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COVID-19 Weekly Update, July 21, 2020

Jul 22, 2020
 

Click here for Spanish translation recording.

Transcript of Dr. Good's COVID-19 Weekly Update, July 21, 2020 

Hello. I'm Michael Good, CEO of University of Utah Health, and we present the COVID update for July 21, 2020. In our COVID update, we look at the data, statistics, and trends with the coronavirus pandemic in our country, our state, and here at the University of Utah.

At the national level, we see similar trends that we've been following for the past few weeks. The last few days we've seen between 63 to 65,000 new coronavirus cases each day in the country. After a few days, up over 70,000. The seven-day average is running around 68,000 new coronavirus cases each day. We talk about this inflection point, we had seen the number of new deaths from coronavirus each day declining, hitting a low point here, a nadir, if you will, on July 5th and then increasing a little bit. The slope has been decreasing, but still seeing on average about 800 new deaths from coronavirus each day.

Again, we've pointed out before so many aspects of the coronavirus pandemic have delays with this low point in the new cases chart, if you will, occurring around June 9, but this similar point in the number of new deaths not occurring until almost a month later on July 5. Again, many reasons for that. Again, both trends at the national level that we'll continue to watch.

Here in Utah, we have, after a long period of increasing numbers of new cases each day, in the last few days, again, early part of the week, new highs related to the number of new cases. But yesterday, and again, today, 400 new cases, causing a little bit of flattening in the number of new cases each day. Taking into account those higher numbers for a few days and lower numbers, we're currently averaging about 642 new coronavirus diagnoses each day.

We're similarly trying to assess the new cases' low point, if you will, occurred around May 27 and somewhat similar to the national level, trying to chart, if there is an inflection point in our number of new cases. Now, I caution the numbers are low. We've been having an average one death, I'm sorry, two deaths, plus or minus, for most of the pandemic. The last few days we've had four new deaths plus or minus one. A little bit wider distance between the May 27 low point in the new cases and the July low point or change from that steady number of new deaths to the increase. But we'll watch and particularly, we want to see these new cases, currently at 642, continue to decline. It's important for our whole community and our health system, just everyone involved, that these new cases per day stabilize and then decrease.

This is another way of looking. This is the number of new cases but shown on a seven-day rolling average. Here, you see a little bit better what I had talked about is a somewhat of a leveling, even a little bit of a decrease here, over the last few days. Again, caution in interpreting short-term trends. We said similar things at this point and similar things at this point, only then to go on and have other periods or subsequent periods where the case load increased. So new cases per day, an important variable that we're watching closely. And hopefully, this leveling can continue, but we caution and need to be ready and prepared if it doesn't.

This is the number of active cases, the number of current infections, and we continue to hold right at 4,000, I'm sorry, four individuals per thousand Utahns with an active coronavirus case. First time we've seen a little bit of a down tick, these two days of 400 to 500 new cases, putting a little bit of a hook on that curve. But again, we'll continue to watch. I find this particular statistic, very challenging. On the one hand, out of every thousand Utahns, 996 do not have a coronavirus virus infection. 996 out of a thousand do not have a coronavirus infection. But the four that do, we're not identifying those four individuals quick enough. And by the time they are identified, get their test, contact tracing identifies those they've been in contact with, on average they've infected five other individuals. And by the time we identify those five with the active infection, they've infected six others. So the numbers are small, but they continue to grow, and so we need to slow down and actually stop the spread of this virus in our community.

This is the number of positive tests per hundred. Or you can think of it as this would be 10 percent of those that get a coronavirus test, test positive. This is 12 percent and so on. As we've done the last few weeks, we are seeing the number of positive tests per hundred come down. The trend line here, we show you what the trend line looked like three weeks ago, and then a week ago, and then in this current update and you can see the trend line is shifting downward. That means for every hundred tests that we run as a state, there's a few less positive tests each week over the last three weeks. Remember, prior, we were concerned we went up here, we had a number of periods where we were seeing 12, 13, 14 percent on average. I do remind you, these are average. I believe they're three-day average positive tests, and so we keep that in mind, but we are seeing this positive move from higher percentage to somewhat lower percentages on the three-day rolling average.

Our reproductive number from Dr. Zhang and Dr. Samore, unfortunately shows a move off of one. We had had nearly a week long period here. This is very worrisome and probably reflects those high days of increased numbers of new cases, a reproductive rate of even 1.2, 1.3. Goes back to what I just said, by the time we identify four people with an infection, they've infected five others, those five have infected six and so on. Our case numbers won't revert until we see a reproductive number less than one. And as I've pointed out before, any period where reproductive number is above one means the case volume will be growing. It's not until we get reproductive number below one that we'll see those case numbers decrease, so we'llcontinue to watch the reproductive number.

