\u00a0While \u201cnew\u201d cases as reported are declining, the additional number of previously unreported cases older than 30 days is soaring.\u00a0These have been added to the aggregate total number of KY cases since at least last June but not included as “new cases” in the weekly reports. This week\u2019s report adds a record high of 6107 previously uncounted cases to the total.\u00a0\u00a0This is\u00a0nearly double\u00a0the number of \u201cnew\u201d cases in the same report!\u00a0\u00a0\u00a0When these previously unreported cases are included in the weekly increments to total cases, there\u2019s has been no decline in cases over the past 5 weeks.\u00a0<\/p>\n\n\n\n
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New Cases Defined:<\/strong> Another factor allowing a new case count to be artifactually low is that the overall number of PCR tests reported electronically is lower than at any point since May and continues to fall. The pool of individuals used as a basis for determination of disease activity is much decreased.<\/p>\n\n\n\n Is Kentucky as a state doing comparatively poorly with its epidemic?<\/strong> Are school-aged individuals over-represented in case counts?<\/strong> Viral RNA in Wastewater-\u00a0\u00a0It is everywhere!<\/strong> As we enter the season of respiratory illness, I am reading that the Federal Government will no longer cover the cost of Covid vaccinations or tests. So much for the “public” part of public health. Are we really reverting to our “every-person-for themself” brand of American healthcare in the middle of an epidemic of historic significance? If my interpretations are correct (and I hope to be very wrong), we are headed for another disastrous winter with our heads in the sand.<\/p>\n\n\n\n Respectfully and with trepidation, Short Link:
Current \u201cnew\u201d cases are derived from a restricted small pool of Kentuckians\u2013 largely only those whose viral PCR tests are reported electronically to the state.\u00a0\u00a0Antigen tests done at home, in offices, or in schools are presumably disregarded.\u00a0\u00a0PCR tests not reported with approved connections, or cases diagnosed clinically are similarly not included.\u00a0\u00a0For example, 79% of new cases this week were derived from the reported PCR pool.\u00a0 This is as high a percentage as ever and several multiples higher than in March when weekly reporting was begun.\u00a0<\/p>\n\n\n\n<\/a><\/figure>\n\n\n\n
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Or is there no way to make a fair comparison any more? I am forced to conclude that the numbers of cases reported directly from the KY Department of Public Health is unreliable. I do not know how the New York Times gets its numbers but their updates were better than the CDC’s for much of the early pandemic and I have always relied on them for national historical comparisons.\u00a0\u00a0Yesterday’s NYT updates has KY standing out clearly as having the highest incidence rate per 100K of any state or territory.\u00a0 Of all the counties in the nation, 15 of the 25 with the highest incidence rates are in Kentucky!\u00a0\u00a0Something is not computing in my aging mind.\u00a0 What am I missing?<\/p>\n\n\n\n
Of the new cases identified by reportable PCR tests, a large proportion of infected individuals are 18 years old or younger. This week that proportion was 39%.\u00a0 The previous week it was 54%.\u00a0 This proportion has been rising erratically since school began in August. This seems high to me. I am unfamiliar how schools test for and report Covid-19 infections.<\/p>\n\n\n\n<\/a><\/figure>\n\n\n\n
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Under the direction of Dr. Ted Smith, the Center for Healthy Air Water and Soil at the Christina Lee Brown Evirome Institute at the University of Louisville has been doing important pioneering work examining the amount of Coronavirus RNA in the sewage of Jefferson County.\u00a0\u00a0The virus is excreted in the feces of infected people and can be reliably measured. Wastewater SARS-CoV-2 RNA is not a substitute for accurate case counts, but this approach provides a broad overview of the amount of recently active Covid disease in the County. It also identifies the prevailing viral variant, currently Omicron BA.5.\u00a0\u00a0In the comprehensive UofL Envirome Institute’s September 2022 report, it looks to me that since January 2021, the levels of viral RNA in wastewater are as high as they have ever been even as reported cases in Louisville have been decreasing.<\/p>\n\n\n\n
Peter Hasselbacher, MD\u00a0
Emeritus Professor of Medicine, UofL
12 October 2022<\/p>\n\n\n\n
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