to the stated hospital bed occupancy.)
There is more that could be said, but it is late in the day. I expect to see our current public health measures extended if not reinforced. There will be much weeping and gnashing of teeth– but so it has always been with plagues. We are in a tough spot.
Peter Hasselbacher, MD
Kentucky Health Policy Institute.
August 8, 2020