Kentucky Covid-19 Update for Week Ending 12/12/20.

Last week was a pivotal one for Kentucky’s Covid-19 epidemic as we enter the winter holiday season. As of yesterday, indoor restrictions for bars and restaurants were lifted following a week when new case counts and hospital utilization remained high. The softening of restrictions was justified in part by a decline in the published Covid-19 Test Rate, but likely was also influenced by social, political, legal, and economic pressures. While it is conceivable that we are entering a period of “plateau,” I believe we need a few more days of case accounting to be totally confident that we have left the exponential growth tangent we were on.  Even so, a daily accumulation of over 3000 new cases, 20 deaths, and record (if not saturated) hospital, ICU, and ventilator utilization does not seem to me to be a place where we should be satisfied. Most of the rest of the country expects things to get a lot worse than they are now. The new availability of vaccines is great news, but for months to come, we must rely on traditional public health measures.

I have updated KHPI’s on-line portfolio of epidemic data visualizations, including a few new ones included below. My attendant comments outline the basis for my understanding of Kentucky’s current epidemic profile.

New Cases: Daily and 14-Day Averages.
As discussed at length everywhere, the practical reality of epidemic data collecting causes large daily swings in reported cases and deaths over any given week both nationally and in Kentucky. When major holidays (like Thanksgiving) add to the disruptions of the weekends, huge swings in virtually all reported case data occurs. Over the last three weeks, reports of new daily cases on Kentucky have doubled or more from one day to the next. Even a 7-Day average of counts has not resolved this volatility.  In the figure below, I added a 14-Day Average marker to the histogram of daily new case counts. I would not predict where we are going from here. Sunday’s and Monday’s counts will not resolve the issue as those days have the lowest counts of the week.

Number of daily new Covid-19 cases with 14-Day Average marker.

While the number of reported new cases last week was lower than the proceeding week, that drop is certainly due to delayed reporting of cases acquired during Thanksgiving week. 

New Covid-19 cases per week. Kentucky as of 12-12-20.
Continue reading “Kentucky Covid-19 Update for Week Ending 12/12/20.”

Kentucky Among States With Fastest Growth of Covid-19.

I updated the data visualizations on KHPI’s Tableau Public Website with Kentucky’s Covid-Tracking numbers as of the end last week (Saturday December 5).  It was once again not a good week. Three of the seven days had the highest daily case-counts of the entire epidemic. The Seven- and Fourteen-Day rolling averages of new cases also reached new highs with the 7-Day average surging past the 14-Day one indicating accelerating growth.  Weekly new cases at 23,883 leapfrogged to a new record high that was 31% higher than the previous week.  Hospitalizations remained high amid increasing concerns of limiting pressures on staff and beds.  Along with these other objective measures of epidemic expansion, weekly deaths increased to 177,  or 74% higher than the previous week.   Total deaths in Kentucky have been increasing exponentially– more sharply so in recent weeks.  At the current rate of increase, total deaths are doubling every 10-11 weeks. Even at the present rate, we could see 3000 aggregate deaths by mid-January. Expectations are that due to the arrival of winter’s indoor weather and its holidays, deaths will accrue even faster.  We are yet two weeks past Thanksgiving Day and have not yet seen the full impact of that holiday week on on cases, hospitalizations or deaths.  In my opinion, these numbers do not suggest that we have controlled our Kentucky epidemic nor to show that have reached a new (acceptable?) plateau. It will take weeks to be able to make such claims.

Deaths have not been increasing in parallel with new cases. That represents the success of better understanding the biology of the disease itself and ways to treat the sick.  Surely even our haphazard state-wide adherence to proven and recommended public health measures has likely kept things from getting even worse.  We have not yet become a “let-nature-take-her-course” epidemic disaster-state like South Dakota, but given the high-powered and effective opposition to even the most reasonable public health preventive measures, there is no intrinsic reason we could not share the status. Today’s headlines rank Kentucky with 12 other states with the fastest spread of Covid-19.   The fact that there are 61 semi-independent public health departments in Kentucky with different resources and abilities (or even willingness) to work off the same page is enough of a handicap.

