We have not yet seen the corner much less turned it.
We anticipate artifactually lower new reported cases and deaths from Covid-19 disease due to holiday work schedules and fewer individuals being tested. New case counts may also be lower recently due to failure of at least parts of the reporting systems of one of the state’s major viral testing laboratories that has not yet been either acknowledged or confirmed by state authorities. If delays and incomplete reporting is the reason, we should expect the record-breaking catch-up counts of the last week to begin to drop, followed much later by a decrease in daily reported Covid-19 deaths. As of January 10, that has not yet happened. At this point, until and unless we see major decreases in daily case and then death counts, we should assume that as is currently the case in many other places in the USA, we are in the middle of a rapidly expanding viral epidemic. The evidence supporting this concern is summarized below and displayed visually on KHPI’s Tableau Public website.
New Record Highs for Daily Cases.
We expect in Kentucky and nationally that certain days of the week will have statistically higher or lower case counts than others. For example, Sunday and Monday have been low-count days. It is noteworthy that in each of the past seven weekdays save one, new record highs were set. The exception was last Tuesday, January 5th with 1693 new unduplicated cases. The last time a Tuesday count was lower than that was October 20th with 1297 new cases. You can step visually through the counts by weekday here.
Weekly New Cases.
Counting cases by week is one way to average out day-to-day variation but even weekly counts are subject to holiday distortion. [KHPI defines weeks as from Sunday through Saturdays.] Weekly counts began to rise sharply in October with a hiatus during Thanksgiving week followed by a corresponding jump upwards to 23,883 cases the following week beginning Nov 29th. For the next two weeks of December, weekly new cases fell modestly to 19,904 for the week ending December 19. I would like to believe that short-lived downward trend was due to the more aggressive public health measures requested but, unfortunately, too often ignored. The very next week was Christmas week when the weekly count ending Dec 26th dropped to 14,999. It’s been all dramatically upwards since then with 26,427 cases the week ending yesterday, January 9th.
Monthly New Cases.
Looking at new cases through a monthly lens tells the same story from a higher elevation. From a more gradual monthly increase in cases that began to accelerate over the summer, there was a sharp jump in the month of October to 38,379 with even more dramatic increases to 72,822 and 93,340 new cases in November and December respectively. The case-counts for the first 10 days of January have reached 34,244. At the current rate, by the end of the month we would have 102,734 January cases.
7-Day and 14-Day Rolling Averages of New Cases.
It has become obvious that even 7-Day averages of new cases are not exempt from artifacts related to data collecting and reporting. For that matter, even a 14-Day rolling average has been all over the place this past month. The current averages for 7-Day and 14-Day rolling averages as of yesterday set new Kentucky record highs at 3828 and 3326 cases respectively. The extent to which the 7-Day average exceeds the 14-Day average can be considered a proxy for the reproduction rate of the virus. By this measure, our rate of epidemic expansion has been increasing for most of the last 3 months. Indeed, rate of increase in the total number of Covid-19 cases has been increasing at almost the same rate since early Summer. Tinkering around the edges of an actively resisting public has not broken the back of this epidemic in Kentucky.
Deaths.
The trends related to death pretty much track those of cases albeit delayed as expected. Deaths in November and December were 423 and 754 respectively. There have been 239 reported so far in the first 10 days of January with many carry-over deaths from infections in December yet to be added to the total.
Immunization Against Covid-19.
As a 75 year-old guy, I plan to get my shot at the earliest opportunity. I trust it will help protect me and those I care most about– including my readers and everybody else! However, it is becoming obvious that the national roll-out has been under-planned, under-financed, and with the buck passed down to local authorities to take either praise or blame. Although it seems clear the immunization will largely protect individuals from the most serious effects of Covid-19 disease, it will take more time and study to determine the extent to which immunization prevents individuals from infecting others or how long the protection lasts. Even conservative experts predict that it will take much if not most of the next year to immunize everyone who wants the shots. It is not even a given we can reach the high degree of community immunization necessary to protect us all into the future in the face of a circulating and changing virus.
I read this morning that some individuals seeking to be immunized in drugstores, supermarkets, or even by healthcare providers are being told these are accepting reservations only from “existing customers” who presumably will buy other items or remain “customers.” Wrong! To the extent can happen, I am much bothered. Finding our way out of the plague of 2020 will require that all individuals living in America will have access to healthcare professionals who are responsible for them and are able to keep track of how they are doing. At the very least, our healthcare and public health systems [Why are they not the same?] need to know who has been immunized and who is due for their second shot. Are immunizations successful in preventing infection or reinfection? From a public health perspective, we need to be able to tell if what we are doing for prevention and treatment is both safe and effective. Please explain to me again why we do not need a national healthcare structure? This is not the last pandemic we will face.
Conclusion.
Until we see some major decreases in new Covid-19 cases, deaths, and hospital utilization, we should expect that for at least the near-future, the worst is yet to come– vaccines or no. I fear that Kentucky is not yet ready collectively to pull together to save either our bodies or the soul of our community.
Peter Hasselbacher, MD
Emeritus Professor of Medicine, UofL
January 11, 2021