Some interesting trends in hospitalization. Certainly the overall trend continues to be up, but a week of approximately stable numbers. Remember, the blue line is the 14-day additive cumulative total of hospital admissions, the left chart in the state, the right chart in our county. Again, a lot of day-to-day variability, but in the large part, most days we're seeing somewhere between 25 and 35 new hospital admissions for coronavirus in our state, a little bit stable over the last week. More of a continuing uptrend in Salt Lake County with approximately 10 to 20 admissions each day for coronavirus, maybe a little bit of settling out here, but in Salt Lake County, a continued uptrend in hospitalizations.

Here's our charts for University of Utah Hospital. Similarly to the Salt Lake County chart, we have seen increased hospitalizations at University Hospital. In fact, a few days ago, we had our highest one-day number of admissions of coronavirus patients, with nine patients. Again, large day-to-day variability after a day of seven admissions and then nine admissions. In the next two days, we had just three and two admissions.

We are seeing the patients admitted to University Hospital are having more severe forms of COVID-19. You see this in the lower right chart where the red line here are the patients that are admitted to the intensive care unit. The light gray line are the patients admitted to the hospital, but not to an intensive care unit. And although again, with day-to-day variability, approximately 18 to 20 patients at any one time. Over the past, almost a month, month and a half, between 15 and 20 patients not in the ICU. We had been seeing about eight to 10 patients in the ICU, and then over the last few weeks, really now more patients in the ICU than not.

You also see, again, increased utilization of our hospital and we continue to do the things we need to do to make sure both ICU beds and beds will be available in the hospital, but we'll clearly have more coronavirus patients in University Hospital than we've had at any point in this pandemic.

We add a new slide this week to add perspective to the coronavirus pandemic. On this chart, we show the three-day average of deaths in Utah from a variety of ailments and conditions ranging from seasonal flu, suicide, stroke, traffic accidents, cancer, and heart disease. And as we've said before, coronavirus is more severe than seasonal flu, both in terms of the hospitalization and the experiences of the patients that are hospitalized. But also, as you can see here on the number of three-day average of deaths, clearly a several-fold higher than seasonal flu. Currently, as shown by the dotted line, COVID-19 average deaths per day in Utah has risen now to be above stroke, but closing in but not yet above traffic accidents. So I think that's helpful.

We spend large parts of our day and our energy focusing on COVID, particularly because of this increasing rate that we see continuing, but for perspective now, COVID in Utah, the average death rate is somewhere between strokes and traffic accidents. This is really encouraging if the trends I'm about to show you continue. Really encouraging news.

On this graph, we show the rolling seven-day average of daily coronavirus cases. This is the average daily number of coronavirus cases. First, on the blue line, in Salt Lake County, the orange line, the rest of Utah, and in the green line toward the bottom Utah County. We also show here at this point when Salt Lake County implemented the mask mandate for Salt Lake County. You can see, again, with some day-to-day variation, but clearly this line begins to level off shortly after that mask mandate. Particularly over the last seven days, we've seen really a positive trend in the number of new cases. That same leveling off has not occurred in the rest of the state, where, for most of the rest of the state, there is not a mask mandate. Masks are encouraged, but not mandated. And again, some recent increases in Utah County.

We do believe masks are very effective at slowing down the transmission of coronavirus. We've had a universal masking policy here at University of Utah Health for many weeks now. University of Utah has a mask mandate and we'll have universal masking when students and faculty return to campus in late August. We're going to continue to watch these trends on a county by county basis. Really a lot of emerging literature suggesting just how beneficial masks can be, not only for the individual that has a coronavirus infection; and it really helps slow the spread of respiratory secretions, but some increasing suggestions and evidence that the mask is actually very beneficial to the person who does not have a coronavirus virus infection. We're beginning to better understand the amount of virus that is transferred from one person to the other may be involved in the severity of the illness that that person experiences. And even though on the healthy individual, the mask may not prevent every single virus from entering, it does decrease the number, and that may be important.

We're learning, as I've shared with you in previous podcasts, that for every person who has coronavirus in the greater Salt Lake City area, there's two other individuals who have had the infection and don't even realize it until they get an antibody test, and the antibody test shows that they've actually had a coronavirus. So it's very, very important that we get everyone wearing masks, and we'll continue to see if that trend between Salt Lake County and the other counties continues.

That completes our COVID 19 update for July 21, 2020. We'll be back next week as we continue to follow the data, statistics, and the trends of the coronavirus pandemic in our nation, our state, and here at the University of Utah. 

 
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Michael Good, MD

Michael Good is CEO of University of Utah Health , Dean of the University of Utah School of Medicine, and A. Lorris Betz Senior Vice President for Health Sciences. A professor of anesthesiology, Good joined U of U Health after more than three decades of teaching, innovation, and leadership at the University of Florida, where he served as dean of the College of Medicine for 10 years.

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