Hospital utilization in crisis state. Deaths rising as expected. Community struggling to find the right path forward.
[Addendum Sept 25, 2021: Data on Tableau Public updated as of Friday. New cases and Test Positivity Rates clearly going down. Deaths not yet showing meaningful declines. Hospital, ICU and Ventilator utilization still at record highs. New cases for ages 18-and-under averaging 27% but declining from high of 31% on September 1. See additional notes at the bottom.]
Since the last article in this Covid-19 tracking series, I have been waiting to get through the low reporting-days of a weekend to allow time for the necessary 7-Day and 14-Day averages to reveal a reliable direction of our Kentucky epidemic of Covid-19. A number of indicators show new daily cases to be holding at a steady state with indications of a possible decline. The concern is that the 14-Day average of some 4000 daily case is still higher than any time since March 2020. With three reporting cases left this week, this September will have given us the largest monthly number so far, probably outstripping even the dark months of last December and January.
On a positive note, case-counts for specific weekdays have been trending down every day for over a week. You can click through the individual days on KHPI’s Public Tableau portfolio of data visualizations. Semi-log plots of New Cases also show a stable accumulation of new cases –but not yet a definite decrease. The Kentucky Department of Public Health Test Positivity Rate has taken a sharp turn downwards since September 8th.
It is clear though that the Coronavirus is still having its way with us. Deaths will continue to increase for a while as new cases work their way through their individual clinical courses. The sporadic reporting of deaths illustrates the delay in time built into our clinical and death certificate reporting systems.
Hospitals and ICUs.
Many if not most Covid-19 deaths occur in hospital facilities. The need to be placed on a ventilator is a strong predictor of a future Covid-related death. One has to be still hiding in their Groundhog-Day hole not to be aware that our Kentucky hospitals are over-whelmed with Covid-19 patients and under-whelmed with a healthy staff to take care of them. The number of patients in the hospital, in ICU beds, and on ventilators are at the highest levels we have ever seen. The fact that inspection of the shape of a curve graphic might be said to be “flattening” is not a good sign when the number of beds is limited!
This is where we are today. It remains to be seen where we are going. We were in a similar place last December but got a lot worse in January. I would like to assume that the seeming temporary stabilization of new reported cases is a result of the good sense and commitment of Kentuckians to their communities. So far there are not enough of us.
Peter Hasselbacher, MD
Emeritus Professor of Medicine, UofL
Kentucky Health Policy Institute
23 September, 2021
[Additional comments to addendum, 9-25-21:
September has been a tough month for Kentucky’s epidemic of Covid-19. So far, even as of only September 24, this month has already had the highest number of new cases (96,964 added to the total number confirmed). The number of cases 18 years old and under has never been higher based on data available to me. The consequences of this flair in deaths, long-term morbidity, and hospital utilization have yet to play out.
There is however some good news in case numbers as Kentuckians take the bit of disease prevention and mitigation between their teeth. (I could not resist using a Kentucky motif.) The number of weekly cases will likely be down somewhat when Saturday’s new case number becomes available on Monday. Better news is that the 7-Day average of new cases is racing the 14 day average downwards as is expected when the virus is (at least temporally) fading. The 7-Day average of the test positivity rate is sharply declining following the same path downwards in its correlation with new cases as it did when were in the home stretch of recovery from last winter’s earlier meet with the virus. The semi-log plots of new cases agains time switched from a rising epidemic trend to a flat steady-state one beginning late August 22. More recently the trend has shifted to a modestly downward slope indicating reversal of the epidemic’s expansion. I take these numbers to suggest our community efforts are advancing us as we make the final turn, but the home stretch lies ahead and we are still far from the finish line. We need to continue to work with our trainers, track authorities, and the real veterinarians to the human animal. P.H.]