Vaccines
In a few days, it appears we will have available for use at least two vaccines against the virus that causes Covid-19.  These are being touted by some as magic bullets that will make everything all right again.  Who could not wish for this to be true! However, these vaccines and the potential for additional ones cannot justify continuing to do the same things we are doing now.  For one thing, initial availability will be quite limited.  People close to the situation stretch availability to the general public well out into the next year. In addition, the physical implementation of such a unprecedented massive vaccination program faces considerable technical and social hurdles. Our fragmented healthcare system is not designed to take care of everyone in the same way.  Do we go to our doctor’s office (if we have one)?  To the local drug or grocery store? To a hospital?  To a parking lot somewhere?  

The clinical data that supported recent emergency FDA approval of these first two vaccines in carefully supervised studies has shown that antibodies are in fact generated, and that the emergence of symptomatic Covid-19 was very much less in individuals who received the vaccine than those who received an inactive placebo injection. A figure in excess of 90% effectiveness is reported.  I have no reason to doubt this statistic.  If Dr. Anthony Fauci says it is correct and the vaccine is acceptably safe to take, I accept both opinions!   The promise of effectiveness is made against the reality of dealing with a brand-new disease and new vaccine methodology.  It is a basic principle of clinical research that the results found in a controlled clinical trial do not always predict what happens when a treatment or test is released into the general population.  There are important factors even with the naturally acquired Covid disease that we are still learning. For how long are infected patients (symptomatic or not) able to transmit the disease?  For how long does the protection of an initial viral exposure last?  How often is a person vulnerable to reinfection from the same or a different mutation of the virus?  What are the long-term consequences for survivors, asymptomatic or not?  Does survival from Covid-19 imply freedom to no longer follow public health measures against spread to others or even reinfection?  These considerations apply to vaccines as well.  

I do not raise these questions as reasons not to accept vaccination from the Moderna or Pfizer vaccines. What I do suggest is that we need to have better systems to collect clinical data and record long-term outcomes from individuals who contract Covid-19 natively or who are vaccinated.  These must be incorporated into vaccination programs from day one.  It is just as important to establish that the vaccinations are safe as it is to prove they are effective.  There will be future choices of vaccines and some may have different important consequences than others.  Safety means more than just a few days of a sore arm, generalized aches, or fever.

The fact that we do not have perfect knowledge has never been an absolute barrier to treating disease.  There is no application of medical science or practice that does not require a balance of benefit against risk.  I am comfortable with moving ahead as impartial FDA, CDC, and NIH experts and officials recommend.  I do argue strongly that to get past our current epidemic, we need a major restructuring of our healthcare systems with a better merging of public health function with personal health. We need to do this now get past our current plague and to prepare for the inevitable next one. We are most certainly all in this together and implementation of our public health approaches must recognize this.

Peter Hasselbacher, MD
Emeritus Professor of Medicine, UofL
7 December 2020

This Week’s Covid-19 Update For Kentucky and The Nation Is Incomplete But Troubling Nevertheless.

Reported Covid-19 data last week were obviously underreported both in Kentucky and in the United States as a whole.  We have come expect that a normal weekend administrative schedule underreports cases and deaths on Sundays and Mondays with corresponding catch-up reporting over the next few days.  Bracketed between two weekends, with Thanksgiving holidays in the middle, this artifact was magnified.  Even 7- and 14-Day averages of new cases were unable to smooth out the trajectory of Kentucky’s epidemic.  New Kentucky cases and deaths for the week were both modestly down from the week before.  However, even with two days of reporting left to go for the month of November, the respective monthly tallies tell the troubling tale.  Total new cases in Kentucky rose 75% from 38,379 in October to 66,963 in November.  Deaths rose 29% over the same period from 311 to 400.  Sunday’s preliminary counts of cases and deaths suggest catch-up already occurring.  Based only on November’s data so far, at the current 14-Day average rate, we remain on-track to double new cases every 3-4 weeks with a possible 5000 new cases daily by mid-December.  Given that travel by car and plane last week reached highest levels by far since the epidemic began, and that Target’s St.  Matthews Black Friday parking lot looked like Christmas; it is almost certain that our rate of epidemic expansion will increase further.  Hospital and ICU occupancy remain at record levels.  The full updated panel of Kentucky’s data visualizations is available at KHPI’s Tableau Public website.

