It has been more than two weeks since I posted a full update of Kentucky’s Covid-19 epidemic status. As I commented on the article in following days, data collection volatility, exacerbated by the Labor Day weekend, did not give me the confidence to opine one way or the other the direction of epidemic status. Available numbers as of the evening of Thursday, September 16 are compatible with the number of new cases entering an interval of steady-state, albeit hovering between 4000 and 4500 news cases per day which exceeds the rate of the darkness of last winter. That is not a good place to be.
[Addendum: Friday evening’s new numbers do not really alter the state of affairs or conclusions outlined in the following paragraphs and graphs. Specific detail is added at the end of this article.]
The 7-Day average of new cases is playing leapfrog with the 14-Day average. When the 7-Day average is higher than the 14-Day, epidemic expansion is occurring. The numbers obviously vary greatly from day-to-day, inserting a large degree of uncertainty into predictability.
Case counts by day of the week for Thursdays, which are weekdays with reliably higher daily counts. Stable or not?
I like to rely on semi-log plots of exponentially rising counts as a way to estimate the rate and direction of epidemic expansion. Since the end of August, the plot of daily new cases is trending to a horizontal line representing a steady-state of the numbers of new cases– even if they are bouncing up against 5000 or more a day! If we had continued at the rate of the previous few weeks, we would have been at 10,000 new cases a day. Surely such a possibility demanded effective interventions, even if unpopular.
As summer activities for children and young adults blossomed and students went back to school, the proportion of new cases 18 years old or younger reported each evening by the Kentucky Department of Public Health rose from a 7-Day average of 18% to over 30% in early September– a greater than 80% increase. This rise occurred in the midst of intense controversy about masking and vaccination of students, teachers, and school staff. Hmm.
Hospitalizations, ICUs or worse.
As would be expected, the number of deaths of cases emerging since July 1( as depicted in the first graph of this series above) is entering a more rapid expansion. It will take a while for a full accounting of those deaths to be finalized. The consensus of reports from hospital and other entities is that this newest expansion of hospitalizations and deaths (and in particular ICU and ventilator use) is occurring almost entirely in unvaccinated individuals and is related to the increased virulence of the current universally present Delta variant of the virus.
We expect Covid-19 deaths and hospitalizations to move in the same direction– albeit out of phase with each other. The sequence begins when individuals are exposed and get infected. Some get symptomatically ill. A smaller proportion of these require hospitalization and an even smaller number require ventilatory support. The odds of surviving being put on a ventilator vary considerably by reporting entity, but they are not what anyone would consider good. Against this context, achieving a “plateau” of hospital, ICU, or ventilator use is not a favorable sign if those facilities are already fully in use. This is happening in many places around the country including Kentucky. Some localities are operating under a formal “crisis status” in which the most difficult life or death triage decisions must be made. (I do not ever want to hear a politician utter the words “death panel” again to scare people into not supporting reform of our non-functional healthcare system!)
I believe Kentucky, indeed the nation, is poised at one of a sequence of tipping points in terms of the future of our Covid-19 epidemic and its consequent effects on our healthcare, social, and financial futures. I am unwilling to concede that we are doing OK. It troubles me that coordinated and informed responses to the virus do not yet exist. Our political system that should be looking our for our health and welfare interests has abandoned that responsibility to business and the private sector. I want very much to believe we can expect a rapid turn-around, but in all honesty I see things getting worse first.
Peter Hasselbacher, MD
Emeritus Professor of Medicine, UofL
Kentucky Health Policy Institute
17 September 2021
[Addendum 9-18-21: A new set of Kentucky Covid update numbers was reported Friday evening. Numbers for Saturday, Sunday and Monday will not be available to me until Monday evening.
New cases increased from Thursday to 5133, one of three times in the last 14 days in which counts exceeded 5000 of which twice occured in the last three daily reports. The 7- and 14-Day averages did not change appreciably. The 7-Day average still exceeds the 14-Day average compatible with epidemic expansion. The number for a Friday has been about the same for the last three weeks. A count for the past week will not be available to me until next Monday but is high. The semi-log plot of new cases remains horizontal describing a steady state of new cases. The 7-Day average of the proportion of new cases in individuals 18 and under remains high at 28.1%.
Testing: The 7-Day number of new tests reported which began rising significantly only in early August is 39,253. In June and until mid-July, daily test counts only occasionally exceeded 10,000. Friday’s 7-Day average of electronically reported tests was 12.9, down from a high of 14.6 on September 8. (There is a complicated but significant correlation of both the Test Positive Rate and number of new cases with the number of tests performed and even hospital census that deserves further consideration.)
Hospital, ICU, and ventilator utilzation for Covid-19 remain at the same high levels as they were last week.
Deaths are clearly on the rise with an additional 45 reported yesterday. This rising trend will surely continue for a while.
The KHPI Tableau Public portfolio of data visualization has been updated with Friday’s numbers as will be with next Monday evening’s.]