What if Kentucky’s New Covid-19 Cases Increase at the Current Exponential Rate?

Yesterday’s (Wednesday) evening Covid-19 update from Frankfort told of 518 new cases but from which there were an unusually high number of 38 removed as duplicates or perhaps for other reasons. KHPI reports new cases as the day-to-day difference in total cases which yields a smaller number of 480 additional new cases. This number, while higher than any new case number earlier than July 7, is less than the several 500s, 646, or 977 counts of the previous 7 days. The rise in the 7-Day average to a new high of 552 was at least temporarily blunted– but it has not begun to fall either. Time will tell us in which direction our case trend is headed. It has only been since July 9 that mandatory mask use was required in Kentucky, but its implementation was challenged in the courts and compliance has been spotty in any event. I suspect it is too early to expect a major effect on spread at this early time. End-of-week Fridays and Saturdays have historically given us higher counts in the past. The monstrously high count of 977 was reported just last Sunday. Three reporting days of the week remain just ahead of us.

[Addendum 7-24-20: Yesterday evening’s data report confirmed ongoing rapid expansion of the epidemic. KHPI noted 607 additions to total cases and 7 new deaths. With two days to go in this calendar week, the number of new cases is already nearly as many as last week. Based on the current rate of increase of the 7-Day average, new cases are doubling by at least every 12-13 days. Hospital and ICU utilization continue to trend upwards. In all this, Kentucky is mirroring the nation overall. We are all in trouble! The full panel of visualizations on-line have been updated.]

[Addendum 7-24 4:30 pm: todays new case reports adds 744 to the total. This is bad news. Even without Saturday’s report tomorrow, the number of new cases has jumped well ahead of last weeks total. At this rate, unless something changes or happens, we will be at 1000 cases per day by August 3d. Deaths in today’s report added 7 new ones. I will elaborate on the weeks finding s tomorrow evening. I place an updated graphic of 7-Day New Cases at the end of this article.]

7-Day rolling average of new cases as of 7-22-20
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Is the Covid-19 Epidemic Still Expanding in Kentucky and Its Neighborhood?

Kentucky and many other states are backing away from public health measures of varying strictness that were adopted in March or April during the exponential expansion phase of the Covid-19 pandemic in the United States. It is appropriate and even necessary to begin this process, but it needs to be done with an acceptable degree of safety. There is no doubt that measures taken so far have at least “bent” the curve, slowing down if not ultimately decreasing the mortality and morbidity of this overtly infectious disease. I believe Kentucky has benefited greatly from our collective efforts despite opposition on several fronts including armed protest. The expectation and promise is that we and the nation will be able to detect “surges” of the epidemic in a timely way and to be able to reinstate restrictions on public interactions that have proven effective. I wish I could be more confident that we can be successful in either instance.

It‘s not over yet.
In the nation as a whole, albeit to a lesser degree in Kentucky, both the number of aggregate cases and deaths continue to increase. Our ability both as a nation and Commonwealth to test for, identify, and report the presence of Covid-19 in the community and to trace exposed persons is still far behind what is needed to detect and respond to localized outbreaks before they show up two or three weeks later as increases in hospitalizations and deaths. It is from such localized hotspots that epidemic expansion can be continuously fueled. More troublesome is a background of resistance from individuals and groups which, for a variety of ideological, religious, political, or business reasons, hold the nation hostage by refusing to follow evidence-based public health initiatives that are effective only when done collectively. Unfortunately, we face these problems with a weakened and fragmented public health system and an inequitably distributed healthcare system overall.

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What Can We Learn from Mini-Coronavirus Updates?

Some weeks ago, when public health experts were still visible in Washington, a reasonable-sounding set of guidelines for opening up the national economy was offered. Sadly, the White House seems now to place all responsibility on the individual states with minimal if any major Federal help. It is walking away from, if not contradicting, the advice of the best public health scientists the nation has to offer. I fear that things are going to get interesting quickly and that we will land in an uncharted place somewhere between good and disastrous.

With individual states beginning to open up their economies in different ways and to different degrees, it is apparent that our ability to identify new cases of Covid-19 infection early, to do so in unexpected places, and to be willing and able to do something about it will be critical.

What is a “Mini-Update?”
The Wall Street Journal and other publications often offer a “Coronavirus Daily Update” sidebar with a simple list of Total Cases, Total Deaths, and Recoveries for both the United States and globally. When applied to a given geographic area, these three totals are important elements for predictive epidemiologic models. The fact that the numerous models offered today differ widely (or even turn out to be wildly wrong) confirms the truism that any model is no better than the assumptions it makes and the data available to it. By themselves, these high-altitude aggregate numbers are not fine-grained enough to help us predict the future for Kentucky. I do suggest there are some insights to be gained by examining them. In any event, the numbers are sobering.

What might we learn?
Readers of these articles may notice that I have been educating myself (and I hope some of you) about how we can best use the limited and imperfect epidemiologic data available to us to monitor the opening our economy. Are we are on the right path– or are we falling off the wagon? This is today the major healthcare challenge facing us as a nation. What might we learn from countries where the epidemic started earlier? How are we similar or dissimilar?

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Reopening Kentucky’s Economy in the Current Covid-19 Epidemic.

How will we know if we are still ahead?

It had to start sometime, but pressure from partisan and a variety of other assemblies have surely advanced the nation-wide schedule for lifting restrictions of non-medicinal management of the Covid-19 epidemic. It is happening in Kentucky too. While there are state differences in degree, the number of new cases identified continues to increase overall. We are “bending the curve.” Because availability of viral testing continues to be limited, as more testing done more cases will be found. How best should we monitor our populations to detect, localize, and quantitate any significant second peak in the curve of disease incidence? I cannot say that I know!

Kentucky has been fortunate to have acted early and aggressively to deal with our rising number of cases. Despite relative success compared to other states, the number of known cases in Kentucky is rising and will continue to do so while our still-modest ability to test for the virus increases. A 7-Day rolling average of daily new cases remains high. Timely identification of new cases will be essential to deal with the brushfire outbreaks that are certain to occur in the months ahead– whatever we do. Depending on the day of the week, the number of tests done, and reporting from new hot-spots, the number of new cases per day varies widely, making predictions uncertain..

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