7- and 14-Day Averages of New Covid-19 cases in Kentucky as of 11-28-20.
Possible projection of new Covid-19 cases based on November cases.

Although Kentucky’s experience with the epidemic has been favorable compared to other states, we are subject to the same problems with data collection and reporting, and also facing the same pressures of Coronavirus fatigue and political push-back.  While waiting for Kentucky’s numbers to settle into something more representative, I looked at National data and found that what has been happening in Kentucky pretty much mirrors the combined experience of other states in form if not degree.  I will use the rest of this article to replicate the data visualizations I have been using for Kentucky using national data.  It must be noted up-front that left to their own devices, states and other geographical units report different categories of data, using different definitions and reporting schedules.  Recognizing that there are apples, oranges, and pears in the fruit basket, comparisons among states must be done with caution.  Nonetheless, I found it noteworthy that the data visualizations looked much the same, representing experiences similar to our own and therefore useful.  For the graphs below, I used the data assembled by the COVID Tracking Project of The Atlantic magazine.

Continue reading “This Week’s Covid-19 Update For Kentucky and The Nation Is Incomplete But Troubling Nevertheless.”

New Kentucky Cases of Covd-19 Doubling Every Three Weeks and Accelerating.

On track to 5000 new cases per day by December 13.  It’s even worse across the nation!

Kentucky is in the 260th day, 37th week, and 9th month of its Covid-19 plague. Hospitals here and nationally are getting slammed with more cases and fewer available clinical staff. With rates of new cases and deaths climbing more rapidly, Kentucky and many (but not all) states are instituting more stringent public health orders and recommendations. New vaccines with initially proven effectiveness but unknown long-term safety are coming before the FDA. These reveal some light at the end of the Covid tunnel. However, vaccines will not be widely available for much if not all of next year.  Something had to be done to stall for more time.  Kentucky’s new emergency orders and suggestions took effect last Friday evening, November 20.   Enforcement is limited and the effect on cases will take some time to be seen. However, the number of new cases daily was accelerating too rapidly to ignore. 

Summary Numbers:
Kentucky has had 155,908 unique cases of Covid-19 since the first one on March 6th.   In nine of the last 10 days through November 21, the number of new cases exceeded 3000. The time-to-double has fallen to 21 days, and at the current short-term rate, a trend line has Kentucky with a possible 5000 new daily cases by December 12.   New cases per week jumped 20.0% from 16,476 to 19,771.  With 8 days to go in November, we have already leapfrogged October’s record from 38,379 to 48,689 new cases.  New cases are now emerging faster in rural and sparsely populated counties than in Jefferson, Fayette and more urban ones.  Weekly deaths are following new cases having jumped 20% from 97 to a new record of 125 deaths.  Deaths are certain to go much higher as the morbidity and mortality of current active cases reveals itself over the next weeks.  Hospitals have never seen higher Covid-19 challenges.

At the end of this article is a selection of graphs that should be self-explanatory by now.  The full portfolio of data visualizations can be viewed on KHPI’s Tableau Public website.    The epidemic experiences of all 120 individual Kentucky Counties and be viewed here.    Viewer-adjustable filters allow the epidemic experience of individual counties or ranges of dates to be explored.  There are many interesting stories being told by the numbers. (Take a look at sparsely populated Lee County which has the highest aggregate number of cases per 1000 residents in the state!)  On October 9th, I published an animated map of new cases as they appeared sequentially among the counties. The Governor’s office used such a similar display during one of last week’s presentations.  A viewer can step through KHPIs visualization at their own pace.  Free to explore some of the other Visualizations that address how and what Covid-19 data can show us. It has been an educational process for me.

I will dispense with additional editorial comment at this time.  Suffice it to say that I fully support the justifiable efforts of Governor Beshear and his Public Health Department team. I correspondently condemn those who automatically for political purposes and without an offer of a rational alternative attempt to thwart at every step the application of standard public health measures.  I blame them as well as the virus for the disastrous economic and medical places to which we have come and will enter further.

Peter Hasselbacher, MD
Emeritus Professor Medicine, UofL
22 November 2020

Read More for Figures:

Continue reading “New Kentucky Cases of Covd-19 Doubling Every Three Weeks and Accelerating.”